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Diagnosis of IPA in HIV: the role of the chest X-ray and radiologist

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Abstract

The role of clinical information and chest film for the discrimination between invasive pulmonary aspergillosis (IPA) and its differential diagnoses in human immunodeficiency virus (HIV) infection was studied. The diagnostic performance of clinical information and chest film alone and in combination was studied for eight internists and eight radiologists with regular exposure to IPA patients. The multicenter case sample consisted of 25 patients with proven IPA and 25 with other pulmonary diseases typical for HIV. The cases were presented on a CD-ROM. Receiver operating characteristics (ROC) methodology was employed. With clinical information alone, internists achieved the highest diagnostic performance (area under curve/AUC=0.84). Viewing the chest films did not contribute to their performance (AUC=0.80, P=0.26). The radiologist’s performance on the basis of viewing the chest film (AUC=0.75) increased significantly (P=0.012) when clinical information (AUC=0.83) was supplied. IPA cases with characteristic radiological appearance were correctly identified in 90% with chest film. For radiologists with regular exposure to HIV patients, chest films hold relevant information and contribute to the determination in cases with characteristic radiological appearance. Overall and especially in cases with less characteristic radiological appearance, they have significant profit from full access to the clinical data. For internists with regular exposure to HIV patients, chest films do not provide information essential for the verification or differentiation of potential IPA.

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Acknowledgments

The relatively high number of authors is caused by the ROC methodology of the study. Roland Felix, Norbert Suttorp, Jürgen Rademaker, Franz Fobbe and Manfred L’age are acknowledged for contributing valuable cases.

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Authors and Affiliations

  1. Institut für Radiologie, Charité—Universitätsmedizin Berlin, Campus Mitte, Schuhmannstr. 20/21, 10117, Berlin, Germany

    Uta Zaspel

  2. Education and Research Centre, Wythenshawe Hospital, The University of Manchester, Manchester, UK

    David W. Denning

  3. Klinik für Strahlenheilkunde, Charité—Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany

    Arne J. Lemke, Rainer Röttgen, Roland Bittner & Joerg W. Oestmann

  4. Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, USA

    Reginald Greene

  5. Medizinische Klinik mit Schwerpunkt Infektiologie und Asthma-Poliklinik, Charité—Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany

    Dirk Schürmann

  6. Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité—Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany

    Georg Maschmeyer

  7. Medizinische Klinik mit Schwerpunkt Onkologie und Hämatologie, Charité—Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany

    Markus Ruhnke

  8. Départment d’Hematologie et d’Oncologie, Hôpital de Hautepierre, Strasbourg, France

    Raoul Herbrecht

  9. Service d’Hematologie, Hôpital Saint-Louis, Paris, France

    Patricia Ribaud

  10. Centre National de Référence des Mycoses et des Antifongiques, Institut Pasteur, Service des Maladies Infectieuses et Tropicales, Hôpital Necker, Université Paris V, Paris, France

    Olivier Lortholary

  11. Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands

    Harmien Zonderland

  12. Department of Pulmology, Leiden University Medical Centre, Leiden, The Netherlands

    Klaus F. Rabe

  13. Krankenhaus und Herzzentrum Bernau, Bernau, Germany

    Klaus Neumann

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  1. Uta Zaspel
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  2. David W. Denning
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  3. Arne J. Lemke
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  14. Roland Bittner
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  15. Klaus Neumann
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  16. Joerg W. Oestmann
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Correspondence to Uta Zaspel.

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The results of this paper are part of the thesis of Uta Zaspel.

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Zaspel, U., Denning, D.W., Lemke, A.J. et al. Diagnosis of IPA in HIV: the role of the chest X-ray and radiologist. Eur Radiol 14, 2030–2037 (2004). https://doi.org/10.1007/s00330-004-2447-5

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  • DOI: https://doi.org/10.1007/s00330-004-2447-5

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