Cancer Research and Treatment

Original Article

Ultra-Low-Dose Chest CT in Patients with Neutropenic Fever and Hematologic Malignancy: Image Quality and Its Diagnostic Performance: Hae Jin Kim, So Young Park, Ho Yun Lee, Kyung Soo Lee, Kyung Eun Shin, Jung Won Moon; Cancer Res Treat. 2014;46(4):393-402. Published online July 18, 2014; DOI: https://doi.org/10.4143/crt.2013.132

Purpose
The aim of this study was to evaluate the image quality of ultra-low-dose CT (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 (ICC).
Results
Of 207 patients, 139 (67%) had pneumonia, 12 had non-infectious lung disease, and 56 had no remarkable chest CT (20 with extra-thoracic fever focus and 36 with no specific disease). Mean radiation expose dose of ULDCT was 0.60 ± 0.15 mSv. Each observer regarded LDCT 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.
Conclusions
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.

Citations

Citations to this article as recorded by

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