Imaging Features of Chest CT and Prognosis of Proven Pulmonary Invasive Fungal Disease After Hematopoietic Stem Cell Transplantation / 中国医学影像学杂志

ABSTRACT

Purpose To assess the initial and follow-up CT findings of proven pulmonary invasive fungal disease (IFD) in patients after hematopoietic stem cell transplantation (HSCT), and to look for the signs for the prognosis. Materials and Methods A retrospective investigation of the CT features and the evolution process was carried out in 13 patients with proven pulmonary IFD diagnosed by histological examination. Results The first abnormal CT finding showed single nodule or mass in 5 cases, two nodules or masses in 2 cases, multiple nodules or masses in 2 cases, patchy consolidation in 1 case, patchy ground glass opacity (GGO) in 1 case, multiple stripes and GGOs in 1 case, and multiple consolidations in peribronchial distribution in 1 case; the presence of reversed halo sign (RHS) was found in 7 cases, not including 4 cases with aspergillosis. The median initial diameter was 32.0 mm, and the median maximum diameter was 51.5 mm. 9 of them reached partial remission after drug treatment, and 9 accepted operation resection. In the end, there were 5 cases cured, 1 keeping stable, 2 suspected recurrent on imaging, and 5 dead. In summary, it showed less than 2 nodules or masses in 7 patients (group 1) and other imaging patterns in 6 patients (group 2), the former group had smaller max diameter (t=4.397, P<0.01), the effective rate within 12 weeks, operation resection rate and final cure rate of group 1 were 85.7%, 100.0% and 71.4%, and those of group 2 were 16.7%, 33.3% and 0, respectively, with group 1 all higher than group 2 (P<0.05). Conclusion Nodule or mass is the most common CT finding of pulmonary IFD in HSCT recipients, with high incidence of reversed halo sign, less than 2 nodules or masses on the first CT imaging may be associated with better prognosis.