High resolution computed tomography angiography improves the radiographic diagnosis of invasive mold disease in patients with hematological malignancies

Marta Stanzani, Claudia Sassi, Russell E. Lewis, Giulia Tolomelli, Alberto Bazzocchi, Michele Cavo, Nicola Vianelli, Giuseppe Battista

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Computed tomography pulmonary angiography (CTPA) may improve the diagnostic capabilities of CT imaging for invasive mold disease, but its performance relative to other signs (ie, halo sign, hypodense sign, pleural effusion, reversed halo sign) is unknown. Methods: We prospectively compared the diagnostic performance of CTPAvs other CT imaging findings in 100 patients with hematological malignancies and possible invasive mold disease defined by EORTC/MSG criteria. After undergoing extensive diagnostic work-up, patients were upgraded to probable or proven mold disease based on galactomannan antigen, culture or histology; or remained as possible mold disease if an alternative diagnosis could not be established. Results: In total, 46 /100 patients who underwent CTPA were upgraded to probable or proven mold disease. Excluding 8 CTPA cases that were nonevaluable by the radiologist, a positive occlusion sign identified by CTPAwas 100% sensitive for the diagnosis of probable or proven mold disease (41/41). Among patients who could not be upgraded from the possible mold disease category (n = 51), 25 (49%) had evidence of vessel occlusion by CTPA with only one positive patient eventually reaching an alternative diagnosis (Staphylococcus aureus septic thrombosis). Intravenous and/or oral antifungal therapy was stopped earlier in patients with a negative vs positive CTPA results (P ≤ .001). Conclusions: Vessel occlusion detected by CTPA is amore sensitive and possibly more specific radiographic sign vs other common CT findings of invasive mold disease in patients with hematological malignancies.

Original languageEnglish
Pages (from-to)1603-1610
Number of pages8
JournalClinical Infectious Diseases
Volume60
Issue number11
DOIs
Publication statusPublished - Jun 1 2015

Keywords

  • aspergillosis
  • computed tomography
  • diagnosis

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)
  • Medicine(all)

Fingerprint Dive into the research topics of 'High resolution computed tomography angiography improves the radiographic diagnosis of invasive mold disease in patients with hematological malignancies'. Together they form a unique fingerprint.

Cite this