Imaging and enhancement characteristics of coccidioidomycosis nodules assessed by dynamic contrast-enhanced computed tomography

Abstract

ObjectiveTo describe the dynamic contrast-enhanced CT (DCECT) appearance of pulmonary nodules related to infection with coccidioidomycosis. MethodsRetrospective review of a database of DCECTs identified a subset of patients with pulmonary nodules related to coccidioidomycosis. General and DCECT imaging characteristics of these nodules were evaluated. Results16 of the 44 nodules identified (36.4%) showed enhancement on DCECT imaging. The majority (74.9%) of enhancing nodules demonstrate delayed (3 or 4 min) peak enhancement. The majority (88.6%) of the 44 nodules were either smooth or lobulated in appearance. Only 1 (2.3%) of the nodules was cavitary. 19 (43.2%) of the nodules had adjacent satellite nodules. DCECT can be a useful study to help characterize pulmonary nodules in areas with endemic Coccidioides with an expected false-positive rate of ∼30–40%. Biopsy could potentially be averted in 60–70% of nodules by evaluating with DCECT prior to tissue sampling. ConclusionWhen combined with morphological, serological, clinical, and historical information DCECT can be a powerful tool for reducing the number of benign nodules being biopsied and/or resected.