Department of Radiology, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
Acad Radiol. 2011 Feb;18(2):184-90. doi: 10.1016/j.acra.2010.09.013. Epub 2010 Nov 20.
The aim of this study was to determine whether a lateral chest radiograph provides additional diagnostic information to a posteroanterior (PA) radiograph in the screening of asymptomatic children with positive purified protein derivative (PPD) skin tests in a nonendemic area.
This was an Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant, retrospective study of 605 consecutive pediatric patients (294 males, 311 females; mean age, 10.8 ± 5.2 years) with positive PPD skin test results, who underwent PA and lateral chest radiographs between July 2003 and May 2009 at a tertiary care pediatric hospital in a nonendemic area for tuberculosis (TB). Two pediatric radiologists independently reviewed each chest radiograph for evidence of abnormalities that may be indicative of acute or chronic TB infection. The reviewers first analyzed the PA radiograph alone and subsequently evaluated the PA and the lateral radiograph together to determine whether any observed abnormality was identified only on the lateral radiograph. When an abnormality was detected on both PA and lateral radiographs, the reviewers determined whether the abnormality on the lateral radiograph changed the reviewer's decision based on the PA radiograph alone. Assessment of nonconcordance between PA and lateral chest radiographs for each reviewer was evaluated by the McNemar test of matched binary pairs. Agreement between reviewers for detecting abnormalities on radiographs was evaluated by using the kappa (κ) statistic.
The frequency of an abnormal chest radiograph related to TB was 1.8% (11/605). The PA radiograph showed abnormalities in all 11 (100%) children with radiographic abnormalities. Lateral radiographs showed abnormalities related to TB in 2 (18.2%) of 11 cases found to be abnormal on PA radiographs. Nine (81.8%) of 11 abnormalities on PA radiographs were not detected on the lateral chest radiographs. There was statistical evidence of nonconcordance between PA and lateral chest radiographs in detecting TB-related abnormalities for reviewer 1 (P < .001) and reviewer 2 (P = .004). In cases with abnormalities observed on both PA and lateral radiographs, there were no cases in which information obtained from the lateral chest radiograph resulted in a change in interpretation based on the PA radiograph alone. A high level of agreement was observed between the two independent reviewers in detecting TB-related abnormalities on PA radiographs (κ = 0.84, P < .001).
A PA radiograph alone is sufficient for TB screening of asymptomatic pediatric patients with positive PPD skin test results in an area non-endemic for TB.
本研究旨在确定在非结核流行地区，对于结核菌素皮肤试验阳性的无症状儿童进行筛查时，侧位胸片是否能提供比后前位胸片更多的诊断信息。
这是一项经机构审查委员会批准、符合《健康保险流通与责任法案》的回顾性研究，纳入了 2003 年 7 月至 2009 年 5 月在一家非结核流行地区的三级儿科医院接受过结核菌素皮肤试验的 605 例连续儿科患者（男 294 例，女 311 例；平均年龄 10.8 ± 5.2 岁）。两位儿科放射科医生分别对前后位和侧位胸片进行评估，以确定是否存在可能提示急性或慢性结核感染的异常。两位放射科医生首先单独分析前后位胸片，然后同时评估前后位和侧位胸片，以确定是否仅在侧位胸片上发现了任何观察到的异常。当前后位和侧位胸片均发现异常时，评估者根据仅前后位胸片的结果，确定侧位胸片上的异常是否会改变评估者的诊断。通过配对二项式 McNemar 检验评估每位评估者前后位和侧位胸片之间的非一致性。通过κ（κ）统计评估评估者在检测胸片异常方面的一致性。
与结核相关的异常胸片的发生率为 1.8%（11/605）。在所有 11 例胸片异常的患儿中，前后位胸片均显示异常。在前后位胸片显示异常的 11 例患儿中，2 例（18.2%）侧位胸片显示与结核相关的异常。9 例（81.8%）前后位胸片的异常在侧位胸片上未被发现。对于评估者 1（P <.001）和评估者 2（P =.004），前后位和侧位胸片在检测与结核相关的异常方面存在统计学证据的不一致。在前后位和侧位胸片均发现异常的病例中，没有从侧位胸片获得的信息导致基于前后位胸片的单独评估发生改变的情况。两位独立评估者在检测前后位胸片与结核相关的异常方面具有高度一致性（κ=0.84，P <.001）。
对于结核菌素皮肤试验阳性的无症状儿童，在非结核流行地区，仅行前后位胸片即可用于结核筛查。
