title: Diagnostic Performance of Ultra-Low-Dose Computed Tomography for Detecting Asbestos-Related Pleuropulmonary Diseases: Prospective Study in a Screening Setting.
abstract: OBJECTIVE
  To evaluate the diagnostic performance of Ultra-Low-Dose Chest CT (ULD CT) for the detection of any asbestos-related lesions (primary endpoint) and specific asbestos-related abnormalities, i.e. non-calcified and calcified pleural plaques, diffuse pleural thickening, asbestosis and significant lung nodules (secondary endpoints).
  
  
  METHODS
  55 male patients (55.7±8.1 years old) with occupational asbestos exposure for at least 15 years and where CT screening was indicated were prospectively included. They all underwent a standard unenhanced chest CT (120kV, automated tube current modulation), considered as the reference, and an ULD CT (135kV, 10mA), both with iterative reconstruction. Two chest radiologists independently and blindly read the examinations, following a detailed protocol. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and error rate of ULD CT were calculated using the exact method of Pearson with a confidence interval of 95%.
  
  
  RESULTS
  Radiation dose was 17.9±1.2mGy.cm (0.25mSv) for the ULD-CT versus 288.8 ±151mGy.cm (4mSv); p <2.2e-16. Prevalence of abnormalities was 20%. The ULD CT's diagnostic performance in joint reading was high for the primary endpoint (sensitivity = 90.9%, specificity = 100%, positive predictive value = 100%, negative predictive value = 97.8%), high for lung nodules, diffuse pleural thickening and calcified pleural plaques (sensitivity, specificity, PPV and NPV = 100%) and fair for asbestosis (sensitivity = 75%, specificity = 100%, PPV = 00%, NPV = 98.1%). Intra-reader accuracy between the ULD CT and the reference CT for the primary endpoint was 98% for the senior and 100% for the junior radiologist. Inter-reader agreement for the primary endpoint was almost perfect (Cohen's Kappa of 0.81).
  
  
  CONCLUSIONS
  ULD CT in the screening of asbestos exposure related diseases has 90.9% sensitivity and 100% specificity, and could therefore be proposed as a first line examination.
authors.affiliation: Service de Radiologie, Centre Hospitalier de Haguenau, Haguenau, France.
authors.forename: Marysa
authors.initials: M
authors.lastname: Schaal
authors.affiliation: Service de Santé Publique, Hôpital Civil, Strasbourg, France.
authors.forename: François
authors.initials: F
authors.lastname: Severac
authors.affiliation: Service de Radiologie, Nouvel Hôpital Civil, Strasbourg, France.
authors.forename: Aissam
authors.initials: A
authors.lastname: Labani
authors.affiliation: Service de Radiologie, Nouvel Hôpital Civil, Strasbourg, France.
authors.forename: Mi-Young
authors.initials: MY
authors.lastname: Jeung
authors.affiliation: Service de Radiologie, Nouvel Hôpital Civil, Strasbourg, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Roy
authors.affiliation: Service de Radiologie, Nouvel Hôpital Civil, Strasbourg, France.|iCube Laboratory, Université de Strasbourg / CNRS, Illkirch, France.
authors.forename: Mickaël
authors.identifier: http://orcid.org/0000-0003-0179-5784
authors.initials: M
authors.lastname: Ohana
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001194:Asbestos / Q000494:pharmacology*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008171:Lung Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects; D010995:Pleural Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D011829:Radiation Dosage; D000069079:Radiation Exposure; D013902:Radiography, Thoracic
chemical_list: D001194:Asbestos