How accurate is high-resolution computed tomography of the chest in differentiating between pulmonary invasive fungal infections and other pulmonary infections in children with cancer?
Janine Nijhuis, Geertje P Verduin, Tom F W Wolfs, Tineke T Stolk, Daniela Cianci, Laura G Y Rotte, Caroline A Lindemans, Louis J Bont, Rutger A J Nievelstein
{"title":"How accurate is high-resolution computed tomography of the chest in differentiating between pulmonary invasive fungal infections and other pulmonary infections in children with cancer?","authors":"Janine Nijhuis, Geertje P Verduin, Tom F W Wolfs, Tineke T Stolk, Daniela Cianci, Laura G Y Rotte, Caroline A Lindemans, Louis J Bont, Rutger A J Nievelstein","doi":"10.1007/s00247-024-06112-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Pulmonary invasive fungal infections pose a serious risk for immunocompromised patients. Although diagnostic imaging plays an important role in the early detection of pulmonary invasive fungal infections, radiological differentiation between invasive fungal infection and other pulmonary infections is challenging.</p><p><strong>Objective: </strong>The aim of this study was to assess the accuracy of chest high-resolution computed tomography (HRCT) in the differentiation between pulmonary invasive fungal infections and other pulmonary infections in paediatric cancer patients.</p><p><strong>Materials and methods: </strong>In this retrospective study, baseline HRCTs of patients with probable or proven invasive fungal infections and other pulmonary infections were blindly assessed by two radiologists, followed by a consensus reading. The scoring form included imaging characteristics and radiological invasive fungal infection probability assessment. Inter-rater reliability was determined with Cohen's kappa.</p><p><strong>Results: </strong>Chest HRCTs (n = 77) of paediatric cancer patients with pulmonary invasive fungal infections (n = 45) and with other pulmonary infections (n = 32) were evaluated. In the consensus reading, nodules with halo sign and wedge-shaped consolidations were observed significantly more in pulmonary invasive fungal infections than in other pulmonary infections (86.7% vs. 34.4% and 28.9% vs. 9.4%), and ground-glass opacities were observed less frequently (61.4% vs. 87.5%). The kappa values for the individual imaging characteristics ranged from 0.121 to 0.408. Sensitivity of the HRCT to diagnose a pulmonary invasive fungal infection ranged from 0.78 to 0.80, and specificity from 0.66 to 0.88.</p><p><strong>Conclusion: </strong>The accuracy of chest HRCTs in differentiating between invasive fungal infections and other pulmonary infections is poor. There are two main reasons for this: no individual imaging characteristic was found to be able to fully distinguish between invasive fungal infections and other pulmonary infections, and the agreement between radiologists was only moderate.</p>","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":"268-279"},"PeriodicalIF":2.1000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Radiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00247-024-06112-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/17 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Pulmonary invasive fungal infections pose a serious risk for immunocompromised patients. Although diagnostic imaging plays an important role in the early detection of pulmonary invasive fungal infections, radiological differentiation between invasive fungal infection and other pulmonary infections is challenging.
Objective: The aim of this study was to assess the accuracy of chest high-resolution computed tomography (HRCT) in the differentiation between pulmonary invasive fungal infections and other pulmonary infections in paediatric cancer patients.
Materials and methods: In this retrospective study, baseline HRCTs of patients with probable or proven invasive fungal infections and other pulmonary infections were blindly assessed by two radiologists, followed by a consensus reading. The scoring form included imaging characteristics and radiological invasive fungal infection probability assessment. Inter-rater reliability was determined with Cohen's kappa.
Results: Chest HRCTs (n = 77) of paediatric cancer patients with pulmonary invasive fungal infections (n = 45) and with other pulmonary infections (n = 32) were evaluated. In the consensus reading, nodules with halo sign and wedge-shaped consolidations were observed significantly more in pulmonary invasive fungal infections than in other pulmonary infections (86.7% vs. 34.4% and 28.9% vs. 9.4%), and ground-glass opacities were observed less frequently (61.4% vs. 87.5%). The kappa values for the individual imaging characteristics ranged from 0.121 to 0.408. Sensitivity of the HRCT to diagnose a pulmonary invasive fungal infection ranged from 0.78 to 0.80, and specificity from 0.66 to 0.88.
Conclusion: The accuracy of chest HRCTs in differentiating between invasive fungal infections and other pulmonary infections is poor. There are two main reasons for this: no individual imaging characteristic was found to be able to fully distinguish between invasive fungal infections and other pulmonary infections, and the agreement between radiologists was only moderate.
期刊介绍：
Official Journal of the European Society of Pediatric Radiology, the Society for Pediatric Radiology and the Asian and Oceanic Society for Pediatric Radiology
Pediatric Radiology informs its readers of new findings and progress in all areas of pediatric imaging and in related fields. This is achieved by a blend of original papers, complemented by reviews that set out the present state of knowledge in a particular area of the specialty or summarize specific topics in which discussion has led to clear conclusions. Advances in technology, methodology, apparatus and auxiliary equipment are presented, and modifications of standard techniques are described.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
