Kang Mandeep, Deoghuria Debasis, Varma Subash, Gupta Dheeraj, Bhatia Anmol, Khandelwal Niranjan
Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Lung India. 2013 Apr;30(2):124-30. doi: 10.4103/0970-2113.110420.
Fever is of grave concern in the management of patients with neutropenia with early detection of a focus of infection being the major goal. As lungs are the most common focus, chest imaging is of vital importance. This Institute Review Board approved prospective study was undertaken to assess the usefulness of high resolution computed tomography (HRCT) in early detection and characterization of pulmonary abnormalities in febrile neutropenia.
A total of 104 consecutive patients (M:F:75:29, age range 11-66 years) with fever of 38.2°C or more with an absolute neutrophil count <500/μl underwent HRCT chest. HRCT diagnosis was compared with final diagnosis based on ancillary investigations.
HRCT could detect pulmonary abnormalities in 93 patients (89.4%) with air space consolidation being the predominant finding (n = 57), followed by ground-glass opacities (Ground glass opacity (GGO), n = 49) and nodules (n = 39). HRCT could correctly characterize the infective lesions in 76 patients (81.7%). Presence of random or pleural-based nodules >10 mm with or without surrounding GGO or cavitations was sensitive (95.23%) and specific (96.7%) for fungal infection, while small (1-4 mm) random or centrilobular nodules with tree-in-bud appearance was sensitive (90%) and highly specific (97.02%) for tuberculosis. Diagnosis of pyogenic infection based on presence of air-space consolidation, pleural effusion, GGO or centrilobular nodules showed a sensitivity of 84.78% and specificity of 93.84%, whereas patchy or diffuse GGO, interstitial thickening and/or air-space consolidation showed high sensitivity (86.7%) and specificity (96.8%) for Pneumocystis jiroveci pneumonia.
HRCT chest is an excellent modality in the diagnostic work-up of patients with febrile neutropenia allowing early detection and characterization of pulmonary abnormalities.
发热是中性粒细胞减少症患者治疗中极为关注的问题，尽早发现感染病灶是主要目标。由于肺部是最常见的感染部位，胸部影像学检查至关重要。本研究经机构审查委员会批准，旨在评估高分辨率计算机断层扫描（HRCT）在发热性中性粒细胞减少症患者肺部异常早期检测及特征描述中的应用价值。
共104例连续患者（男∶女 = 75∶29，年龄范围11 - 66岁），体温≥38.2°C且绝对中性粒细胞计数<500/μl，接受了胸部HRCT检查。将HRCT诊断结果与基于辅助检查的最终诊断结果进行比较。
HRCT可检测出93例（89.4%）患者的肺部异常，其中以实变影最为常见（n = 57），其次为磨玻璃影（磨玻璃密度影（GGO），n = 49）和结节（n = 39）。HRCT能正确判断76例（81.7%）患者的感染性病变。直径>10 mm的随机分布或胸膜下结节，伴或不伴有周围GGO或空洞，对真菌感染的敏感性为95.23%，特异性为96.7%；而直径1 - 4 mm的随机分布或小叶中心性结节伴树芽征，对肺结核的敏感性为90%，特异性高达97.02%。基于实变影、胸腔积液、GGO或小叶中心性结节诊断化脓性感染，敏感性为84.78%，特异性为93.84%；斑片状或弥漫性GGO、间质增厚和/或实变影对耶氏肺孢子菌肺炎的敏感性为86.7%，特异性为96.8%。
胸部HRCT是发热性中性粒细胞减少症患者诊断检查中的一种优秀手段，能够早期检测并描述肺部异常情况。
