Specificity Of Chest X-ray Research Articles

Diagnostic accuracy of chest x-ray in covid -19, taking high resolution computed tomography as gold standard

ABSTRACT Objective: To determine sensitivity & specificity of chest X-ray in COVID-19, taking High-Resolution Computed Tomography as gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Radiology Deptt, Margalla Hospital, Taxila and Islamabad Diagnostic Centre, Wah. Two years (February 2020 to February 2022). Patients and Methods: The sample comprised 100 COVID-19 patients (Positive Polymerase chain reaction (PCR) test). Their HighResolution Computed Tomography (HRCT) was done which was considered a gold standard for diagnosing COVID-19. Their Chest X-rays (CXR) were performed, and findings of both modalities were compared. Patients having respiratory tract symptoms but PCR negative for COVID-19 were excluded. Results: The research had 49 males & 51 females having a median (IQR) age of 46.50(35-55.75) years. The minimum & maximum ages were 6 years and 83 years respectively. Among 100 PCR-positive patients, 29 were found normal on HRCT and 30 on CXR. For moderate cases, the chest X-rays were 72% sensitive & 90.67% specific, with Positive Predictive Value (PPV), Negative Predictive Value (NPV) & diagnostic efficacy of 72%,90.67% & 86% respectively. Similarly, other severity levels were assessed. Conclusion: CXR has acceptable diagnostic accuracy for COVID-19 patients, especially with good sensitivity for moderate cases and better specificity for severe cases. A portable chest radiograph might be regarded as an initial alternative imaging modality for patients with COVID-19 signs and symptoms in remote areas. Key words: COVID-19, CXR , HRCT

Diagnosis of pneumonia in paediatric age group by comparing two modalities chest x-ray versus ultrasonography at tertiary care hospital

: Up to 20 million cases of pneumonia in children ages 0 to 5 years require hospitalization each year, from total 150 million cases of pneumonia. The most common cause of death in children worldwide is pneumonia. Due to the general non-specificity of the signs and symptoms, clinical history and physical examination cannot reliably distinguish between the causes of respiratory cases. As a result, accurate diagnosis frequently requires medical imaging, but two-thirds of the world's population lack access to diagnostic imaging, which lead to increasing the consequences of respiratory illnesses. : To know the characteristic of pneumonia in x-ray and ultrasonography. To compare X-ray chest and USG for early diagnosis. : A Prospective observational study was conducted among 100 paediatric patients diagnosed with pneumonia and admitted in paediatric ward, at New Civil Hospital, Surat. : Out of total, 52.7% and 47.3% patients were Males and Females, respectively. 87.2% cases were fully immunized, while remaining were partially immunized. Sensitivity and specificity of chest X-ray is 83.4 % and 86.8 % respectively. Sensitivity and specificity of USG thorax is 96.8 % and 90.5 % respectively. Young children are at least four times more susceptible to radiation damage than adults.: In comparison to chest radiography, lung ultrasound has the potential advantages of being more sensitive and specific, radiation-free, subject to less regulatory constraints, relatively less expensive so it can be used in diagnosis in patients with pneumonia.

DISTRIBUTION AND ANALYSIS OF CHEST RADIOGRAPHIC FINDINGS IN COVID-19 POSITIVE SYMPTOMATIC AND ASYMPTOMATIC PATIENTS – ANALYSIS OF 668 PATIENTS IN INDIA

Current COVID-19 radiological literature is dominated by CT and a detailed description of chest x-ray (CXR) appearances in relation to the disease time course is lacking. However, it poses a great challenge on the radiology department,as it is difficult to decontaminate entire CT suite(Zhao et al.,2020)11. This study is aimed to correlate clinical symptoms with the chest X-ray findings in COVID positive patients and to calculate the sensitivity and specificity of chest x ray in diagnosing COVID 19. The present study compares frequency and distribution of chest radiographic findings in COVID 19 positive symptomatic and asymptomatic patients. Patients with a RT-PCR-positive results for COVID 19 infection were 668.Of these,437 were males (65.4%),230 females (34.4%) and 1 transgender (0.04%) with a mean age of 44 years (range 2–87 years). Only 18 CXRs were negative for radiological thoracic involvement (6.4%) among symptomatic patients (280). Among the baseline CXR of 668 patients, 375 (56.1%) were normal and 293 (43.8%) were abnormal. Sensitivity and specificity of CXR were 93.91% and 93.3% respectively. Positive and negative predictive values were 90.97% and 95.51% respectively. We found a statistically significant relationship between CXR severity score and age, symptoms, death (P<0.001).We even found significant relationship between age and symptoms, death of COVID positive patients (P<0.001). The relationship between CXR severity and gender, age and gender were not significant (P=0.539,P=0.864 respectively).

A morphological study comparing heart size measurement on chest radiograph with echocardiography in local population.

To investigate heart size on chest X-ray via cardiothoracic ratio, and to correlate it with echocardiographic measurements. The comparative analytical, cross-sectional study was conducted at the Pakistan Navy Station Shifa Hospital, Karachi, between January 2021 and July 2021. The radiological parameters were measured on chest X-rays posterior-anterior view, and the echocardiographic parameters were measured using 2-dimensional transthoracic echocardiography. The absence or presence of cardiomegaly on both imaging modalities was modelled as a binary categorical variable and compared. Data was analysed using SPSS 23. Of the 79 participants, 44(55.7%) were males and 35(44.3%) were females. The mean age of the sample was 52.71±14.54 years. There were 28(35.44%) enlarged hearts on chest X-ray and 46(58.22%) on echocardiography. The sensitivity and specificity of chest X-ray were 54.35% and 90.90%, respectively. The positive and negative predictive values were 89.28% and 58.82%, respectively. The accuracy of chest X-ray in identifying an enlarged heart was 69.62%. The cardiac silhouette on a chest X-ray could demonstrate heart size through simple measurements with high specificity and reasonable accuracy. However, a normal heart size on chest X-ray may not have a normal function.

Diagnostic accuracy of thoracic imaging modalities for the detection of COVID-19.

The ongoing coronavirus disease 2019 (COVID-19) pandemic continues to present diagnostic challenges. The use of thoracic radiography has been studied as a method to improve the diagnostic accuracy of COVID-19. The ‘Living’ Cochrane Systematic Review on the diagnostic accuracy of imaging tests for COVID-19 is continuously updated as new information becomes available for study. In the most recent version, published in March 2021, a meta-analysis was done to determine the pooled sensitivity and specificity of chest X-ray (CXR) and lung ultrasound (LUS) for the diagnosis of COVID-19. CXR gave a sensitivity of 80.6% (95%CI: 69.1-88.6) and a specificity of 71.5% (95%CI: 59.8-80.8). LUS gave a sensitivity rate of 86.4% (95%CI: 72.7-93.9) and specificity of 54.6% (95%CI: 35.3-72.6). These results differed from the findings reported in the recent article in this journal where they cited the previous versions of the study in which a meta-analysis for CXR and LUS could not be performed. Additionally, the article states that COVID-19 could not be distinguished, using chest computed tomography (CT), from other respiratory diseases. However, the latest review version identifies chest CT as having a specificity of 80.0% (95%CI: 74.9-84.3), which is much higher than the previous version which indicated a specificity of 61.1% (95%CI: 42.3-77.1). Therefore, CXR, chest CT and LUS have the potential to be used in conjunction with other methods in the diagnosis of COVID-19.

Diagnostic impact of bedside chest X-ray features of 2019 novel coronavirus in the routine admission at the emergency department: case series from Lombardy region

PurposeTo evaluate the diagnostic accuracy and the imaging features of routine admission chest X-ray in patients suspected for novel Coronavirus 2019 (SARS-CoV-2) infection. MethodWe retrospectively evaluated clinical and X-ray features in all patients referred to the emergency department for suspected SARS-CoV-2 infection between March 1st and March 13th. A single radiologist with more than 15 years of experience in chest-imaging evaluated the presence and extent of alveolar opacities, reticulations, and/or pleural effusion. The percentage of lung involvement (range <25 % to 75–100 %) was also calculated. We stratified patients in groups according to the time interval between symptoms onset and X-ray imaging (≤ 5 and > 5 days) and according to age (≤ 50 and > 50 years old). ResultsA total of 518 patients were enrolled. Overall 314 patients had negative and 204 had positive RT-PCR results. Lung lesions in patients with SARS-Cov2 pneumonia primarily manifested as alveolar and interstitial opacities and were mainly bilateral (60.8 %). Lung abnormalities were more frequent and more severe by symptom duration and by increasing age. The sensitivity and specificity of chest X-ray at admission in the overall cohort were 57 % (95 % CI = 47–67) and 89 % (83–94), respectively. Sensitivity was higher for patients with symptom onset > 5 days compared to ≤ 5 days (76 % [62–87] vs 37 % [24–52]) and in patients > 50 years old compared to ≤ 50 years (59 % [48–69] vs 47 % [23–72]), at the expense of a slightly lower specificity (68 % [45–86] and 82 % [73–89], respectively). ConclusionsOverall chest X-ray sensitivity for SARS-CoV-2 pneumonia was 57 %. Sensitivity was higher when symptoms had started more than 5 days before, at the expense of lesser specificity, while slightly higher in older patients in comparison to younger ones.

Lung ultrasound in the diagnosis of neonatal respiratory failure prior to patient transport.

Lung ultrasound (LUS) at the point-of-care is a new method that is increasingly used in neonatology. The aim of this study was to determine the utility of the addition of LUS prior to the interhospital transport of neonates with respiratory failure. LUS was performed on 50 newborns with respiratory failure prior to transport to a tertiary neonatal intensive care unit. We analyzed the performance of LUS for diagnosing the cause of respiratory failure, the concordance between LUS, chest X-ray (CXR) and final clinical diagnosis, and the impact of LUS on clinical decision making before transport. LUS sensitivity for the diagnosis of respiratory distress syndrome was 91.3% (95%CI: 70.5-98.5%), and specificity was 92.6% (95%CI: 74.2-98.7%), whereas sensitivity and specificity of CXR were 69.6% (95%CI: 47.0-85.9%) and 81.5% (95%CI: 61.2-92.9%), respectively. For the recognition of pneumothorax (PTX) LUS had a sensitivity of 83.3% (95%CI: 36.5-99.1%) and a specificity of 100% (95%CI: 89.9-100%). For CXR, sensitivity was 16.7% (95%CI: 0.01-63.5%) and specificity was 97.7% (95%CI: 86.4-99.9%). The agreement between LUS and CXR in diagnosing the cause of respiratory failure was substantial (κ of 0.57 [95%CI: 0.40-0.74]) and the agreement between LUS and the final clinical diagnosis was very good (κ of 0.86 [95%CI: 0.74-0.98]). In 42% of the patients, a LUS examination prior to transport indicated the need for endotracheal tube repositioning or PTX decompression. LUS may be a reliable imaging technique for differentiating the causes of respiratory failure before neonatal transport. Use of LUS may optimize the care of infants during transport.

Diagnostic Accuracy of Computed Tomography Scout Film and Chest X-ray for Detection of Rib Fractures in Patients with Chest Trauma: A Cross-sectional Study.

Background: Rib fractures are a major source of morbidity in patients with chest trauma. Computed tomography (CT) scout film is a low-dose image that is obtained prior to a complete chest CT study for all patients undergoing a CT scan. In this study, we evaluated the diagnostic performance of CT scout film vis-à-vis that of chest X-ray for detection of rib fractures using chest CT scan as the reference standard.Methods: A cross-sectional study was performed at the radiology department of Aga Khan University Hospital (Karachi, Pakistan) from October 1, 2013 to September 31, 2014. Patients who underwent CT chest for evaluation of thoracic trauma were included in the study. Sensitivity and specificity of chest X-ray and CT scout film were calculated.Results: A total of 207 patients were included in the study (193 were male). Penetrating and blunt thoracic injuries affected 104 (50.2%) and 103 (49.8%) patients respectively. On CT chest, 75 (36.2%) patients had evidence of rib fractures. Sensitivity and specificity of CT scout film for detection of rib fractures were 56% and 87.9%, while those of chest X-ray were 61.3% and 98.5% respectively. The overall accuracy of CT scout film and chest X-ray for detection of rib fractures were 76.3% and 85% respectively.Conclusion: Diagnostic performance of CT scout film for detection of rib fractures was comparable to that of the plain chest radiograph. CT scout film does not provide any additional information or advantage over a plain chest radiograph. In patients with severe thoracic trauma, CT chest remains the modality of choice for accurate delineation of rib fractures and associated internal injuries.

Diagnostic Accuracy of InitiaI Chest X-Rays in Thorax Trauma.

To evaluate the efficacy, sensitivity and specificity of chest x-ray as a diagnostic imaging tool in management of thorax traumas. Descriptive study. Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey, between December 2014 and December 2015. Case records of patients admitted to the emergency department with thoracic trauma were retrospectively analysed through the hospital database. Plain postero-anterior chest X-rays and thorax computerised tomography (CT) scans were evaluated seperately by same radiologist. Accurcy of signs of thoracic trama was determined using CT scan as gold standard. Nine of 23 pneumothorax patients were diagnosed by chest X-ray. Sensitivity and specificity of PA chest X-ray in the diagnosis of pneumothorax was 39.1% and 100%, respectively. Positive predictive values of chest X-ray for diagnosis of pneumothorax was 100% and negative predictive value was 97.1%. Twenty-four patients had pleural effusions on CT scans, while only 15 could be diagnosed in chest X-rays. Chest X-rays were 62.5% sensitive and 100% specific with positive and negative predictive values of 100% and 98.1%, respectively. Twenty of 41 rib fractures were diagnosed with X-rays. Chest x rays had a 48.8% sensitivity and 100% specificity, and positive and negative predictive values were 100% and 95.6%, respectively. Chest X-ray should not be used as a sole diagnostic imaging tool for exclusion of pneumothorax, hemothorax, and lung contusion. Due to high predictive values of chest X-rays, they can be used for follow-up.

Chest X-rays in detecting injuries caused by blunt trauma.

The appropriate sequence of different imagings and indications of thoracic computed tomography (TCT) in evaluating chest trauma have not yet been clarified at present. The current study was undertaken to determine the value of chest X-ray (CXR) in detecting chest injuries in patients with blunt trauma. A total of 447 patients with blunt thoracic trauma who had been admitted to the emergency department (ED) in the period of 2009-2013 were retrospectively reviewed. The patients met inclusion criteria (age>8 years, blunt injury to the chest, hemodynamically stable, and neurologically intact) and underwent both TCT and upright CXR in the ED. Radiological imagings were re-interpreted after they were collected from the hospital database by two skilled radiologists. Of the 447 patients, 309 (69.1%) were male. The mean age of the 447 patients was 39.5±19.2 (range 9 and 87 years). 158 (35.3%) patients were injured in motor vehicle accidents (MVA). CXR showed the highest sensitivity in detecting clavicle fractures [95%CI 78.3 (63.6-89)] but the lowest in pneuomediastinum [95%CI 11.8 (1.5-36.4)]. The specificity of CXR was close to 100% in detecting a wide array of entities. CXR remains to be the first choice in hemodynamically unstable patients with blunt chest trauma. Moreover, stable patients with normal CXR are candidates who should undergo TCT if significant injury has not been ruled out.

Diagnostic Accuracy of Chest x-Ray and Ultrasonography in Detection of Community Acquired Pneumonia; a Brief Report.

Chest x-ray (CXR) is the simplest diagnostic tool of Community Acquired Pneumonia (CAP), but it has some limitation. Therefore, the aim of this study is comparing the diagnostic accuracy of CXR and chest ultrasonography (CUS) in detection of CAP. In the present study, a consecutive sample of suspected patients with CAP was underwent CUS, CXR, and chest computed tomography (CT) scan. Diagnostic accuracy of CUS and CXR was assessed by calculating the sensitivity, specificity, predictive values, and likelihood ratios using SPSS 20 statistical software. 30 patients with CAP were enrolled (93.3% male with mean age of 63.8 ± 18.3 years). Sensitivity of CUS and CXR in detection of CAP were 100.0% (95% Cl: 85.4-100.0) and 93.1% (95% Cl: 75.8-98.8), respectively. Specificity of CXR was 0.0 (95% Cl: 0.0-94.5), while the CUS specificity was not calculable. Findings of the present study demonstrated on the higher diagnostic accuracy of CUS versus CXR in detection of pneumonia.

The Application of MDCT in the Diagnosis of Chest Trauma

Traumas are the third most common cause of death worldwide, after cardiovascular diseases and neoplasms, and the main cause of death of patients under 40 years of age. Contemporary image diagnosis of chest trauma uses chest X-ray (CXR), multidetector computed tomography (MDCT), transthoracic and transoesophageal ultrasound (USG), X-ray angiography and magnetic resonance. The aim of the present study was to evaluate MDCT results in the examination of posttraumatic chest injuries and to compare the results of CXR and MDCT in chosen chest traumatic injuries. The sixty patients with chest trauma included in the study were diagnosed at the Department of Radiology of the Institute of Tuberculosis and Lung Diseases between May 2004 and October 2007. MDCT was performed in all patients. Two groups with different types of injury (blunt or penetrating chest trauma) were distinguished. The analysis of injuries in both groups was conducted depending on the mechanism of trauma. The detection of 20 selected injuries at CXR and MDCT was compared. Moreover, the compatibility of MDCT with the results of intraoperative assessment and bronchoscopy was analysed. The influence of MDCT on the treatment modality was also assessed. History of blunt chest trauma was found in 51 patients (group 1) and of penetrating trauma in 9 patients (group 2). The most frequent injuries among group 1 were lung contusion and rib fractures, and among group 2 it was pericardial hematoma. Compared to MDCT, the sensitivity and specificity of CXR were 66.7 and 58%, respectively. Change of treatment modality was observed after MDCT in 83% of patients. The sensitivity and specificity of MDCT in diagnosing tracheobronchial injury, compared to bronchoscopy, were 72.7% and 100%, respectively. Compatibility of MDCT results and intraoperative assessment was observed in 43% of patients, and the main reason for discrepancy was underdiagnosis of diaphragm injury in MDCT. MDCT was a valuable diagnostic method in recognition of chest trauma, characterized by high sensitivity and specificity in the assessment of life-threatening injures and for depicting tracheal and bronchial injuries. The diagnostic value of CXR was low. The compatibility of MCTD and intraoperative assessment was confirmed, with the exception of diaphragm injures and lung laceration. Change of treatment modality was certified after MDCT in 83% of patients.

Year in review 2011: Respiratory infections, tuberculosis, pleural diseases, bronchoscopic intervention and imaging

This review highlights important contributions published in Respirology and other reputable respiratory journals in 2011 in four principle respiratory medicine areas, namely pulmonary infections, tuberculosis (TB), pleural diseases and chest imaging/interventional pulmonology. The articles have been selected for their insight, reliability and potential impact on clinical practice. From a total of 111 original articles and 40 review papers published in Respirology that year, 34% and 40%, respectively, were devoted to the earlier topics.