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BackgroundAn algorithm for distinguishing invasive pulmonary aspergillosis (IPA) in critically ill patients (AspICU) has been proposed but not tested.MethodsThis was a prospective observational study applying the AspICU protocol to patients with positive Aspergillus culture (PAC group) and those with negative aspergillus culture but positive galactomannan test in respiratory tract samples (only positive galactomannan (OPG group)). Patients underwent a standardized diagnostic workup with bronchoscopy, computed tomography (CT), and galactomannan determination in serum and bronchoalveolar lavage fluid (BALF).ResultsWe included 85 patients in the study. Of these, 43 had positive aspergillus cultures and 42 patients had only a positive galactomannan test. There were no statistically significant differences in baseline characteristics, underlying conditions or ICU scores between the two groups. The galactomannan titre in BALF was significantly higher in the positive aspergillus culture (PAC) group (enzyme immunoassay (EIA) 5.9, IQR 3.2–5.7) than in the OPG group (EIA 1.7, IQR 0.9–4.5) (p < 0.001). Classic features of IPA were detected on CT in 37.5 % and 36.6 % of patients in the PAC and OPG groups, respectively. There were no statistically significant differences between the PAC and the OPG group in relation to AspICU or European Organization for the Research and Treatment of Cancer (EORTC) criteria. A positive aspergillus culture was a stronger trigger for initiating antimycotic treatment than positive BALF galactomannan: 88.4 % of patients in the PAC group were regarded by clinicians as having IPA and received antimycotic treatment as opposed to 59.5 % in the OPG group (p = 0.002). The 180-day mortality was 58.1 % in the PAC group and 59.5 % in the OPG group.ConclusionsThe inclusion of BALF galactomannan as an additional entry criterion for the AspICU clinical algorithm could increase the diagnostic sensitivity for IPA in ICU patients.Trial registrationThe study was registered at ClinicalTrials.gov (registration number NCT01866020) on 27 May 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1326-1) contains supplementary material, which is available to authorized users.

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Cite this article as: Behzadi C, Welsch GH, Laqmani A, Henes FO, Kaul MG, Schoen G, et al. The immediate effect of long-distance running on T 2 and T 2 * relaxation times of articular cartilage of the knee in young healthy adults at 3.0 T MR imaging. Br J Radiol 2016; 89: 20151075. FULL PAPERThe immediate effect of long-distance running on T 2 and T 2 * relaxation times of articular cartilage of the knee in young healthy adults at 3. Objective: To quantitatively assess the immediate effect of long-distance running on T 2 and T 2 * relaxation times of the articular cartilage of the knee at 3.0 T in young healthy adults. Methods: 30 healthy male adults (18-31 years) who perform sports at an amateur level underwent an initial MRI at 3.0 T with T 2 weighted [16 echo times (TEs): 9.7-154.6 ms] and T 2 * weighted (24 TEs: 4.6-53.6 ms) relaxation measurements. Thereafter, all participants performed a 45-min run. After the run, all individuals were immediately re-examined. Data sets were post-processed using dedicated software (ImageJ; National Institute of Health, Bethesda, MD). 22 regions of interest were manually drawn in segmented areas of the femoral, tibial and patellar cartilage. For statistical evaluation, Pearson product-moment correlation coefficients and confidence intervals were computed. Results:Mean initial values were 35.7 ms for T 2 and 25.1 ms for T 2 *. After the run, a significant decrease in the mean T 2 and T 2 * relaxation times was observed for all segments in all participants. A mean decrease of relaxation time was observed for T 2 with 4.6 ms (63.6 ms) and for T 2 * with 3.6ms (65.1 ms) after running. Conclusion: A significant decrease could be observed in all cartilage segments for both biomarkers. Both quantitative techniques, T 2 and T 2 *, seem to be valuable parameters in the evaluation of immediate changes in the cartilage ultrastructure after running. Advances in knowledge: This is the first direct comparison of immediate changes in T 2 and T 2 * relaxation times after running in healthy adults.