Low-dose computed tomography in assessment of pulmonary abnormalities in children with febrile neutropenia suffering from malignant diseases

Zaleska-Dorobisz, Urszula; Olchowy, Cyprian; Łasecki, Mateusz; Sokołowska-Dąbek, Dąbrówka; Pawluś, Aleksander; Frączkiewicz, Jowita; Gorczyńska, Ewa

doi:10.17219/acem/68292

Cited by 10 publications

(3 citation statements)

References 10 publications

(13 reference statements)

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“…In patients with clinical signs and symptoms of pneumonia radiographic imaging (conventional chest X-ray radiography (CXR) or chest CT scan) is recommended and should be obtained within 24 h. In one study, sensitivity, specificity, positive predictive value, and negative predictive value for conventional radiography were 36%, 93%, 50% and 88%, and for low-dose CT scan 73%, 91%, 62%, and 94%, respectively [ 127 ]. Therefore, chest CT scan is the preferred modality owing to the higher sensitivity and specificity [ 127 , 128 ]. The optimal timing of radiological imaging is not known; in studies and in clinical practice, CXR or chest CT scan is often performed within 24 h [ 127 , 129 ].…”

Section: Resultsmentioning

confidence: 99%

The Dutch Working Party on Antibiotic Policy (SWAB) Recommendations for the Diagnosis and Management of Febrile Neutropenia in Patients with Cancer

et al. 2022

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Introduction This guideline was written by a multidisciplinary committee with mandated members of the Dutch Society for Infectious Diseases, Dutch Society for Hematology, Dutch Society for Medical Oncology, Dutch Association of Hospital Pharmacists, Dutch Society for Medical Microbiology, and Dutch Society for Pediatrics. The guideline is written for adults and pediatric patients. Method The recommendations are based on the answers to nine questions formulated by the guideline committee. To provide evidence-based recommendations we used all relevant clinical guidelines published since 2010 as a source, supplemented with systematic searches and evaluation of the recent literature (2010–2020) and, where necessary, supplemented by expert-based advice. Results For adults the guideline distinguishes between high- and standard-risk neutropenia based on expected duration of neutropenia (> 7 days versus ≤ 7 days). Where possible a distinction has been made between pediatric and adult patients. Conclusion This guideline was written to aid diagnosis and management of patients with febrile neutropenia due to chemotherapy in the Netherlands. The guideline provides recommendation for children and adults. Adults patient are subdivided as having a standard- or high-risk neutropenic episode based on estimated duration of neutropenia. The most important recommendations are as follows. In adults with high-risk neutropenia (duration of neutropenia > 7 days) and in children with neutropenia, ceftazidime, cefepime, and piperacillin–tazobactam are all first-choice options for empirical antibiotic therapy in case of fever. In adults with standard-risk neutropenia (duration of neutropenia ≤ 7 days) the MASCC score can be used to assess the individual risk of infectious complications. For patients with a low risk of infectious complications (high MASCC score) oral antibiotic therapy in an outpatient setting is recommended. For patients with a high risk of infectious complications (low MASCC score) antibiotic therapy per protocol sepsis of unknown origin is recommended. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-022-00700-1.

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Section: Resultsmentioning

confidence: 99%

The Dutch Working Party on Antibiotic Policy (SWAB) Recommendations for the Diagnosis and Management of Febrile Neutropenia in Patients with Cancer

et al. 2022

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“…A MEDLINE search was performed, using the following terms: "CT scan hematological malignancy pulmonary infection", "CT scan pulmonary aspergillosis stem cell transplantation", "CT scan pulmonary aspergillosis hematopoietic stem cell transplantation", "CT scan pulmonary aspergillosis bone marrow transplantation", to identify CT scan findings helpful in defining infectious etiological diagnosis of pneumonia in HM-HSCT patients. A total of 22 studies were identified [11][12][13][14][15][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34], 13 of them [4,[11][12][13][14][15]19,21,24,[35][36][37][38] specifically describing different radiological findings in pediatric patients with fungal, bacterial and viral pneumonia.…”

Section: Image Analysismentioning

confidence: 99%

How Useful can be CT Scan in the Differential Diagnosis of Pneumonia in Immunocompromised Children? The Experience at a Tertiary Care Pediatric Center

2023

Infect Dis Diag Treat

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Background and Objective: Identifying radiological findings evocative of pneumonia etiology in hematologic-pediatric patients is challenging, mainly due to the non-specificity of CT findings in this population. Materials and Methods: This is a retrospective study conducted in a tertiary care pediatric hospital. All hematological patients admitted from 02/01/2009 to 12/31/2021 with a chest CT-scan performed and an etiological diagnosis of pneumonia were included; we excluded pneumonia due to Pneumocystis jirovecii. Pneumonia etiological diagnosis was made by clinicians based on clinical, microbiological and radiological findings (according to guidelines) and was defined as "definite diagnosis". The primary aim was to identify radiological findings suggestive alone of specific pneumonia etiology, secondary aims were agreement among "radiological" and "definite diagnosis", and intra and inter-observer agreement. So, two radiologists (one Senior and one Junior), blinded to patient's characteristics and "definite diagnosis", performed two readings of CT-scans of included patients; for each reading, they hypothesized a "radiological diagnosis". To reach the primary aim a sub-analysis of the "radiological diagnosis" with the highest agreement with "definite diagnosis" was performed. Results: Twenty-four CT scans from 23 hematological patients were analyzed. Pneumonia's "definitive diagnosis" was fungal and bacterial in 16 and 8 cases, respectively; no definite diagnosis of viral pneumonia was identified in the period of study. Senior "radiological diagnosis" derived from the first reading (S1) was the one with the best agreement with "definite diagnosis" (83.3%). The sub-analysis of S1 suggested that no radiological findings were indicative alone of specific infectious etiology. Intra-observer agreement was higher comparing J1 vs. J2 than S1 vs. S2. Inter-observer agreement was slight. Conclusions: Our study confirms the non-specificity of CT-scan findings alone in children with hematologic diseases. However, senior expertise allowed us to achieve the correct radiological diagnosis (compared to "definite diagnosis") in 83% of CT-readings. We believe it's essential to teach the knowledge to the youngest, as the cooperation between infectious disease and radiologist specialists.

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“…U njih 116 (84,06 %) detektirali su ground-glass zamućenja (n = 79), nodule (n = 60) i zračno-bronhogramske konsolidacije (n = 58). Nadalje, kod njih 94 (81,03 %) točno su dijagnosticirali upalne infiltrate 45 . Sun i sur.…”

Section: Ldct Pregledi Torakalnih Organaunclassified

Application of low dose computed tomography protocols in pediatric radiology

Atalić

Vujaklija

Jurković

et al. 2020

Med. Flum. (Online)

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Djeca su zbog svoje male veličine, brojnih staničnih dioba još uvijek rastućih i razvijajućih tkiva i organa, kao i dužeg očekivanog životnog vijeka, otprilike tri puta osjetljivija na iste doze ionizirajućeg zračenja od odraslih. To je posebno izraženo kod pregleda kompjutoriziranom tomografijom (engl. computerized tomography, CT) koji, iako čine samo 17 % ionizirajućih radioloških pregleda, sudjeluju s čak 49 % u ukupnom ozračivanju pacijenata. Zbog toga se pod utjecajem kampanje Image Gently početkom 2010-ih godina razmišljalo o potpunom napuštanju CT pregleda u pedijatrijskoj radiologiji te njihovoj zamjeni ultrazvučnim odnosno pregledima učinjenim magnetskom rezonancijom kao metodama izbora. Pojava Flash CT tehnike koja istovremeno skraćuje vrijeme snimanja i smanjuje doze zračenja dovela je do odustajanja od toga. Tome u prilog išle su i činjenice da su s jedne strane CT pregledi praktički nezamjenjivi u slučajevima trauma, dok su s druge strane djeca, kao uostalom i pripadnici svih drugih dobnih skupina, neprestano izložena manjoj ili većoj količini pozadinskog ionizirajućeg zračenja (Zemlja, svemir, zrakoplovi). U tome smislu danas se sve više preporučuje uporaba low dose CT (LDCT) tehnika individualno prilagođenih svakom pacijentu zbog njihove manje količine ionizirajućeg zračenja. Na tome putu nastojali smo napraviti pregled najnovijih spoznaja o spomenutoj problematici na temelju znanstvenih radova objavljenih u protekle tri godine (2016. – 2018.). Oni pokazuju da CT pregledi ne samo da nisu napušteni u pedijatrijskoj radiologiji, već naprotiv, u slučajevima brojnih indikacija LDCT pregledi čine zlatni standard.

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Low-dose computed tomography in assessment of pulmonary abnormalities in children with febrile neutropenia suffering from malignant diseases

Cited by 10 publications

References 10 publications

The Dutch Working Party on Antibiotic Policy (SWAB) Recommendations for the Diagnosis and Management of Febrile Neutropenia in Patients with Cancer

The Dutch Working Party on Antibiotic Policy (SWAB) Recommendations for the Diagnosis and Management of Febrile Neutropenia in Patients with Cancer

How Useful can be CT Scan in the Differential Diagnosis of Pneumonia in Immunocompromised Children? The Experience at a Tertiary Care Pediatric Center

Application of low dose computed tomography protocols in pediatric radiology

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