CT findings of cases diagnosed with pulmonary fungal disease in non-immunosuppressed patients

Abstract

Objective To investigate the CT findings of three types of pulmonary fungal disease in non-immunosuppressed patients. Methods We retrospectively collected 109 cases diagnosed with pulmonary fungal disease with pathological evidence which between January 2011 and October 2015 in the First Affiliated Hospital of Zhengzhou University, among which pulmonary aspergillosis were 48 cases, pulmonary cryptococcosis 45 cases and pulmonary mucormycosis 16 cases. Each patient underwent a chest MSCT scan. The data were analyzed that including underlying diseases, lesion types, lesion size, number, accompanying signs of CT scan, etc. χ2 test or Fisher exact test were used when compared underlying disease, lesion types, various of CT signs etc between different types of pulmonary fungal disease. Kruskal-Wallis H test were used when compared the incidence rate of lesions numbers and diameter. The ROC curve was used to analyze probability of predicting the fungal types by combined signs. Results The incidence of pulmonary mucormycosis with diabetes was higher than pulmonary aspergillosis and pulmonary cryptococcosis(χ2=2.704, 17.509, P<0.017) .The incidence of pulmonary mucormycosis with no underlying disease was lower than pulmonary aspergillosis and pulmonary cryptococcosis(Fisher test, P<0.017). Nodular or mass were main CT findings in the three pulmonary fungal disease. Consolidation, ground glass opacity and other manifestations were rare. Nodular or mass lesions in pulmonary aspergillosis accompany with CT signs like tree-in-bud, bronchogram sign, cavities, the air crescent sign, halo sign, the reversed-halo sign were rspectively 18, 10, 19, 10, 23, 0 cases; To pulmonary cryptococcosis were 4, 14, 6, 0, 11, 0 cases. To pulmonary mucormycosis were 2, 0, 4, 0, 4, 6 cases. Lesion number's distribution had a statistically difference between pulmonary aspergillosis and pulmonary cryptococcosis in nodular or mass lesions (P< 0.05). Lesions size's distribution had statistically differences respectively between pulmonary mucormycosis and pulmonary aspergillosis, pulmonary cryptococcosis (P<0.05). Nodular lesions of pulmonary aspergillosis had higher incidence of tree-in-bud, cavity and air-crescent compared to pulmonary cryptococcosis (χ2= 9.972, 21.841, 8.047, P<0.017). Reversed halo sign was mostly seen in pulmonary mucormycosis than in pulmonary aspergillosis and pulmonary cryptococcosis (Continuous correction χ2=23.936, 21.374, P<0.017). The area under the ROC curve for the combined signs predictive fungal disease type was 0.819. Conclusions Nodules or masses are the most common image findings in pulmonary aspergillosis, pulmonary cryptococcosis and pulmonary mucormycosis. The distribution of size and numbers and CT accompanied signs have a higher diagnostic efficacy in diagnosing and distinguishing pulmonary fungal disease. Key words: Lung disease, fungal; Tomography, X-ray computed