High-resolution computed tomographic findings of Aspergillus infection in lung transplant patients

Objective

The aim of this study was to assess high-resolution computed tomographic (HRCT) findings at presentation in lung transplant patients diagnosed with pulmonary Aspergillus infection.

Materials and methods

We retrospectively reviewed HRCT findings from 23 patients diagnosed with pulmonary aspergillosis. Imaging studies were performed 2–5 days after the onset of symptoms. The patient sample comprised 12 men and 11 women aged 22–59 years (mean age, 43.6 years). All patients had dyspnea, tachypnea, and cough. Diagnoses were established with Platelia Aspergillus enzyme immunoassays for galactomannan antigen detection in bronchoalveolar lavage and recovery of symptoms, and HRCT findings after voriconazole treatment. The HRCT scans were reviewed independently by two observers who reached a consensus decision.

Results

The main HRCT pattern, found in 65% (n = 15) of patients, was centrilobular tree-in-bud nodules associated with bronchial thickening. This pattern was described in association with areas of consolidation and ground-glass opacities in 13% (n = 3) of patients. Consolidation and ground-glass opacities were the main pattern in 22% (n = 5) of patients. The pattern of large nodules with and without the halo sign was observed in 13% (n = 3) of patients, and were associated with consolidation and ground-glass opacities in one case.

Conclusion

The predominant HRCT findings in lung transplant patients with pulmonary aspergillosis were bilateral bronchial wall thickening and centrilobular opacities with the tree-in-bud pattern. Ground-glass opacities and/or bilateral areas of consolidation were also common findings. Pulmonary nodules with the halo sign were found in only 13% of patients.     

免疫力低下肺部侵袭性曲霉菌感染的早期及进展期CT征象回归分析

目的探讨免疫力低下患者肺部侵袭性曲霉菌感染的早期及进展期的CT征象。资料与方法分析符合免疫力低下继发肺部感染的72例患者的CT资料,其中32例为肺部侵袭性曲霉菌感染,40例为肺部常规细菌感染。将曲霉菌感染者作为研究组,常规细菌感染者作为对照组,对相应CT征象分析采用二分类Logistic回归分析,逐步筛选出对诊断免疫力低下肺部侵袭性霉菌感染的早期及进展期有统计学意义的CT征象。结果肺部侵袭性曲霉菌感染的早期及进展期表现一般出现两种或两种以上的CT征象。最多见者为晕征+枝果征,占73.4%,其次为肺段性楔形实变+晕征+枝果征,占64.6%,再次为毛玻璃征+晕征+枝果征,占58.3%。对诊断早期及进展期肺部侵袭性曲霉菌感染有显著性影响的CT表现依次为晕征、枝果征、病灶数目多发及空气新月征。结论免疫力低下肺部侵袭性曲霉菌感染早期及进展期的CT表现具有一定的特异性,对临床治疗及预后具有重要指导意义。     

High-resolution computed tomography (HRCT) of lung infections in non-AIDS immunocompromised patients

Non-AIDS immunocompromised patients are susceptible to infections by a wide range of organisms. In the past several decades, advances in the treatment of cancer, organ transplantation, and immunosuppressive therapy have resulted in large numbers of patients who develop abnormalities in their immune system. Moreover, mildly impaired host immunity as it occurs in chronic debilitating illness, diabetes mellitus, malnutrition, alcoholism, advanced age, prolonged corticosteroid administration, and chronic obstructive lung disease have also been regarded as predisposing factors of pulmonary infections. Imaging plays a crucial role in the detection and management of patients with pulmonary infectious diseases. When pulmonary infection is suspected, knowledge of the varied radiographic manifestations will narrow the differential diagnosis, helping to direct additional diagnostic measures and serving as an ideal tool for follow-up examinations. Combination of pattern recognition with knowledge of the clinical setting is the best approach to pulmonary infection occurring in the immunocompromised patients.     

免疫健全和免疫抑制患者肺隐球菌病的CT表现

目的探讨不同免疫状态患者肺隐球菌病(pulmonary cryptococcosis,PC)的临床及CT表现,旨在提高对该病的认识和诊断水平。方法搜集经病理或细菌学证实的46例PC患者的临床及CT资料,分别对免疫健全和免疫抑制患者的CT征象进行分析。结果免疫健全患者临床症状较轻而CT表现较明显,CT像上以结节/肿块、实变影多见;免疫抑制患者临床症状与CT表现一致,CT像上以片状浸润/渗出影、空洞多见。结论 PC的CT表现多样化,病变多见于两下肺;其影像学表现与患者免疫状态有关,免疫健全患者以结节/肿块型为主。CT对PC的诊断有一定价值。     

造血干细胞移植术后肺部并发症的CT表现

造血干细胞移植术后不同肺部并发症具有不同的时间分布特点。早期（术后30d内）多见感染性病变和非感染性病变,以肺水肿、弥漫性肺泡出血以及特发性肺炎综合征为主。中期（术后30~100d）感染性病变多为巨细胞病毒、侵袭性真菌感染,非感染性病变以特发性肺炎综合征、急性移植物抗宿主病、急性放射性肺炎以及肺细胞溶解性血栓为主。后期（术后100d以后）多以非感染性病变为主,慢性移植物抗宿主病最常见。综述早期、中期、晚期不同胸部并发症的CT表现。     

"Crazy-Paving" Patterns on High-Resolution CT Scans in Patients with Pulmonary Complications after Hematopoietic Stem Cell Transplantation

Objective

To describe the pulmonary complications following hematopoietic stem cell transplantation (HSCT) that can present with a "crazy-paving" pattern in high-resolution CT scans.

Materials and Methods

Retrospective review of medical records from 2,537 patients who underwent HSCT. The "crazy-paving" pattern consists of interlobular and intralobular septal thickening superimposed on an area of ground-glass attenuation on high-resolution CT scans. The CT scans were retrospectively reviewed by two radiologists, who reached final decisions by consensus.

Results

We identified 10 cases (2.02%), seven male and three female, with pulmonary complications following HSCT that presented with the "crazy-paving" pattern. Seven (70%) patients had infectious pneumonia (adenovirus, herpes simplex, influenza virus, cytomegalovirus, respiratory syncytial virus, and toxoplasmosis), and three patients presented with non-infectious complications (idiopathic pneumonia syndrome and acute pulmonary edema). The "crazy-paving" pattern was bilateral in all cases, with diffuse distribution in nine patients (90%), predominantly in the middle and inferior lung regions in seven patients (70%), and involving the anterior and posterior regions of the lungs in nine patients (90%).

Conclusion

The "crazy-paving" pattern is rare in HSCT recipients with pulmonary complications and is associated with infectious complications more commonly than non-infectious conditions.     

白血病造血干细胞移植后肺部毛霉菌病CT特征表现

目的 总结白血病造血干细胞移植(HSCT)后肺部毛霉菌病CT特征表现,为指导临床治疗提供及时、准确、有效的帮助.方法 回顾性总结和分析9例白血病HSCT治疗后经手术、穿刺活检及痰培养证实的肺部毛霉菌感染CT特征表现,对其分布、形态、征象等进行分析,总结其肺部CT表现特征.所有患者均行MSCT平扫.结果 7例肺部见“反晕征”;团状磨玻璃影5例;3例见双肺内多发斑片状、结节状磨玻璃样高密度影;1例双肺多发小空洞影,其周围见长毛刺;胸腔积液2例;纵隔积气1例.部分患者存在2种或2种以上征象.本组7例患者CT出现“反晕征”时间与移植间期为0.5～19个月,中位数10个月,其中6例(85.7％,6/7)出现在18个月以内.本组8例患者以咳嗽、咳黄(白)色黏痰为主要临床症状,占88.9％(8/9);其中4例痰中带有血丝或伴有咯血,占50％(4/8);3例伴有左侧胸痛,占37.5％(3/8);1例无明显咳嗽、咳痰症状.本组6例患者体温明显升高,占66.7％(6/9),在38.4℃～39.6℃之间,中位数39.0℃;3例体温正常,占33.3％(3/9).本组患者白细胞计数在0.16～3.31×109/L之间,中位数0.7×109/L;中性粒细胞计数在0～2.46×109/L之间,中位数0.09×109/L.本组7例(77.8％,7/9)存在“反晕征”患者中性粒细胞计数在0～1.63×109/L之间,中位数0.09×109/L.结论 白血病HSCT后肺部毛霉菌病影像学表现呈多样性,当白血病HSCT后处于粒细胞缺乏期时,且肺部感染中出现特征性征象“反晕征”时,则高度提示肺毛霉菌感染.     

免疫抑制状态下并发肝脏真菌感染的CT表现

目的:探讨免疫抑制状态下肝脏真菌感染的临床和CT表现及CT诊断价值。方法:9例经临床和/或病理证实的免疫抑制状态下肝脏真菌感染的患者,采用16层CT机行平扫及3期增强扫描。9例患者经抗真菌治疗1～3个月后复查,肝、脾病灶体积缩小,病灶数量减少或完全消失。结果:9例中7例CT表现为肝内多发类圆形低密度影,2例肝内弥漫分布小结节状低密度影,直径0.4～4.8cm,部分病灶边界清楚,增强扫描后病灶无强化或呈轻度～中度环形强化;其中2例可见脾内多发低密度影,强化方式与肝内病灶相同。结论:CT检查能很好显示肝真菌感染,并能对抗真菌治疗后疗效进行评价。     

造血干细胞移植术后肺部非感染性并发症的CT分析

目的:探讨造血干细胞移植术(HSCT)后肺部非感染性并发症的CT诊断价值。方法:回顾性分析7例HSCT后伴肺部非感染性并发症患者的临床、实验室以及肺部CT检查及治疗后复查资料。结果:7例中CT显示柱状支气管扩张3例,弥漫性马赛克样磨玻璃影2例,条状或分叉状影2例,小叶中心结节融合片状影2例,肺气肿2例,不规则实变1例,气胸1例,双侧胸腔积液1例。3例支气管扩张均合并肺气肿或气胸。弥漫马赛克样磨玻璃病变2例于抗免疫治疗后短期内好转,其中1例合并肺部不规则实变。结论:HSCT术后肺部非感染性并发症常见且致命.其CT表现具有一定特点,短期内复查CT并结合临床往往可做出准确诊断。     

低剂量全身照射在非清髓性干细胞移植中的临床研究

目的 观察非清髓性低剂量全身照射的临床效果和急性毒副作用。方法 2006年1月至2008年1月对27例异基因造血干细胞移植患者采用含有全身照射的非清髓预处理方案:全身照射(TBI)2 Gy,一次完成;受者原发病不同,受者机体状态、年龄、脏器功能以及供受者HAL相合情况等不同,使用的化疗方案也有不同,包括氟达拉宾、环磷酰胺、阿糖胞苷、马法兰等。预防移植物抗宿主病(GVHD)采用:环孢霉素、霉酚酸酯。结果 造血重建情况: 27例均于移植后第4~8天外周血WBC降至(0.05~0.9)×10⁹/L。中性粒细胞计数>0.5×10⁹/L为8~22 d(中位数为10.5 d),血小板计数>30×10⁹/L为11~28 d(中位数为14.5 d)。1、2年生存率为85.2%(23/27)、77.8%(21/27)。发热率65%,10例发生感染。无出血性膀胱炎和肝静脉闭塞症等并发症。急性GVHD 4例(15%), 慢性GVHD 5例(19%)。随访3~22个月21例(77.8%)仍存活。结论 采用低剂量全身照射的非清髓性造血干细胞移植预处理方案简便安全,并发症少,适应证广;全身照射总剂量2 Gy,1次完成的方案是安全有效的,可以达到免疫抑制效果。     

儿童重症腺病毒肺炎临床影像表现分析

目的 探讨儿童重症腺病毒肺炎的影像与临床表现.方法回顾性分析3例儿童重症腺病毒肺炎的临床与影像学表现.3例均进行了胸部X线及CT检查.结果 X线和CT显示左肺下叶、左肺上叶尖后段亚段实变各1例,其内均见支气管气像,伴体积缩小1例.两肺间质性改变1例.伴胸腔少量积液1例,心影增大3例.3例均咳嗽、发热(T 38.4℃～40.3℃),听诊:呼吸音均减低,均可闻及小水泡音.实验室检查:谷草转氨酶、乳酸脱氢酶、羟丁酸脱氢酶、肌酸激酶均升高,血腺病毒检查均阳性.结论 儿童肺炎如表现为两肺单一或多发节段性实变影,伴肝脏、心肌损害表现,应高度怀疑为儿童重症腺病毒肺炎.     

Gastrointestinal complications following hematopoietic stem cell transplantation in children

Gastrointestinal system involvement is one of the principal complications seen in the recipients of hematopoietic stem cell transplantation (HSCT), and it is also a major cause of morbidity and death in these patients. The major gastrointestinal complications include typhlitis (neutropenic enterocolitis), pseudomembranous enterocolitis, viral enteritis, graft-versus-host disease, benign pneumatosis intestinalis, intestinal thrombotic microangiopathy, and post-transplantation lymphoproliferative disease. As these patients present with nonspecific abdominal symptoms, evaluation with using such imaging modalities as ultrasonography and CT is essential in order to assess the extent of gastrointestinal involvement and to diagnose these complications. We present here a pictorial review of the imaging features and other factors involved in the diagnosis of these gastrointestinal complications in pediatric HSCT recipients.     

高分辨力CT在肾移植术后疑似肺炎患者中的应用价值

目的:评价高分辨率CT(HRCT)在诊断肾移植术后疑似肺炎中的应用价值。方法:33例肾移植术后疑似肺炎患者行胸片、胸部HRCT检查。所有患者均经影像学、实验室检查及临床随访而明确诊断。对33例患者的胸片和HRCT图像进行回顾性对比分析。结果:33例中10例(30.3%)胸片未见异常,其中9例HRCT提示肺炎并最终证实;23例胸片和HRCT均见异常,22例最终证实为肺炎,其中18例HRCT可提供更多更准确的信息,仅4例(12.1%)胸片与HRCT及最终诊断结果基本一致。结论:HRCT较胸片更敏感,有助于早期确诊肺炎,所有疑似肺炎的肾移植患者均应行HRCT检查,肾移植术后肺炎常见HRCT改变为磨玻璃样改变、小结节影和小片状实变。     

Fractal Dimension Analysis of MDCT Images for Quantifying the Morphological Changes of the Pulmonary Artery Tree in Patients with Pulmonary Hypertension

Objective

The aim of this study was to use fractal dimension (FD) analysis on multidetector CT (MDCT) images for quantifying the morphological changes of the pulmonary artery tree in patients with pulmonary hypertension (PH).

Materials and Methods

Fourteen patients with PH and 17 patients without PH as controls were studied. All of the patients underwent contrast-enhanced helical CT and transthoracic echocardiography. The pulmonary artery trees were generated using post-processing software, and the FD and projected image area of the pulmonary artery trees were determined with ImageJ software in a personal computer. The FD, the projected image area and the pulmonary artery pressure (PAP) were statistically evaluated in the two groups.

Results

The FD, the projected image area and the PAP of the patients with PH were higher than those values of the patients without PH (p < 0.05, t-test). There was a high correlation of FD with the PAP (r = 0.82, p < 0.05, partial correlation analysis). There was a moderate correlation of FD with the projected image area (r = 0.49, p < 0.05, partial correlation analysis). There was a correlation of the PAP with the projected image area (r = 0.65, p < 0.05, Pearson correlation analysis).

Conclusion

The FD of the pulmonary arteries in the PH patients was significantly higher than that of the controls. There is a high correlation of FD with the PAP.     

Benefit of combining quantitative cardiac CT parameters with troponin I for predicting right ventricular dysfunction and adverse clinical events in patients with acute pulmonary embolism

Objective

To prospectively evaluate the diagnostic accuracy of quantitative cardiac CT parameters alone and in combination with troponin I for the assessment of right ventricular dysfunction (RVD) and adverse clinical events in patients with acute pulmonary embolism (PE).

Materials and results

This prospective study had institutional review board approval and was HIPAA compliant. In total 83 patients with confirmed PE underwent echocardiography and troponin I serum level measurements within 24 h. Three established cardiac CT measurements for the assessment of RVD were obtained (RV/LV_axial, RV/LV_4-CH, and RV/LV_volume). CT measurements and troponin I serum levels were correlated with RVD found on echocardiography and adverse clinical events according to Management Strategies and Prognosis in Pulmonary Embolism Trial-3 (MAPPET-3 criteria. 31 of 83 patients with PE had RVD on echocardiography and 39 of 83 patients had adverse clinical events. A RV/LV_volume ratio > 1.43 showed the highest area under the curve (AUC) (0.65) for the prediction of adverse clinical events when compared to RV/LV_axial, RV/LV_4Ch and troponin I. The AUC for the detection of RVD of RV/LV_axial, RV/LV_4Ch, RV/LV_volume, and troponin I were 0.86, 0.86, 0.92, and 0.69, respectively. Combination of RV/LV_axial, RV/LV_4Ch, RV/LV_volume with troponin I increased the AUC to 0.87, 0.87 and 0.93, respectively.

Conclusion

A combination of cardiac CT parameters and troponin I measurements improves the diagnostic accuracy for detecting RVD and predicting adverse clinical events if compared to either test alone.     

Bone marrow MR imaging as predictors of outcome in hemopoietic stem cell transplantation

The purpose of this study is to investigate the role of femoral marrow MR imaging as predictor of outcome for hemopoietic stem cell transplantation (HSCT) in beta-thalassemia major. MR imaging of the proximal femur, including T1- and T2-weighted spin echo and short-tau inversion recovery and in-phase and out-of-phase fast field echo images, was prospectively performed in 27 thalassemia major patients being prepared for HSCT. The area of red marrow and its percentage of the proximal femur were measured, and the presence of marrow hemosiderosis was assessed. Age-adjusted multivariate logistic regression was used to determine the relationship between red marrow area percentage and marrow hemosiderosis and HSCT outcome. Red area percentage were less in patients with successful (90.25 +/- 4.14%) compared to unsuccessful transplants (94.54% +/- 2.93%; p = 0.01). Red marrow area percentage correlated positively with duration of symptoms(r = 0.428, p = 0.026) and serum ferritin (r = 0.511, p = 0.006). In multivariate-adjusted logistic regression analyses, red marrow area percentage was significantly inversely associated with successful HSCT (OR = 1.383, 95% CI: 1.059-1.805, p = 0.005). Marrow hemosidersosis and duration of sympotms and serum ferritin were not associated with HSCT outcome(p = 0.174, 0.974, 0.762, respectively). Red marrow area percentage of proximal femur on MR imaging is a useful predictor of HSCT outcome.     

Prediction of adverse clinical outcome in patients with acute pulmonary embolism: Evaluation of High-Sensitivity Troponin I and quantitative CT parameters

Purpose

To evaluate the accuracy of high-sensitivity-cardiac-troponin-I (hs-cTnI) and quantitative CT-parameters, alone and in combination, for predicting right-ventricular-dysfunction (RVD) and adverse clinical outcome in patients with acute pulmonary embolism (PE).

Materials and methods

65 patients with PE and hs-cTnI measurements within 24 h of CT were retrospectively included. RVD was assessed on CT by calculating right ventricular/left ventricular (RV/LV) diameter ratios on transverse sections (RV/LVtrans), four-chamber-views (RV/LV4ch), and RV/LV volume ratio (RV/LVvol). Pulmonary CTA-obstruction-scores (OS) (Qanadli, Mastora) were calculated. Receiver operator characteristic (ROC) analysis was performed to compare Hs-cTnI, RV/LV ratios, and OS for predicting adverse clinical outcome (i.e. intensive care treatment, death).

Results

12 patients with PE had adverse clinical outcome and showed significantly higher RV/LV ratios and OS compared to those without. ROC analysis revealed a cutoff value of 0.042 ng/mL for hs-cTnI resulting in a sensitivity and specificity of 84% and 92% for predicting adverse clinical outcome, respectively. Elevated hs-cTnI was significantly associated with adverse clinical outcome. In a ROC analysis the AUC for the prediction of adverse clinical outcome of RV/LV4Ch, RV/LVvol, and hs-cTnI were 0.77, 0.76, and 0.71. The combination of hs-cTnI and RV/LV ratios increased the AUC for the prediction of adverse clinical outcome.

Conclusions

Hs-cTnI is associated with adverse clinical outcome in patients with acute PE. A combination of hs-cTnI with quantitative CT-parameters improves the prediction of adverse clinical outcome.     

全身放射治疗对自体干细胞移植后造血重建的影响及其短期不良反应

目的 探讨自体干细胞移植预处理方案中使用全身放射治疗(TBI)对造血重建的影响及其短期不良反应。方法 对1990-2012年的103例自体干细胞移植患者进行回顾性分析,根据预处理方案不同分为TBI组和NTBI组(不含全身照射),比较两组造血重建的差异,及其相关短期不良反应的异同。结果 两组中性粒细胞植活中位时间均为12 d,TBI组血小板植活中位时间为11 d,而NTBI组为10.5 d,两组间差异无统计学意义,在短期不良反应上TBI组的口腔黏膜炎、胃肠道反应的发生率高于NTBI组(χ²=6.458、22.400,P<0.05),而在感染等方面两组差异无统计学意义。结论 预防治疗后TBI做为预处理方案较NTBI组未见较为严重的短期不良反应,有较好的耐受性。     

艾滋病胸部影像学表现分析

目的分析艾滋病胸部影像学表现,为认识和诊断艾滋病提供影像学依据。方法回顾分析46例艾滋病胸部X线和CT表现。结果20例表现为两肺弥漫性病变,呈两肺网状合并斑片状、小片状、大片状、结节状及两肺磨玻璃状改变。10例表现为一侧肺部病变,其中1例合并有左上肺空洞。5例仅表现为两肺纹理增多、紊乱。11例两肺胸片未见异常。结论胸部影像学表现可反映出艾滋病患者合并的胸部病理变化。