Chest low-dose computed tomography in neutropenic acute myeloid leukaemia patients

Patsios, Demetris; Maimon, Nimrod; Chung, TaeBong; Roberts, Heidi; Disperati, Patricia; Minden, Mark; Paul, Narinder

doi:10.1016/j.rmed.2009.11.003

« Previous Next »Respiratory Medicine
Volume 104, Issue 4 , Pages 600-605, April 2010

Chest low-dose computed tomography in neutropenic acute myeloid leukaemia patients

Demetris Patsios
- Department of Medical Imaging, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
- Corresponding author at: University Health Network, Toronto Western Hospital, McL Wing, 3rd Floor, Room 428, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada. Tel.: +1 416 603 5800x2583; fax: +1 416 603 4257.
- These two authors contributed equally to this paper.
Nimrod Maimon
- Joint Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
- These two authors contributed equally to this paper.
TaeBong Chung
- Department of Medical Imaging, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
Heidi Roberts
- Department of Medical Imaging, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
Patricia Disperati
- Department of Oncology, Princess Margaret Hospital, 610 University Avenue, Toronto, ON M5G 2M9, Canada
Mark Minden
- Department of Oncology, Princess Margaret Hospital, 610 University Avenue, Toronto, ON M5G 2M9, Canada
Narinder Paul
- Department of Medical Imaging, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada

Received 20 February 2008; accepted 9 November 2009. published online 17 December 2009.

Summary

Background

We aimed to compare chest low-dose computed tomography (LDCT) with chest radiography (CXR) in the assessment of febrile acute myeloid leukaemia neutropenic patients.

Methods

A prospective non-randomized study was carried out between 30 May, 2003 and 3 June, 2004 in consecutive neutropenic patients who required imaging of the thorax and were treated for acute myeloid leukaemia. Each patient had a baseline 2-view chest radiograph followed by LDCT. Both the CXR and the LDCT studies were blindly and independently reviewed by two chest radiologists.

Results

Forty patients were enrolled: 24 male and 16 female, mean age 53.5years (range 18–83) and an average neutrophil count of 0.78×10⁹/L. Patients had CXR within a mean of 40min from the LDCT. Overall, 31 (77.5%) of 40 CXR were abnormal, whereas LDCT detected abnormalities in 38 (95%) of 40 patients. LDCT demonstrated three times the number of lung nodules as CXR and twice as many ground-glass opacities. Lung consolidation was detected similarly using both techniques, but LDCT demonstrated more extensive and multi-focal consolidation. The majority of nodules detected only on LDCT were subcentimetre in diameter. The additional information provided by LDCT led to an alteration in the clinical management of 11 (27.5%) of 40 patients.

Conclusion

LDCT is a useful tool in the initial investigation of suspected pulmonary complication in neutropenic patients. This is supported by the additional information it provides to the CXR with reduced radiation when compared to conventional CT.

Keywords: Chest low-dose computed tomography, Chest radiography, Neutropenic fever, Acute myeloid leukaemia