Abstract
Purpose
Chest radiography (CXR) of immunocompromised patients has low sensitivity in the early evaluation of pulmonary abnormalities suspected to be infectious. The purpose of the study was to evaluate whether the knowledge of clinical data improves the diagnostic sensitivity of CXR in the particular setting of immunocompromised patients after hematopoietic stem cell transplantation (HSCT).
Materials and methods
Sixty-four CXRs of immunocompromised patients with clinically suspected pneumonia were retrospectively and independently evaluated by two radiologists to assess the presence of radiological signs of pneumonia, before (first reading) and after (second reading) the knowledge of clinical data. A chest computed tomography (CT) performed within 3 days was assumed as the standard of reference. For each reading, sensitivity of both radiologists was calculated.
Results
Readers showed a sensitivity of 39% and 58.5% for the first reading, and 43.9% and 41.5% for the second reading, respectively. For both readers, these values were not significantly different from those obtained at first reading (McNemar’s test, p>0.05). Interobserver agreement at second reading was fair (Cohen test, k=0.33).
Conclusions
The sensitivity of CXR is too low to consider it a stand-alone technique for the evaluation of immunocompromised patients after HSCT with suspected pneumonia, even if the radiologist knows detailed clinical data. For these patients, an early chest CT evaluation is therefore recommended.
Riassunto
Obiettivo
La radiografia (Rx) del torace ha bassa sensibilità nell’individuazione precoce di infiltrati polmonari di sospetta natura infettiva nei pazienti immunocompromessi. Scopo dello studio è stato valutare se la conoscenza della clinica del paziente possa migliorarne la sensibilità diagnostica nel particolare contesto dei pazienti immunodepressi per trapianto di cellule staminali.
Materiali e metodi
Due medici radiologi hanno valutato retrospettivamente 64 radiografie del torace di pazienti immunocompromessi con sospetto clinico di polmonite per l’eventuale presenza di reperti compatibili con polmonite, senza conoscere (prima lettura) e conoscendone (seconda lettura) la storia clinica. Il gold standard utilizzato è stato una tomografia computerizzata (TC) del torace eseguita entro tre giorni dall’Rx. Per ciascuna lettura, è stata calcolata la sensibilità dei due lettori.
Risultati
La sensibilità dei due radiologi è stata rispettivamente del 39% e del 58,5% nella prima lettura e del 43,9% e del 41,5% nella seconda lettura. Confrontando i dati ottenuti nella prima e nella seconda lettura è emerso come, per entrambi i lettori, la differenza non fosse statisticamente significativa (test di McNemar, p>0,05). Nella seconda lettura, la correlazione inter-osservatore è stata discreta (k di Cohen 0,33).
Conclusioni
Anche alla luce di dettagliate informazioni cliniche, la sensibilità della radiografia del torace rimane troppo bassa per considerare tale indagine sufficiente nella valutazione dei pazienti immunocompromessi, in seguito a trapianto di cellule staminali emopoietiche, con sospetta polmonite. In tali pazienti, è dunque consigliabile un precoce utilizzo della TC torace.
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Cereser, L., Zuiani, C., Graziani, G. et al. Impact of clinical data on chest radiography sensitivity in detecting pulmonary abnormalities in immunocompromised patients with suspected pneumonia. Radiol med 115, 205–214 (2010). https://doi.org/10.1007/s11547-009-0433-3
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DOI: https://doi.org/10.1007/s11547-009-0433-3