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

C. Henzler; T. Henzler; D. Buchheidt; John W. Nance; C. A. Weis; R. Vogelmann; U. Benck; T. Viergutz; T. Becher; T. Boch; S. A. Klein; D. Heidenreich; L. Pilz; M. Meyer; P. M. Deckert; W. K. Hofmann; S. O. Schoenberg; M. Reinwald

doi:10.1038/s41598-017-04470-6

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

C. Henzler, T. Henzler, D. Buchheidt, John W. Nance, C. A. Weis, R. Vogelmann, U. Benck, T. Viergutz, T. Becher, T. Boch, S. A. Klein, D. Heidenreich, L. Pilz, M. Meyer, P. M. Deckert, W. K. Hofmann, S. O. Schoenberg, M. Reinwald

Houston Methodist

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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.

Original language	English (US)
Article number	4483
Journal	Scientific Reports
Volume	7
Issue number	1
DOIs	https://doi.org/10.1038/s41598-017-04470-6
State	Published - Dec 1 2017

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Henzler, C., Henzler, T., Buchheidt, D., Nance, J. W., Weis, C. A., Vogelmann, R., Benck, U., Viergutz, T., Becher, T., Boch, T., Klein, S. A., Heidenreich, D., Pilz, L., Meyer, M., Deckert, P. M., Hofmann, W. K., Schoenberg, S. O., & Reinwald, M. (2017). Diagnostic Performance of Contrast Enhanced Pulmonary Computed Tomography Angiography for the Detection of Angioinvasive Pulmonary Aspergillosis in Immunocompromised Patients. Scientific Reports, 7(1), Article 4483. https://doi.org/10.1038/s41598-017-04470-6

Henzler, C, Henzler, T, Buchheidt, D, Nance, JW, Weis, CA, Vogelmann, R, Benck, U, Viergutz, T, Becher, T, Boch, T, Klein, SA, Heidenreich, D, Pilz, L, Meyer, M, Deckert, PM, Hofmann, WK, Schoenberg, SO & Reinwald, M 2017, 'Diagnostic Performance of Contrast Enhanced Pulmonary Computed Tomography Angiography for the Detection of Angioinvasive Pulmonary Aspergillosis in Immunocompromised Patients', Scientific Reports, vol. 7, no. 1, 4483. https://doi.org/10.1038/s41598-017-04470-6

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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.",

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AU - Henzler, T.

AU - Buchheidt, D.

AU - Nance, John W.

AU - Weis, C. A.

AU - Vogelmann, R.

AU - Benck, U.

AU - Viergutz, T.

AU - Becher, T.

AU - Boch, T.

AU - Klein, S. A.

AU - Heidenreich, D.

AU - Pilz, L.

AU - Meyer, M.

AU - Deckert, P. M.

AU - Hofmann, W. K.

AU - Schoenberg, S. O.

AU - Reinwald, M.

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N2 - 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.

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

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