Computed Tomographic Pulmonary Angiography for Diagnosis of Invasive Mold Diseases in Patients With Hematological Malignancies

Stanzani, Marta; Battista, Giuseppe; Sassi, Claudia; Lewis, Russell E.; Tolomelli, Giulia; Clissa, Cristina; Femia, R.; Bazzocchi, Alberto; Tumietto, Fabio; Viale, Pierluigi; Ambretti, Simone; Baccarani, Michele; Vianelli, Nicola

doi:10.1093/cid/cir861

Cited by 56 publications

(34 citation statements)

References 27 publications

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“…A recent study suggests a role for CT pulmonary angiography in the diagnosis of pulmonary mold infections, exploiting the fact that such infections are angioinvasive. 54 …”

Section: How Do I Make the Diagnosis? Can Imaging Distinguish Variousmentioning

confidence: 99%

How I manage pulmonary nodular lesions and nodular infiltrates in patients with hematologic malignancies or undergoing hematopoietic cell transplantation

Wingard

Hiemenz

Jantz

2012

Blood

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Pulmonary nodules and nodular infiltrates occur frequently during treatment of hematologic malignancies and after hematopoietic cell transplantation. In patients not receiving active immunosuppressive therapy, the most likely culprits are primary lung cancer, chronic infectious or inactive granulomata, or even the underlying hematologic disease itself (especially in patients with lymphoma). In patients receiving active therapy or who are otherwise highly immunosuppressed, there is a wider spectrum of etiologies with infection being most likely, especially by bacteria and fungi. Characterization of the pulmonary lesion by highresolution CT imaging is a crucial first diagnostic step. Other noninvasive tests can often be useful, but invasive testing by bronchoscopic evaluation or acquisition of tissue by one of several biopsy techniques should be performed for those at risk for malignancy or invasive infection unless contraindicated. The choice of the optimal biopsy technique should be individualized, guided by location of the lesion, suspected etiology, skill and experience of the diagnostic team, procedural risk of complications, and patient status. Although presumptive therapy targeting the most likely etiology is justified in patients suspected of serious infection while evaluation proceeds, a structured evaluation to determine the specific etiology is recommended. Interdisciplinary teamwork is highly desirable to optimize diagnosis and therapy. (Blood. 2012;120(9):1791-1800)

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“…A recent study suggests a role for CT pulmonary angiography in the diagnosis of pulmonary mold infections, exploiting the fact that such infections are angioinvasive. 54 …”

Section: How Do I Make the Diagnosis? Can Imaging Distinguish Variousmentioning

confidence: 99%

How I manage pulmonary nodular lesions and nodular infiltrates in patients with hematologic malignancies or undergoing hematopoietic cell transplantation

Wingard

Hiemenz

Jantz

2012

Blood

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“…42 In addition, a recent study showed that computed tomographic pulmonary angiography is a promising tool for detecting vessel interruption in cases of angioinvasion associated with IMIs. 43 Finally, our data challenge the notion, derived mainly from studies of monomicrobial infections in murine models, 44, 45 on whether single-pathogen molecular “signatures” or serum cytokine profile 46 would be diagnostically useful in real life, at least in heavily immunocompromised patients with hematological malignancies.…”

Section: Discussionmentioning

confidence: 68%

Concurrent lung infections in patients with hematological malignancies and invasive pulmonary aspergillosis: How firm is the Aspergillus diagnosis?

Georgiadou

Kontoyiannis

2012

Journal of Infection

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Summary Background Immunocompromised patients with hematological malignancies and/or recipients of hematopoietic stem cell transplants are constantly exposed to several fungal, bacterial, and viral respiratory pathogens. Methods We retrospectively evaluated all patients with invasive pulmonary aspergillosis (IPA) and underlying hematological malignancies for the presence of concurrent, microbiologically documented pulmonary infections during a 5-year period (2005–2010). Results We found 126 such patients that frequently had coinfections (49%) with respiratory pathogens other than Aspergillus species, with a higher rate in patients with probable IPA (53%) than in those with proven IPA (29%; P = .038). Conclusions As the majority of patients with IPA in daily practice have probable IPA, often according to only the combination of positivity for serological biomarkers and radiological findings, our data may raise skepticism about both the certainty of IPA diagnosis and the evaluation of response to antifungals in a subset of these patients.

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“…who initially proposed the use of CTPA in immunocompromised patients with hematologic disorders and suspected IPA 22 .…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the diagnostic performance of VOS in our study might have been (negatively) impacted. Finally, as an inherent limitation of CTPA it should be mentioned that small lesions with a diameter ≤ 10 mm are not adequately evaluable for the presence of the VOS 22 .…”

Section: Discussionmentioning

confidence: 99%

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

Henzler

Buchheidt

et al. 2017

Sci Rep

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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.

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Computed Tomographic Pulmonary Angiography for Diagnosis of Invasive Mold Diseases in Patients With Hematological Malignancies

Abstract: We conclude that CTPA appears to be a promising tool to exclude the diagnosis of IMD in high-risk patients without specific findings on HRCT scans, and it is most useful in the presence of well-circumscribed lesions in which there is suspicion for IMD.

Cited by 56 publications

References 27 publications

How I manage pulmonary nodular lesions and nodular infiltrates in patients with hematologic malignancies or undergoing hematopoietic cell transplantation

How I manage pulmonary nodular lesions and nodular infiltrates in patients with hematologic malignancies or undergoing hematopoietic cell transplantation

Concurrent lung infections in patients with hematological malignancies and invasive pulmonary aspergillosis: How firm is the Aspergillus diagnosis?

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

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