PULMONARY COMPLICATIONS IN CHILDREN WITH HEMATOLOGIC MALIGNANCIES - ACCURACY OF DIAGNOSIS WITH CHEST RADIOGRAPHY AND CT

PURPOSE: To determine the diagnostic accuracy of chest radiography and computed tomography (CT) in patients with complications during treatm ent for hematologic malignancies. MATERIALS AND METHODS: CT scans were obtained 1 week or less before bronchoscopic sampling or biopsy in 48 pediatric patients (age range, 8 months to 18 years at diagnosis) und ergoing treatment for leukemia, lymphoma, or myeloproliferative diseas e. Radiographs were obtained less than 1 week before CT. Pulmonary com plications comprised fungal (n = 11), viral (n = 4), and bacterial (n = 5) pneumonias; cryptogenic organizing pneumonia ([COP] n = 4); and p ulmonary tumor (n = 4). Chest radiographs and CT scans were rated inde pendently by three radiologists who were unaware of these diagnoses. R ESULTS: Satisfactory diagnostic accuracy, defined by the area under th e receiver operating characteristic (ROC) curve, was noted for fungal pneumonia (radiography, ROC area = 0.82; CT, ROC area = 0.78), COP (ra diography, ROC area = 0.75; CT, ROC area 0.75), and pulmonary tumor (r adiography, ROC area = 0.73; CT, ROC area = 0.83). Generalizability wa s good for fungal pneumonia (radiography, generalizability coefficient [GC] = 0.84; CT, GC = 0.84) and COP (radiography, GC = 0.75; CT, GC = 0.99). There was no statistically significant difference in diagnosti c accuracy between radiography and CT for any of the diagnoses.CONCLUS ION: Radiography and CT have satisfactory accuracies for fungal pneumo nia and COP. For these conditions, CT identified more true-positive ca ses than did radiography.