Diagnostic Performance of Contrast Enhanced Pulmonary Computed Tomography Angiography for the Detection of Angioinvasive Pulmonary Aspergillosis in Immunocompromised Patients

C. Henzler; T. Henzler; D. Buchheidt; John W. Nance; C. A. Weis; R. Vogelmann; U. Benck; T. Viergutz; T. Becher; T. Boch; S. A. Klein; D. Heidenreich; L. Pilz; M. Meyer; P. M. Deckert; W.-K. Hofmann; S. O. Schoenberg; M. Reinwald

doi:10.1038/s41598-017-04470-6

Scientific Reports (Jun 2017)

Diagnostic Performance of Contrast Enhanced Pulmonary Computed Tomography Angiography for the Detection of Angioinvasive Pulmonary Aspergillosis in Immunocompromised Patients

C. Henzler,
T. Henzler,
D. Buchheidt,
John W. Nance,
C. A. Weis,
R. Vogelmann,
U. Benck,
T. Viergutz,
T. Becher,
T. Boch,
S. A. Klein,
D. Heidenreich,
L. Pilz,
M. Meyer,
P. M. Deckert,
W.-K. Hofmann,
S. O. Schoenberg,
M. Reinwald

Affiliations

C. Henzler: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University
T. Henzler: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University
D. Buchheidt: Department of Hematology and Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University
John W. Nance: Department of Radiology, Medical University of South Carolina
C. A. Weis: Department of Pathology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University
R. Vogelmann: Department of Gastroenterology and Infectious Diseases, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University
U. Benck: Department of Nephrology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University
T. Viergutz: Department of Anesthesiology and Intensive Care Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University
T. Becher: Department of Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University
T. Boch: Department of Hematology and Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University
S. A. Klein: Department of Hematology and Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University
D. Heidenreich: Department of Hematology and Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University
L. Pilz: University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University
M. Meyer: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University
P. M. Deckert: Department of Hematology and Oncology, Medical University of Brandenburg (MHB) Theodor Fontane
W.-K. Hofmann: Department of Hematology and Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University
S. O. Schoenberg: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University
M. Reinwald: Department of Hematology and Oncology, Medical University of Brandenburg (MHB) Theodor Fontane

DOI: https://doi.org/10.1038/s41598-017-04470-6
Journal volume & issue: Vol. 7, no. 1
pp. 1 – 9

Abstract

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Abstract Invasive pulmonary aspergillosis (IPA) is one of the major complications in immunocompromised patients. The mainstay of diagnostic imaging is non-enhanced chest-computed-tomography (CT), for which various non-specific signs for IPA have been described. However, contrast-enhanced CT pulmonary angiography (CTPA) has shown promising results, as the vessel occlusion sign (VOS) seems to be more sensitive and specific for IPA in hematologic patients. The aim of this study was to evaluate the diagnostic accuracy of CTPA in a larger cohort including non-hematologic immunocompromised patients. CTPA studies of 78 consecutive immunocompromised patients with proven/probable IPA were analyzed. 45 immunocompromised patients without IPA served as a control group. Diagnostic performance of CTPA-detected VOS and of radiological signs that do not require contrast-media were analyzed. Of 12 evaluable radiological signs, five were found to be significantly associated with IPA. The VOS showed the highest diagnostic performance with a sensitivity of 0.94, specificity of 0.71 and a diagnostic odds-ratio of 36.8. Regression analysis revealed the two strongest independent radiological predictors for IPA to be the VOS and the halo sign. The VOS is highly suggestive for IPA in immunocompromised patients in general. Thus, contrast-enhanced CTPA superior over non-contrast_enhanced chest-CT in patients with suspected IPA.

Published in Scientific Reports

ISSN: 2045-2322 (Online)
Publisher: Nature Portfolio
Country of publisher: United Kingdom
LCC subjects: Medicine; Science
Website: https://www.nature.com/srep/

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