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

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.

本研究针对化疗所致发热性中性粒细胞减少症（chemotherapy induced febrile neutropenia）患者开展前瞻性研究，旨在对比低剂量计算机断层扫描（low-dose computed tomography）与标准胸部X线摄影（standard chest radiography）的诊断价值。本研究的核心目标为比较两种影像学手段在肺部感染检出中的效能，并探索低剂量计算机断层扫描早期检出侵袭性真菌病的临床效能。研究全程对低剂量计算机断层扫描结果实施盲法管控，由专家小组针对发热事件作出的一致性诊断作为本研究的参照金标准。本研究共纳入67例发热性中性粒细胞减少症发病首日的连续性患者，依据专家小组的一致性诊断结果，其中11例患者（占比16.4%）确诊肺部感染。胸部X线摄影的敏感度、特异度、阳性预测值及阴性预测值分别为36%、93%、50%及88%；低剂量计算机断层扫描的对应指标则分别为73%、91%、62%及94%。未校正的McNemar检验结果显示，两种影像学手段的检出效能无统计学差异（p=0.197）。低剂量计算机断层扫描的平均辐射剂量为0.24毫西弗（mSv）。在纳入的5例确诊侵袭性真菌病的患者中，有4例在发热首日接受的低剂量计算机断层扫描影像中呈现出疑似侵袭性真菌病的影像学异常，而同期的胸部X线摄影未检出任何异常征象。本研究结论表明，在发热性中性粒细胞减少症发病首日的初始评估中，胸部X线摄影对于肺部异常的检出价值有限。低剂量计算机断层扫描可提升肺部浸润影的检出效能，且能够以极低的辐射剂量实现侵袭性真菌病的早期检出。