Ultra-Low-Dose Chest CT in Patients with Neutropenic Fever and Hematologic Malignancy: Image Quality and Its Diagnostic Performance
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PurposeThe aim of this study was to evaluate the image quality of ultra-low-dose computedtomography (ULDCT) and its diagnostic performance in making a specific diagnosis ofpneumonia in febrile neutropenic patients with hematological malignancy. Materials and MethodsULDCT was performed prospectively in 207 febrile neutropenic patients with hematologicalmalignancy. Three observers independently recorded the presence of lung parenchymalabnormality, and also indicated the cause of the lung parenchymal abnormality betweeninfectious and noninfectious causes. If infectious pneumonia was considered the cause oflung abnormalities, they noted the two most appropriate diagnoses among four infectiousconditions, including fungal, bacterial, viral, and Pneumocystis pneumonia. Sensitivity forcorrect diagnoses and receiver operating characteristic (ROC) curve analysis for evaluationof diagnostic accuracy were calculated. Interobserver agreements were determined usingintraclass correlation coefficient. ResultsOf 207 patients, 139 (67%) had pneumonia, 12 had noninfectious lung disease, and 56had no remarkable chest computed tomography (CT) (20 with extrathoracic fever focus and36 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 inmaking a specific pneumonia diagnosis were 63.0%, 0.65 for reader 1; 63.0%, 0.61 forreader 2; and 65.0%, 0.62 for reader 3; respectively. ConclusionULDCT, with a sub-mSv radiation dose and acceptable image quality, provides ready andreasonably acceptable diagnostic information for pulmonary infection in febrile neutropenicpatients with hematologic malignancy.
Abstract
PurposeThe aim of this study was to evaluate the image quality of ultra-low-dose computedtomography (ULDCT) and its diagnostic performance in making a specific diagnosis ofpneumonia in febrile neutropenic patients with hematological malignancy. Materials and MethodsULDCT was performed prospectively in 207 febrile neutropenic patients with hematologicalmalignancy. Three observers independently recorded the presence of lung parenchymalabnormality, and also indicated the cause of the lung parenchymal abnormality betweeninfectious and noninfectious causes. If infectious pneumonia was considered the cause oflung abnormalities, they noted the two most appropriate diagnoses among four infectiousconditions, including fungal, bacterial, viral, and Pneumocystis pneumonia. Sensitivity forcorrect diagnoses and receiver operating characteristic (ROC) curve analysis for evaluationof diagnostic accuracy were calculated. Interobserver agreements were determined usingintraclass correlation coefficient. ResultsOf 207 patients, 139 (67%) had pneumonia, 12 had noninfectious lung disease, and 56had no remarkable chest computed tomography (CT) (20 with extrathoracic fever focus and36 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 inmaking a specific pneumonia diagnosis were 63.0%, 0.65 for reader 1; 63.0%, 0.61 forreader 2; and 65.0%, 0.62 for reader 3; respectively. ConclusionULDCT, with a sub-mSv radiation dose and acceptable image quality, provides ready andreasonably acceptable diagnostic information for pulmonary infection in febrile neutropenicpatients with hematologic malignancy.
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