Improving early diagnosis of pulmonary infections in patients with febrile neutropenia using low-dose chest computed tomography

Autor: R W Sprengers, A. van Rhenen, Jan Willem J. Lammers, M G Gerritsen, P. A. de Jong, Monique C. Minnema, Frank J. Wessels, Martin J. Willemink, Esther Pompe, T. van der Bruggen
Přispěvatelé: Hematology, AII - Infectious diseases, Radiology and nuclear medicine, AII - Inflammatory diseases, Graduate School
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Lung Diseases
Male
0301 basic medicine
Pulmonology
Cell Transplantation
Radiography
Fevers
lcsh:Medicine
Pathology and Laboratory Medicine
Diagnostic Radiology
White Blood Cells
0302 clinical medicine
Animal Cells
Medicine and Health Sciences
Blood and Lymphatic System Procedures
Image Processing
Computer-Assisted
Stage (cooking)
lcsh:Science
Prospective cohort study
Tomography
Multidisciplinary
Radiology and Imaging
Fungal Diseases
Bacterial Infections
Middle Aged
Infectious Diseases
Treatment Outcome
Virus Diseases
030220 oncology & carcinogenesis
Predictive value of tests
Female
Radiography
Thoracic
Radiology
Cellular Types
Research Article
Adult
medicine.medical_specialty
Neutropenia
Imaging Techniques
Immune Cells
Immunology
030106 microbiology
Neuroimaging
Surgical and Invasive Medical Procedures
Research and Analysis Methods
Sensitivity and Specificity
Young Adult
03 medical and health sciences
Signs and Symptoms
McNemar's test
Diagnostic Medicine
Predictive Value of Tests
medicine
Journal Article
Humans
Aged
Transplantation
Blood Cells
business.industry
lcsh:R
Biology and Life Sciences
Cell Biology
Pneumonia
medicine.disease
Computed Axial Tomography
Mycoses
Respiratory Infections
lcsh:Q
Tomography
X-Ray Computed
business
Febrile neutropenia
Neuroscience
Stem Cell Transplantation
Zdroj: PLoS ONE, 12(2). Public Library of Science
PLoS ONE [E], 12(2). Public Library of Science
PLoS ONE, Vol 12, Iss 2, p e0172256 (2017)
PLOS ONE
PLoS ONE
Gerritsen, M G, Willemink, M J, Pompe, E, van der Bruggen, T, van Rhenen, A, Lammers, J W J, Wessels, F, Sprengers, R W, de Jong, P A & Minnema, M C 2017, ' Improving early diagnosis of pulmonary infections in patients with febrile neutropenia using low-dose chest computed tomography ', PLoS ONE, vol. 12, no. 2, pp. e0172256 . https://doi.org/10.1371/journal.pone.0172256
ISSN: 1932-6203
DOI: 10.1371/journal.pone.0172256
Popis: We performed a prospective study in patients with chemotherapy induced febrile neutropenia to investigate the diagnostic value of low-dose computed tomography compared to standard chest radiography. The aim was to compare both modalities for detection of pulmonary infections and to explore performance of low-dose computed tomography for early detection of invasive fungal disease. The low-dose computed tomography remained blinded during the study. A consensus diagnosis of the fever episode made by an expert panel was used as reference standard. We included 67 consecutive patients on the first day of febrile neutropenia. According to the consensus diagnosis 11 patients (16.4%) had pulmonary infections. Sensitivity, specificity, positive predictive value and negative predictive value were 36%, 93%, 50% and 88% for radiography, and 73%, 91%, 62% and 94% for low-dose computed tomography, respectively. An uncorrected McNemar showed no statistical difference (p = 0.197). Mean radiation dose for low-dose computed tomography was 0.24 mSv. Four out of 5 included patients diagnosed with invasive fungal disease had radiographic abnormalities suspect for invasive fungal disease on the low-dose computed tomography scan made on day 1 of fever, compared to none of the chest radiographs. We conclude that chest radiography has little value in the initial assessment of febrile neutropenia on day 1 for detection of pulmonary abnormalities. Low-dose computed tomography improves detection of pulmonary infiltrates and seems capable of detecting invasive fungal disease at a very early stage with a low radiation dose.
Databáze: OpenAIRE
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