Diagnostic Accuracy in Detecting Fungal Infection with Ultra-Low-Dose Computed Tomography (ULD-CT) Using Filtered...

Area of Science:

• Radiology
• Medical Imaging
• Infectious Diseases

Background:

• Fungal infections pose a significant threat to immunocompromised (IC) patients.
• Accurate and timely diagnosis is crucial for effective treatment.
• Low-dose chest CT (LDCT) is a standard imaging technique, but radiation exposure is a concern.

Purpose of the Study:

• To evaluate the diagnostic accuracy of ultra-low-dose CT (uLDCT) compared to standard LDCT for detecting fungal infections in IC patients.
• To assess image quality and diagnostic confidence between the two CT protocols.
• To determine the radiation dose reduction achievable with uLDCT.

Main Methods:

• A paired-scan study involving 100 IC patients who underwent both LDCT and uLDCT.
• Independent review of CT images by three chest radiologists assessing image quality, diagnostic confidence, and detection of fungal criteria using a Likert scale.
• Statistical analysis including inter-rater reliability (ICC) and Wilcoxon paired test.
• Radiation dose comparison between LDCT and uLDCT.

Main Results:

• uLDCT demonstrated high accuracy (96% for major, 84% for minor findings) in detecting fungal disease criteria.
• Image quality and diagnostic confidence scores for uLDCT were slightly lower than LDCT but generally clinically acceptable, except in obese patients (BMI ≥ 30 kg/m²).
• uLDCT achieved a 75% reduction in effective radiation dose (0.9 mGy vs. 3.7 mGy) with no significant difference in inter-rater agreement (ICC values 0.51-0.96).

Conclusions:

• Thoracic uLDCT is a viable alternative to standard LDCT for diagnosing fungal infections in IC patients with BMI < 30.0 kg/m².
• The significant radiation dose reduction makes uLDCT a safer imaging option.
• Further evaluation may be needed for obese patients to ensure optimal image quality.