Invasive pulmonary aspergillosis- early diagnosis in febrile neutropenic patients using high resolution CT scan of thorax as a screening tool
Bibliographic record
Abstract
Aim.The aim of our study was to determine the sensitivity and specificity of thoracic high resolution CT scan (HRCT) for the early diagnosis of invasive pulmonary aspergillosis (IPA) in febrile neutropenic patients not responding to broad- spectrum antibiotics. Methods. Patients of haematological disorders with febrile neutropenia not responding to broad spectrum antibiotics were screened with chest x-ray (CXR) and HRCT chest. The radiological findings were correlated with microbiological cultures and serum galactomannan results to calculate the sensitivity and specificity of CXR and HRCT for diagnosing IPA. Results. We studied76 febrile episodes. HRCT showed abnormalities in 56 (84%) patients. Normal CXR with abnormal CT was seen in 18 (24%) patients. Typical CT findings included nodules, n=32(43%); nodules with halo sign, n=20(34%); segmental consolidation, n= 46(61%); cavitation/air crescent sign, n=9(16%); fungal ball, n=5(7%); pleural effusion, n=3(5%); and hilar/paratracheal lymphadenopathy n=2(3%). Multiple abnormalities were seen in 35(47%) patients. Based on microbiological and serological criteria and histopathology (where available) the final diagnoses as per EORTC guidelines (excluding the radiological criteria) were: a) definite / proven IPA-none, b) probable IPA -1, c) suspected IPA-32 . Overall HRCT had a high sensitivity(96)% and negative predictive value(83%)compared to CXR (78% and 77% respectively) in diagnosing IPA. The sensitivity and specificity of the halo sign were 41% and 81% and that of the air crescent sign were 31 % and 98% respectively in diagnosing IPA.Presence of ground glass opacities/patchy consolidation had the highest sensitivity among the various radiological signs for IPA diagnosis(57%) but was associated with low specificity(50%).Clinical management was altered in 18 patients with HRCT abnormalities whose chest X-ray was normal. Conclusion.We conclude HRCT is a useful screening tool for the early diagnosis of IPA. Its high sensitivity and NPV will guide decisions regarding starting or delaying empirical anti-fungal therapy in this group of high risk patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".