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线摄影的诊断价值。本研究核心目标为比较两种影像学手段对肺部感染的检出效能，并探索低剂量计算机断层扫描在侵袭性真菌病早期检出中的应用表现。研究期间，低剂量计算机断层扫描结果全程保持盲态。本研究以专家小组针对本次发热发作作出的一致性诊断作为参考标准。研究共纳入67例于发热性中性粒细胞减少症发作首日就诊的连续性患者。经一致性诊断确认，其中11例（16.4%）患者合并肺部感染。X线摄影的灵敏度、特异度、阳性预测值与阴性预测值分别为36%、93%、50%及88%；低剂量计算机断层扫描的对应指标依次为73%、91%、62%及94%。未校正的麦克内马尔检验结果显示两组间差异无统计学意义（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5例确诊为侵袭性真菌病的纳入患者中，有4例在发热首日的低剂量计算机断层扫描影像中呈现疑似侵袭性真菌病的影像学异常，而同期胸部X线摄影未检出任何此类异常。本研究结论认为，在发热性中性粒细胞减少症首日的初始评估中，胸部X线摄影对肺部异常的检出价值有限。低剂量计算机断层扫描可显著提升肺部浸润影的检出率，且能够以极低的辐射剂量实现侵袭性真菌病的早期检出。