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
Department of Haematology, University Medical Center Utrecht Cancer Center, Utrecht, the Netherlands.
Department of Haematology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
PLoS One. 2017 Feb 24;12(2):e0172256. doi: 10.1371/journal.pone.0172256. eCollection 2017.
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.
我们对化疗引起的发热性中性粒细胞减少症患者进行了一项前瞻性研究，以调查低剂量计算机断层扫描与标准胸部X线摄影相比的诊断价值。目的是比较这两种检查方式对肺部感染的检测能力，并探索低剂量计算机断层扫描对侵袭性真菌病早期检测的性能。在研究期间，低剂量计算机断层扫描的结果保持盲态。由专家小组对发热发作做出的共识诊断用作参考标准。我们纳入了67例发热性中性粒细胞减少症第一天的连续患者。根据共识诊断，11例患者（16.4%）有肺部感染。胸部X线摄影的敏感性、特异性、阳性预测值和阴性预测值分别为36%、93%、50%和88%，低剂量计算机断层扫描分别为73%、91%、62%和94%。未经校正的McNemar检验显示无统计学差异（p = 0.197）。低剂量计算机断层扫描的平均辐射剂量为0.24 mSv。在纳入的5例诊断为侵袭性真菌病的患者中，4例在发热第1天进行的低剂量计算机断层扫描中发现有疑似侵袭性真菌病的影像学异常，而胸部X线摄影均未发现。我们得出结论，胸部X线摄影在发热性中性粒细胞减少症第1天对肺部异常检测的初始评估中价值不大。低剂量计算机断层扫描可提高肺部浸润的检测能力，似乎能够在早期以低辐射剂量检测到侵袭性真菌病。
