Performance of magnetic resonance imaging in pulmonary fungal disease compared to high‐resolution computed tomography

Abstract

To evaluate the performance of magnetic resonance imaging (MRI) compared to computed tomography (CT) in patients diagnosed with pulmonary mycosis. We prospectively included 21 patients diagnosed with pulmonary mycosis between January 2013 and October 2014. Inclusion criteria were presence of respiratory symptoms, histopathological diagnosis of mycosis and absence of mycosis treatment. Reviewers identified one predominant imaging pattern per patient: nodular, reticular or airspace pattern. Afterwards, all CT findings were analysed separately per lobe and compared to MRI. Nodular pattern was the most common found (CT: 76.20%; MRI: 80.96%), followed by airspace pattern (CT and MRI: 9.52%) and reticular (CT: 9.52%; MRI: 4.76%). Compared to CT, MRI performance varied according to radiological finding and pulmonary region. For nodules, MRI presented high sensitivity (100% [95% CI: 93.52-100]) and specificity (100% [95% CI: 92.00-100]). For bronchiectasis and septal thickening, there were poorer positive predictive values (33.33% [95% CI: 1.77-87.47]; and 83.33% [95% CI: 50.88-97.06] respectively). As specificity and negative predictive value had superior results than sensitivity and positive predictive value, rather than for diagnosis of this condition, MRI might be more considered for the follow-up of patients with pulmonary mycosis, an alternative to multiple radiation exposures with CT follow-up.

ACR Appropriateness Criteria® Acute Respiratory Illness in Immunocompromised Patients

“…CT is preferable to MRI in immunocompromised patients with ARI who have normal, equivocal, or nonspecific chest radiographs. CT remains superior to MRI in the detection and characterization of pulmonary parenchymal infection [9,10]. However, MRI can be considered as an alternative imaging modality, albeit less sensitive.…”

Endemic pulmonary fungal diseases in immunocompetent patients: an emphasis on thoracic imaging

“…DWI is a non-invasive MRI technique that is capable of probing the structure of biological tissues at a molecular level and provide information about tumor cellularity and cell membrane integrity. Recent studies have demonstrated the potential of this modality to differentiate malignant from benign pulmonary tissues.MRI is now considered to be an alternative radiation-free method for the evaluation of lung parenchymal diseases and is particularly helpful in children, pregnant women, and young patients requiring multiple follow-up studies [4,[85][86][87].…”

“…Lung mycoses are usually self-limited, but some patients develop acute or chronic infection. A high index of suspicion may be required to diagnose fungal infections, particularly for patients who do not reside in endemic areas [3,4].…”

“…There is limited literature in this regard and further studies are warranted [8][9][10][11]. Magnetic resonance imaging (MRI) might be more considered for the follow-up of patients with pulmonary mycosis, with the great advantage of non-use of ionizing radiation [4]. CT is the gold standard imaging method for the diagnosis and follow-up of lung mycosis [12].…”

A systematic review and meta-analysis: pulmonary mycosis pathogen distribution

“…Patients usually present with fever, cough, hemoptysis, chest tightness, and difficulty breathing. The imaging of fungi is not specific; however, the halo sign and air crescent sign have certain guiding significance in the diagnosis of pulmonary mycosis (8,9). Fungi can destroy host tissue cells and multiply rapidly in bronchial cavities and lung cavities, causing damage to human tissues.…”