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

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.

Challenges and Solution of Invasive Aspergillosis in Non-neutropenic Patients: A Review

“…High-resolution CT pulmonary angiography (CTPA) can detect angio-invasion and vessel occlusion signs (VOS). VOS has been shown to be superior to classic CT signs observed in non-contrast enhanced studies to diagnose invasive pulmonary aspergillosis in immunocompromised patients, including those with hematologic malignancies and other causes, with a sensitivity of 0.94, specificity of 0.71 and a diagnostic odds-ratio of 36.8 [ 54 ].…”

Invasive mould infections in solid organ transplant patients: modifiers and indicators of disease and treatment response

“…In patients with haematological malignancies, computed tomography pulmonary angiography (CTPA) has been shown to detect vessel occlusion sign (VOS) [35,36], which provides direct evidence of an angioinvasive process. Recently, Henzler et al [37] suggested that CTPA may also be a very sensitive and specific radiological test for SOT recipients, as VOS in non-neutropenic patients was the strongest radiological predictor of IA.…”

Invasive aspergillosis in children in debut of acute myeloid leukemia

“…Один из основных методов диагностики -КТ органов грудной клетки, специфичные проявления при этом -симптом «серпа» (2,2%), симптом «матового стекла» (11%) и формирование полостей (24,5%) [34]. По данным нашего регистра, наиболее частыми КТ-признаками были симптом «матового стекла» наряду с инфильтративными изменениями -37,5% и симптом «серпа» -12,5%.…”

“…Известно, что симптом «серпа» не характерен для пациентов с нейтропенией, но может появляться в периоде восстановления лейкопоэза [15]. Дополнительным методом диагностики служит КТ-ангиография, которая позволяет диагностировать признаки сосудистой инвазии и окклюзии; чувствительность и специфичность этого метода -0,94 и 0,71 соответственно [34]. Использование позитронно-эмиссионной томографии с 18F-фтордезоксиглюкозой не позволяет в полной мере дифференцировать ИА легких от других воспалительных очагов или метастатического поражения [35].…”