Radiology, Vol 193, 127-133, Copyright © 1994 by Radiological Society of North America
Childhood leukemia: diagnostic accuracy of bedside chest radiography for severe pulmonary complications
HT Winer-Muram, SA Rubin, BD Fletcher, WM Kauffman, SG Jennings, KL Arheart and PM Bozeman
Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN 38101-0318.
PURPOSE: To determine the diagnostic accuracy of bedside chest radiography
in patients who develop severe pulmonary complications while undergoing
therapy for leukemia. MATERIALS AND METHODS: The authors studied 45
patients, aged 21 years and younger, who died of leukemia or of treatment
complications and for whom autopsy findings were available. Pulmonary
findings at autopsy comprised pneumonia (n = 25), adult respiratory
distress syndrome (ARDS) (n = 16), hemorrhage (n = 38), infarction (n =
18), and leukemic cellular infiltration (n = 11). Four radiologists who
were unaware of the autopsy diagnoses independently rated antemortem
bedside chest radiographs. RESULTS: Diagnostic accuracy for each disease
was as follows: ARDS, 0.81 +/- .03 (standard error); all pneumonias, 0.56
+/- .04; hemorrhage, 0.47 +/- .07; infarction, 0.50 +/- .12; and pulmonary
leukemic cellular infiltration, 0.38 +/- .12. CONCLUSION: The specific
radiographic appearance of ARDS permits excellent diagnostic accuracy.
