Accuracy of chest radiography for evaluating significantly abnormal pulmonary vascularity in children with congenital heart disease.

The purpose is to determine the accuracy of chest radiography for evaluating significantly abnormal pulmonary vascularity in children with congenital heart disease. This retrospective study included 120 children. Forty pediatric congenital heart disease patients with a ratio of pulmonary to systemic blood flow (Qp:Qs) lower than 0.8 by cardiac catheterization were enrolled as the decreased pulmonary vascularity group. Another forty pediatric congenital heart disease patients with a Qp:Qs higher than 1.5 were enrolled as the increased pulmonary vascularity group. Forty pediatric patients who had no cardiopulmonary problems were enrolled as the normal control group. All chest radiographs were reviewed by three readers. The results were compared to cardiac catheterization as a gold standard. Linear weighted kappa test was used to determine intra- and inter-observer agreements. The accuracy, specificity, positive predictive value, and negative predictive value of chest radiography to characterize pulmonary vascularity patterns in the three groups were moderate to high, falling between 73 and 92 %, 61 and 96 %, 71 and 94 %, and 71 and 98 %, respectively. The sensitivity of chest radiography to interpret decreased pulmonary vascularity patterns was low (24-68 %), whereas the sensitivity to interpret normal and increased pulmonary vascularity patterns were high (84-94 %). The inter-observer agreement was moderate to good (k = 0.53-0.67). The intra-observer reliability was good (k = 0.71-0.79). Pediatric chest radiography exhibits good accuracy and reproducibility to identify significantly abnormal pulmonary vascularity in children with congenital heart disease. However, the sensitivity to detect decreased pulmonary vascularity pattern is low.