Diagnostic accuracy of thin-section CT and chest radiography of pediatric interstitial lung disease

OBJECTIVE. We assessed the accuracy of thin-section CT and chest radiograph y to diagnose pediatric interstitial lung disease. MATERIALS AND METHODS. We identified 20 infants, boys, and girls (age range , 1 month to 14 years) with histopathologic confirmation of interstitial lu ng disease. Six boys and girls without interstitial lung disease were also included. Two observers independently assessed chest radiograph and CT imag es. The observers stated the most likely diagnosis and a differential diagn osis. We evaluated individual CT features and their distribution. RESULTS. Observers' diagnoses on CT images were correct (first choice or di fferential) in 66% of observations versus 45% on chest radiographs (p < 0.0 25). Correct diagnoses were made on first choice in 61% of CT observations versus 34% on chest radiographs (p < 0.005). Observers were confident (vers us uncertain) in 42% of the CT observations versus 18% on chest radiographs ; of the confident diagnoses made on CT, 91% were correct. CT interpretatio ns were most accurate in the diagnosis of pulmonary alveolar proteinosis, c ongenital lymphangiectasia, and idiopathic pulmonary hemosiderosis. All hea lthy patients examined with CT were correctly identified as such. We noted a distinctive CT pattern in three patients with nonspecific interstitial pn eumonitis and one patient with desquamative interstitial pneumonitis; the C T pattern consisted of upper zone predominant honeycombing on a background of ground-glass attenuation. CONCLUSION. A higher proportion of pediatric interstitial lung diseases can be diagnosed on thin-section CT than on chest radiographs. In our study, c onfident and correct diagnoses were made more frequently with CT than with chest radiographs.