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Published on: November 21, 2018
Rapid lung MRI - paradigm shift in evaluation of febrile neutropenia in children with leukemia: a pilot study
Kushaljit Singh Sodhi1, Niranjan Khandelwal1, Akshay Kumar Saxena1
1a Department of Radio Diagnosis and Imaging , Post Graduate Institute of Medical Education and Research , Chandigarh , India.
Insights
Rapid lung MRI is a feasible and accurate tool for detecting pulmonary nodules in children with leukemia and neutropenia. This imaging technique shows high correlation with CT scans, aiding early diagnosis and treatment.
Area of Science:
- Pediatric Oncology
- Radiology
- Infectious Diseases
Background:
- Children with hematological malignancies, particularly leukemia, face a high risk of life-threatening pulmonary infections.
- Prompt diagnosis and treatment are crucial for reducing morbidity and mortality in this vulnerable population.
Purpose of the Study:
- To evaluate the feasibility and diagnostic accuracy of rapid lung Magnetic Resonance Imaging (MRI) compared to High-Resolution Computed Tomography (HRCT) for detecting pulmonary nodules.
- To assess MRI's potential as a first-line imaging modality in immunocompromised children with leukemia and persistent febrile neutropenia.
Main Methods:
- A prospective study included 26 children (aged 5-13 years) with leukemia, fever, and neutropenia.
- All participants underwent same-day HRCT and MRI of the chest, with HRCT serving as the reference standard.
- Statistical analysis included kappa test for agreement and McNemar test for significant differences between modalities.
Main Results:
- There was perfect agreement between MRI and HRCT findings (kappa = 1).
- No statistically significant difference was observed between the two imaging modalities (p > 0.05).
- Rapid lung MRI demonstrated high correlation, sensitivity, and specificity compared to CT scans.
Conclusions:
- Rapid lung MRI is technically feasible for pediatric patients.
- MRI shows excellent concordance with HRCT for identifying pulmonary nodules in children with leukemia and febrile neutropenia.
- Lung MRI may serve as an effective initial imaging choice for this patient group, facilitating timely intervention.
Abstract:
Immunocompromised children with hematological malignancies are at increased risk of developing potentially fatal pulmonary infections. Early detection and prompt treatment is critical to combat morbidity and mortality in these children. Twenty-six children with leukemia (age range: 5-13years) presenting with fever and neutropenia were included in this prospective study, which was approved by the institutional ethics committee. All patients underwent HRCT and MRI of the chest on the same day. The findings of HRCT and MRI were compared, with HRCT as the standard of reference. There was perfect agreement between MRI and CT examinations findings by kappa test (κ = 1). No significant difference was observed between the two modalities by the McNemar test (p > 0.05). Rapid lung MRI is technically feasible; has a high correlation, sensitivity and specificity to CT scan; and can emerge as the first line modality for the detection of pulmonary nodules in children with leukemia and persistent febrile neutropenia.
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