       Document 0102
 DOCN  M9440102
 TI    Diagnosis of thoracic complications in AIDS: accuracy of CT.
 DT    9404
 AU    Hartman TE; Primack SL; Muller NL; Staples CA; Department of Radiology,
       University of British Columbia,; Vancouver, Canada.
 SO    AJR Am J Roentgenol. 1994 Mar;162(3):547-53. Unique Identifier :
       AIDSLINE MED/94152559
 AB    OBJECTIVE. The purpose of this study was to assess the accuracy of CT
       interpretation in the diagnosis of thoracic complications of AIDS. If CT
       is accurate, more invasive diagnostic procedures can be avoided.
       MATERIALS AND METHODS. We reviewed the CT scans of 102 patients who had
       AIDS with proved thoracic complications and 20 HIV-positive patients
       without active intrathoracic disease. The scans were independently
       assessed by two observers from a different institution who did not know
       the clinical or pathologic data. The observers listed the three most
       likely diagnoses in order of probability and recorded the degree of
       confidence in their first-choice diagnosis. Imaging diagnoses were
       compared with final diagnoses based on results of sputum cultures,
       bronchoscopy, fine-needle aspiration, mediastinoscopy, open lung biopsy,
       autopsy, gallium scans, other clinical data, and extensive follow-up.
       RESULTS. Nineteen of the 20 cases in which no active disease was present
       were correctly identified by one observer, and 18 were correctly
       identified by the other. All 102 cases of active disease were correctly
       identified as abnormal by one observer, and 101 cases were identified as
       abnormal by the second observer. The correct first-choice diagnosis,
       regardless of the degree of confidence, was made in 66% of the cases. A
       confident diagnosis was made in 48% of all cases, and the observers were
       correct in 92% of those cases. There was good agreement between the two
       observers in the confident diagnosis based on CT (kappa statistic =
       0.71). The interpretations of CT scans were most often accurate in the
       confident diagnosis of pneumocystis pneumonia (94%) and Kaposi's sarcoma
       (90%) and in the exclusion of active thoracic disease (93%). CONCLUSION.
       Certain findings on chest CT scans allow confident diagnoses of specific
       complications in patients with AIDS. CT-based diagnosis may preclude
       more invasive diagnostic procedures in selected cases.
 DE    Acquired Immunodeficiency Syndrome/*COMPLICATIONS  Adult  AIDS-Related
       Opportunistic Infections/RADIOGRAPHY  Female  Human  Lung
       Diseases/COMPLICATIONS/RADIOGRAPHY  Male  Middle Age  Thoracic
       Diseases/COMPLICATIONS/*RADIOGRAPHY  Thoracic
       Neoplasms/COMPLICATIONS/RADIOGRAPHY  Thoracic Radiography  *Tomography,
       X-Ray Computed  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

