Visual assessment of total heart volume and specific chamber size from standard chest radiographs

Ten radiologists at three levels of training visually assessed total heart and individual chamber size in 95 adults of both sexes with well defined cardiac diagnoses. Overall accuracy was highest for total heart size (82.2% correct), followed by left ventricular size, left atrial size and right heart size 79.6%, 75.0%, and 72.8%, respectively. Right heart and left atrial enlargement had a statistically significant negative effect on visual assessment of other chambers (P less than .05). Attempts to subclassify left ventricular enlargement into hypertrophy and hypertrophy and dilatation groups proved unsuccessful. While 63% of the hypertrophy group was detected as abnormal, only 24.3% were correctly subclassified as hypertrophy. For the hypertrophy and dilatation group, the corresponding values were 82% and 70%, respectively. Oblique views were useful in assessing left ventricular size only when inexperienced observers were included in the group of evaluators (P less than .05). A statistically significant improvement in assessment of normal left ventricular size and overall left atrial size was noted with experience (P less than .01 and P less than .05, respectively).
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