Risk of hematologic malignant neoplasms from head CT radiation in children and adolescents presenting with minor head trauma: a nationwide population-based cohort study.

Autor: Lee S; Department of Radiology, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, South Korea.; Institute of Health and Environment, Seoul National University, Seoul, South Korea., Kim HY; Department of Radiology, Asan Medical Center, Seoul, South Korea., Lee KH; Department of Radiology, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, South Korea.; Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, 13620, Gyeonggi-Do, South Korea., Cho J; Department of Radiology, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, South Korea., Lee C; Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA., Kim KP; Department of Nuclear Engineering, Kyung Hee University, Seoul, Gyeonggi-Do, South Korea., Hwang J; Department of Radiology, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, South Korea.; Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea., Park JH; Department of Radiology, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, South Korea. pjihoon79@gmail.com.; Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, 13620, Gyeonggi-Do, South Korea. pjihoon79@gmail.com.; Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea. pjihoon79@gmail.com.; Department of Medical Device Development, Seoul National University College of Medicine, Seoul, South Korea. pjihoon79@gmail.com.
Jazyk: angličtina
Zdroj: European radiology [Eur Radiol] 2024 Sep; Vol. 34 (9), pp. 5934-5943. Date of Electronic Publication: 2024 Feb 15.
DOI: 10.1007/s00330-024-10646-2
Abstrakt: Objectives: The carcinogenic risks of CT radiation in children and adolescents remain debated. We aimed to assess the carcinogenic risk of CTs performed in children and adolescents with minor head trauma.
Methods: In this nationwide population-based cohort study, we included 2,411,715 patients of age 0-19 with minor head trauma from 2009 to 2017. We excluded patients with elevated cancer risks or substantial past medical radiation exposure. Patients were categorized into CT-exposed or CT-unexposed group according to claim codes for head CT. The primary outcome was development of hematologic malignant neoplasms. Secondary outcomes included development of malignant solid neoplasms and benign neoplasms in the brain. We measured the incidence rate ratio (IRR) and incidence rate difference (IRD) using G-computation with Poisson regression adjusting for age, sex, hospital setting, and the type of head trauma.
Results: Hematologic malignant neoplasms developed in 100 of 216,826 patients during 1,303,680 person-years in the CT-exposed group and in 808 of 2,194,889 patients during 13,501,227 person-years in the CT-unexposed group. For hematologic malignant neoplasms, the IRR was 1.29 (95% CI, 1.03-1.60) and the IRD was 1.71 (95% CI, 0.04-3.37) per 100,000 person-years at risk. The majority of excess hematologic malignant neoplasms were leukemia (IRR, 1.40 [98.3% CI, 1.05-1.87]; IRD, 1.59 [98.3% CI, 0.02-3.16] per 100,000 person-years at risk). There were no between-group differences for secondary outcomes.
Conclusions: Radiation exposure from head CTs in children and adolescents with minor head trauma was associated with an increased incidence of hematologic malignant neoplasms.
Clinical Relevance Statement: Our study provides a quantitative grasp of the risk conferred by CT examinations in children and adolescents, thereby providing the basis for cost-benefit analyses and evidence-driven guidelines for patient triaging in head trauma.
Key Points: • This nationwide population-based cohort study showed that radiation exposure from head CTs in children and adolescents was associated with a higher incidence of hematologic malignant neoplasms. • The incidence rate of hematologic malignant neoplasms in the CT-exposed group was 29% higher than that in the CT-unexposed group (IRR, 1.29 [95% CI, 1.03-1.60]), and there were approximately 1.7 excess neoplasms per 100,000 person-years at risk in the CT-exposed group (IRD, 1.71 [0.04-3.37]). • Our study provides a quantified grasp of the risk conferred by CT examinations in children and adolescents, while controlling for biases observed in previous studies via specifying CT indication and excluding patients with predisposing conditions for cancer development.
(© 2024. The Author(s), under exclusive licence to European Society of Radiology.)
Databáze: MEDLINE
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