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. 2023 Dec 29;16(1):186.
doi: 10.3390/cancers16010186.

The Use of Low-Dose Chest Computed Tomography for the Diagnosis and Monitoring of Pulmonary Infections in Patients with Hematologic Malignancies

Efthimios Agadakos  1 , Alexandra Zormpala  1 , Nikolaos Zaios  2 , Chrysoula Kapsiocha  1 , Maria N Gamaletsou  3 , Michael Voulgarelis  3 , Nikolaos V Sipsas  3 , Lia Angela Moulopoulos  2 , Vassilis Koutoulidis  2
Affiliations

The Use of Low-Dose Chest Computed Tomography for the Diagnosis and Monitoring of Pulmonary Infections in Patients with Hematologic Malignancies

Efthimios Agadakos et al. Cancers (Basel). .

Abstract

The study aimed to assess the image quality and diagnostic performance of low-dose Chest Computed Tomography (LDCCT) in detecting pulmonary infections in patients with hematologic malignancies. A total of 164 neutropenic patients underwent 256 consecutive CT examinations, comparing 149 LDCCT and 107 Standard-Dose Chest CT (SDCCT) between May 2015 and June 2019. LDCCT demonstrated a 47% reduction in radiation dose while maintaining acceptable image noise and quality compared to SDCCT. However, LDCCT exhibited lower sensitivity in detecting consolidation (27.5%) and ground glass opacity (64.4%) compared to SDCCT (45.8% and 82.2%, respectively) with all the respective p-values from unadjusted and adjusted for sex, age, and BMI analyses being lower than 0.006 and the corresponding Odds Ratios of detection ranging from 0.30 to 0.34. Similar trends were observed for nodules ≥3 mm and ground glass halo in nodules but were not affected by sex, age and BMI. No significant differences were found for cavitation in nodules, diffuse interlobular septal thickening, pleural effusion, pericardial effusion, and lymphadenopathy. In conclusion, LDCCT achieved substantial dose reduction with satisfactory image quality but showed limitations in detecting specific radiologic findings associated with pulmonary infections in neutropenic patients compared to SDCCT.

Keywords: CT noise reduction algorithms; diagnostic performance; hematologic malignancies; low-dose chest CT; lung abnormalities; neutropenic patients; radiation dose; standard-dose chest CT.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Distribution (boxplots) of objective analysis values by protocol.
Figure 2
Figure 2
Agreement between examiner #1 (RG1-Radiographer) and examiner #2 (RG2-Radiographer) on subjective analysis. Bars represent percentages of concordance (light gray) or discordance (dark gray) cases. Agreement is the percentage of overall observed agreement, and Kappa is Cohen’s coefficient of agreement.
Figure 3
Figure 3
Agreement between examiner #1 (RD1-Radiologist MD) and examiner #2 (RD2) on radiologic findings. Bars represent percentages of concordance (light gray) or discordance (dark gray) cases. Agreement is the percentage of overall observed agreement, and Kappa is Cohen’s coefficient of agreement.
Figure 4
Figure 4
1.0 mm axial CT images demonstrating important pulmonary infection-specific findings i.e., Consolidation, Ground Glass Opacity, and Nodules (≥3 mm) on patients who presented with febrile neutropenia and underlying acute myeloid leukemia; (A): SDCCT SAFIRETM S3 (Deff = 1.06 mSv; SNR = 6.49; CNR = 8.46) on 54 y.o. male (BMI:20); (B): LDCCT SAFIRETM S3 (Deff = 0.74 mSv; SNR = 3.95; CNR = 4.07) on 77 y.o. male (BMI:21).
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