title: Improving early diagnosis of pulmonary infections in patients with febrile neutropenia using low-dose chest computed tomography.
abstract: 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.
authors.affiliation: Department of Haematology, University Medical Center Utrecht Cancer Center, Utrecht, the Netherlands.|Department of Haematology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: M G
authors.identifier: http://orcid.org/0000-0003-2922-5556
authors.initials: MG
authors.lastname: Gerritsen
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Willemink
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.|Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Pompe
authors.affiliation: Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: van der Bruggen
authors.affiliation: Department of Haematology, University Medical Center Utrecht Cancer Center, Utrecht, the Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: van Rhenen
authors.affiliation: Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: J W J
authors.initials: JW
authors.lastname: Lammers
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Wessels
authors.affiliation: Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands.
authors.forename: R W
authors.initials: RW
authors.lastname: Sprengers
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: P A
authors.initials: PA
authors.lastname: de Jong
authors.affiliation: Department of Haematology, University Medical Center Utrecht Cancer Center, Utrecht, the Netherlands.
authors.forename: M C
authors.initials: MC
authors.lastname: Minnema
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008171:Lung Diseases / Q000150:complications* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications / Q000000981:diagnostic imaging; D009503:Neutropenia / Q000150:complications* / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D013902:Radiography, Thoracic; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014777:Virus Diseases / Q000150:complications / Q000000981:diagnostic imaging; D055815:Young Adult