Evaluation of heart size and pulmonary vasculature

Inter- and intraobserver variation and diagnostic accuracy in estimation of heart size and pulmonary vasculature were evaluated for conventional film-screen technique and image intensifier photofluorography. Interpretation of 218 p.a. and lateral chest films by both imaging techniques was performed independently by 4 readers. Heart size relative to body surface area measured from the plain chest films was used as the reference in cardiac size determination. Overall diagnostic accuracies of conventional radiography and image intensifier photofluorography for cardiomegaly were close to each other, 0.70 vs 0.68, respectively. Specificity of film-screen radiography was better than that of photofluorography (0.92 vs 0.84, p<0.05). Interobserver agreement was poor both in assessment of the heart size and pulmonary vasculature (range of kappa coefficients 0.18-0.59) while the intraobserver consistency (kappa coefficients 0.60-0.85) was good to excellent. The results suggest a limited usefulness of visual assessment of heart size and pulmonary vasculature in chest roentgenographs. (orig.)