Reduced-dose computerized tomography (CT) imaging was able to detect more than 90% of lung nodules in pediatric and young adult populations, according to results of a prospective study published in the American Journal of Roentgenology.
CT imaging remains the modality of choice for diagnosing and monitoring lung metastasis. Some evidence suggests lower-dose CT images are effective with adult populations, but little evidence is available on younger patients.
To assess whether reduced-dose CT was efficacious in younger populations, the researchers recruited 78 patients aged 4 to 21 years undergoing chest CT at the Cincinnati Children’s Hospital Medical Center between November 2018 and August 2020. The participants underwent weight-dependent reduced-dose (100-120 kV) CT imaging in addition to the clinically indicated CT studies.
The patient cohort comprised 44 male patients and 34 female patients, mean age 15.2±3.8 years.
The average effective dose was 1.8±1.1 mSv for the clinical scan and 0.3±0.1 mSv for the reduced-dose scan.
According to the clinical CT, 58% of participants had nonatelectatic lung nodules with a mean size of 3.4±3.3 mm.
The presence of nodules had moderate agreement between scan methods, according to all 3 reviewers, who were blinded to acquisition technique (k range, 0.48-0.57). Regarding only definite nodules, agreement was moderate to substantial (k range, 0.45-0.67).
For all nodules, the intraobserver agreement between clinical and reduced-dose CT, respectively, was 0.54 and 0.53 for presence of any nodule, 0.66 and 0.74 for number of nodules, and 0.72 and 0.72 for largest nodule size.
This study may have been limited as 47% of clinical images were obtained using contrast material.
The study authors concluded that a reduced-dose CT examination identified more than 90% of lung nodules in pediatric and young adult patients, making it a feasible method for detecting and monitoring pulmonary metastatic disease with the benefit that it reduces radiation exposure by 83%.
Thapaliya S, Gilligan LA, Brady SL, et al. Comparison of 0.3-mSv CT to standard-dose CT for detection of lung nodules in children and young adults with cancer. AJR Am J Roentgenol. Published online July 7, 2021. doi:10.2214/AJR.21.26183