Skip to main content

Advertisement

SpringerLink
Log in

The accuracy of chest radiographs in the detection of congenital heart disease and in the diagnosis of specific congenital cardiac lesions

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

Congenital heart disease (CHD) is a significant cause of morbidity and mortality in pediatric patients. Traditional teaching holds that specific types of CHD can be diagnosed on the chest radiograph (CXR) through pattern recognition.

Objective

To determine the accuracy of radiologists in detecting CHD on the CXR.

Materials and methods

This study was a blinded retrospective review of chest radiographs from 281 patients (<12 years) by five pediatric radiologists from three institutions. Thirteen groups were evaluated that included 12 categories of CHD and a control group of patients without heart disease. Radiographs were assessed for heart size, heart and mediastinal shape and vascularity. Clinical information, angiography, echocardiograms and surgery were used as the gold standard for definitive diagnosis.

Results

The average accuracy of the five readers in distinguishing normal from CHD patients was 78% (range of 72% to 82%). The overall measure of accuracy in distinguishing specific congenital cardiac lesions among 13 groups of patients was 71% (range of 63% to 79%).

Conclusion

CXR alone is not diagnostic of specific cardiac lesions, with a low accuracy of only 71%. We believe that less emphasis should be placed on the use of radiographs alone in diagnosing specific congenital cardiac lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Meberg A, Otterstad JE, Froland G, et al (2000) Outcome of congenital heart defects: a population-based study. Acta Paediatr 89:1344–1351

    Article  PubMed  CAS  Google Scholar 

  2. Hoffman JI (1995) Incidence of congenital heart disease: II. Prenatal incidence. Pediatr Cardiol 103:155–165

    Google Scholar 

  3. Gerald B, Clifton D (1970) Radiologic accuracy in evaluating congenital heart disease in the young child. South Med J 63:106–108

    PubMed  CAS  Google Scholar 

  4. Swenson JM, Fischer DR, Miller SA, et al (1997) Are chest radiographs and electrocardiograms still valuable in evaluating new pediatric patients with heart murmurs or chest pain? Pediatrics 99:1–3

    Article  PubMed  CAS  Google Scholar 

  5. Obuchowski NA, Goske MJ, Applegate KE (2001) Assessing physicians’ accuracy in diagnosing pediatric patients with acute abdominal pain: measuring accuracy for multiple diseases. Stat Med 20:3261–3278

    Article  PubMed  CAS  Google Scholar 

  6. Obuchowski NA, Applegate KE, Goske MJ, et al (2001) The “differential diagnosis” for multiple diseases: comparison with the binary-truth state experiment in two empirical studies. Acad Radiol 8:947–954

    Article  PubMed  CAS  Google Scholar 

  7. Newburger JW, Rosenthal A, Williams RG, et al (1983) Noninvasive tests in the initial evaluation of heart murmurs in children. N Engl J Med 308:61–64

    Article  PubMed  CAS  Google Scholar 

  8. Danford DA, Nasir A, Gumbiner C (1993) Cost assessment of the evaluation of heart murmurs in children. Pediatrics 91:365–368

    PubMed  CAS  Google Scholar 

  9. Fayad LM, Boxt LM (1999) Chest film diagnosis of congenital heart disease. Semin Roentgenol 34:228–248

    Article  PubMed  CAS  Google Scholar 

  10. Crowley JJ, Sang OK, Newman B, et al (1993) Telltale signs of congenital heart disease. Radiol Clin North Am 31:573–582

    PubMed  CAS  Google Scholar 

  11. Donnelly LF, Hurst DR, Strife JL, et al (1995) Plain-film assessment of the neonate with D-transposition of the great vessels. Pediatr Radiol 25:195–197

    Article  PubMed  CAS  Google Scholar 

  12. Strife JL, Sze RW (1999) Radiographic evaluation of neonate with congenital heart disease. Radiol Clin North Am 37:1093–1107

    Article  PubMed  CAS  Google Scholar 

  13. Temmerman AM, Mooyaart EL, Taverne PP (1991) The value of chest roentgenogram in the cardiological evaluation of infants and children. A prospective study. Eur J Pediatr 150:623–626

    Article  PubMed  CAS  Google Scholar 

  14. Marek J, Skovranek J, Hucin B, et al (1995) Seven-year experience of noninvasive preoperative diagnostics in children with congenital heart defects: comprehensive analysis of 2,788 consecutive patients. Cardiology 86:488–495

    Article  PubMed  CAS  Google Scholar 

  15. Birkebaek NH, Hansen LK, Oxhoj H (1995) Diagnostic value of chest radiography and electrocardiography in the evaluation of asymptomatic children with a cardiac murmur. Acta Paediatr 84:1379–1381

    Article  PubMed  CAS  Google Scholar 

  16. Birkebaek NH, Hansen LK, Elle B, et al (1999) Chest roentgenogram in the evaluation of heart defects in asymptomatic infants and children with a cardiac murmur: reproducibility and accuracy. Pediatrics 103:E15

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, St. Luke’s Medical Center, Quezon, Philippines

    Bernard F. Laya

  2. Section of Pediatric Radiology, The Children’s Hospital, The Cleveland Clinic Foundation, Cleveland, OH, USA

    Marilyn J. Goske, Stuart Morrison & Janet R. Reid

  3. Department of Radiology, The University of Texas Medical Branch, Galveston, TX, USA

    Leonard Swischuck

  4. Department of Medical Imaging, The Children’s Medical Center, Dayton, OH, USA

    Elizabeth H. Ey

  5. Department of Pediatrics, Stanford University Medical Center, Palo Alto, CA, USA

    Daniel J. Murphy

  6. Department of Quantitative Health Sciences, The Cleveland Clinic Foundation, Cleveland, OH, USA

    Michael Lieber & Nancy Obuchowski

  7. Department of Radiology, Children’s Hospital Medical Center of Akron, One Perkins Square, Akron, OH, 44308-1062, USA

    Marilyn J. Goske

Authors
  1. Bernard F. Laya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marilyn J. Goske
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stuart Morrison
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Janet R. Reid
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Leonard Swischuck
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Elizabeth H. Ey
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Daniel J. Murphy
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michael Lieber
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nancy Obuchowski
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marilyn J. Goske.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Laya, B.F., Goske, M.J., Morrison, S. et al. The accuracy of chest radiographs in the detection of congenital heart disease and in the diagnosis of specific congenital cardiac lesions. Pediatr Radiol 36, 677–681 (2006). https://doi.org/10.1007/s00247-006-0133-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-006-0133-2

Keywords

Search

Navigation