Cancer Res Treat.  2014 Oct;46(4):393-402. 10.4143/crt.2013.132.

Ultra-Low-Dose Chest CT in Patients with Neutropenic Fever and Hematologic Malignancy: Image Quality and Its Diagnostic Performance

• Kim HJ
• Park SY
• Lee HY
• Lee KS
• Shin KE
• Moon JW

• KMID: 2380377
• DOI: http://doi.org/10.4143/crt.2013.132

Abstract

PURPOSE
The aim of this study was to evaluate the image quality of ultra-low-dose computed tomography (ULDCT) and its diagnostic performance in making a specific diagnosis of pneumonia in febrile neutropenic patients with hematological malignancy.
MATERIALS AND METHODS
ULDCT was performed prospectively in 207 febrile neutropenic patients with hematological malignancy. Three observers independently recorded the presence of lung parenchymal abnormality, and also indicated the cause of the lung parenchymal abnormality between infectious and noninfectious causes. If infectious pneumonia was considered the cause of lung abnormalities, they noted the two most appropriate diagnoses among four infectious conditions, including fungal, bacterial, viral, and Pneumocystis pneumonia. Sensitivity for correct diagnoses and receiver operating characteristic (ROC) curve analysis for evaluation of diagnostic accuracy were calculated. Interobserver agreements were determined using intraclass correlation coefficient.
RESULTS
Of 207 patients, 139 (67%) had pneumonia, 12 had noninfectious lung disease, and 56 had no remarkable chest computed tomography (CT) (20 with extrathoracic fever focus and 36 with no specific disease). Mean radiation expose dose of ULDCT was 0.60+/-0.15 mSv. Each observer regarded low-dose CT scans as unacceptable in only four (1.9%), one (0.5%), and three (1.5%) cases of ULDCTs. Sensitivity and area under the ROC curve in making a specific pneumonia diagnosis were 63.0%, 0.65 for reader 1; 63.0%, 0.61 for reader 2; and 65.0%, 0.62 for reader 3; respectively
CONCLUSION
ULDCT, with a sub-mSv radiation dose and acceptable image quality, provides ready and reasonably acceptable diagnostic information for pulmonary infection in febrile neutropenic patients with hematologic malignancy

Keyword

Hematologic neoplasms; Febrile neutropenia; Pulmonary infection; Ultra-low-dose CT

MeSH Terms

Diagnosis
Febrile Neutropenia
Fever*
Hematologic Neoplasms*
Humans
Lung
Lung Diseases
Pneumonia
Pneumonia, Pneumocystis
Prospective Studies
ROC Curve
Thorax
Tomography, X-Ray Computed*

Figure

• 

  Fig. 1. Representative figures for assessment of image quality. (A) Excellent image quality. (B) Acceptable image quality. (C) Unacceptable image quality.

• 

  Fig. 2. Representative cases for infectious pneumonia. (A) Transverse ultra-low-dose computed tomography (ULDCT) scan in a patient with Aspergillus infection shows a nodule surrounded by a halo of ground-glass opacity in the left lower lobe (arrow). All three observers reached a consensus as an excellent image quality level. (B) Transverse ULDCT scans in a patient with Pneumocystis pneumonia show bilateral patchy areas of ground-glass opacity (arrows). All three observers reached a consensus as an acceptable image quality level. (C) Transverse and coronal ULDCT scans in a patient with streptococcal pneumonia show consolidation involving the posterior basal segment of the right lower lobe (arrows). All three observers reached a consensus as an acceptable image quality level. (D) Transverse ULDCT scans in a patient with coronavirus infection show multiple centrilobular nodules (arrowheads) and bilateral areas of lobular consolidation of peribronchial distributions (arrows). All three observers reached a consensus as an unacceptable image quality level.

Reference

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