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

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

doi:10.1038/s41598-017-04470-6

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.

Highlights

Invasive pulmonary aspergillosis (IPA) is a severe, life-threatening complication in immunocompromised patients, contributing significantly to morbidity and mortality[1]
Sonnet et al have shown that CT pulmonary angiography (CTPA) may increase the diagnostic potential in this situation: In a trial encompassing 12 proven/probable invasive mould disease (IMD) patients, the authors demonstrated that IPA patients had CTPA findings consistent with interruption of arterial vessels[7]
Our study demonstrates that vessel occlusion sign (VOS) as observed on CTPA examinations is superior to classic CT signs observed in non-contrast enhanced studies to diagnose invasive pulmonary aspergillosis in immunocompromised patients

Summary

Introduction

Invasive pulmonary aspergillosis (IPA) is a severe, life-threatening complication in immunocompromised patients, contributing significantly to morbidity and mortality[1]. Sonnet et al have shown that CT pulmonary angiography (CTPA) may increase the diagnostic potential in this situation: In a trial encompassing 12 proven/probable invasive mould disease (IMD) patients, the authors demonstrated that IPA patients had CTPA findings consistent with interruption of arterial vessels[7]. This so called “vessel occlusion sign” (VOS) reflects the angioinvasive growth pattern of Aspergillus spp. and Mucor spp. that can be observed in vivo. The current study evaluates the accuracy of CTPA in diagnosing IPA in a broader cohort of immunocompromised patients, including both those with hematologic malignancies and other causes

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Conclusion