CT Findings for Differentiating Pulmonary Mucormycosis From Invasive Pulmonary Aspergillosis, Prior to Invasive Procedure Such as a Biopsy or Surgery: A 22-Year Single-Center Experience.
Hyeon Mu Jang, Mi Young Kim, So Yun Lim, Eui-Jin Chang, Seongman Bae, Jiwon Jung, Min Jae Kim, Yong Pil Chong, Sang-Ho Choi, Sang-Oh Lee, Yang Soo Kim, Sung-Han Kim
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Abstract
Objectives: Computed tomography (CT) plays a critical role in the early detection and diagnosis of pulmonary invasive mould infection. This study aimed to compare the CT findings of proven invasive pulmonary aspergillosis (IPA) and proven pulmonary mucormycosis (PM) and develop a clinical scoring system based on CT features to differentiate PM from IPA.
Methods: The medical records of the pathology database among adult patients (aged ≥ 18 years) diagnosed with proven IPA or PM between January 2003 and June 2024 were retrospectively reviewed, according to the 2020 European Organisation for Research and Treatment of Cancer criteria. CT scans were reviewed by an experienced radiologist. The primary outcome was CT findings in PM and IPA. We investigated and compared the thoracic CT findings between PM and IPA to identify the predictors of PM compared to IPA prior to invasive diagnostic procedures.
Results: A total of 94 patients were included (60 with IPA and 34 with PM). The most common underlying conditions were malignancy (53.2%) and transplantation (47.9%). In univariable analysis, CT features significantly associated with PM, compared to IPA (p < 0.05), included representative lesion size ≥ 4 cm (odds ratio [OR] 3.61, 95% CI 1.48-8.79), consolidation (OR 5.56, 95% CI 1.52-20.38), halo sign (OR 3.33, 95% CI 1.39-8.02), reverse halo sign (RHS) (OR 6.73, 95% CI 2.39-18.98) and airway-invasive lesion (OR 0.32, 95% CI 0.13-0.78). In multivariate analysis, representative lesion size ≥ 4 cm, RHS, and airway-invasive lesion were identified as independent predictors of PM, compared to IPA. These three factors were incorporated into a point-based scoring system (representative lesion size ≥ 4 cm = 11 points; RHS = score 17 points; airway-invasive lesion = -12 points). A total score of > 8 differentiated PM from IPA with 70.6% sensitivity and 78.3% specificity.
Conclusions: CT findings of large consolidative lesions, the presence of a reverse halo sign, and the absence of airway invasion may aid in the early differentiation of PM from IPA.
期刊介绍：
The journal Mycoses provides an international forum for original papers in English on the pathogenesis, diagnosis, therapy, prophylaxis, and epidemiology of fungal infectious diseases in humans as well as on the biology of pathogenic fungi.
Medical mycology as part of medical microbiology is advancing rapidly. Effective therapeutic strategies are already available in chemotherapy and are being further developed. Their application requires reliable laboratory diagnostic techniques, which, in turn, result from mycological basic research. Opportunistic mycoses vary greatly in their clinical and pathological symptoms, because the underlying disease of a patient at risk decisively determines their symptomatology and progress. The journal Mycoses is therefore of interest to scientists in fundamental mycological research, mycological laboratory diagnosticians and clinicians interested in fungal infections.
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