INVASIVE PULMONARY ASPERGILLOSIS - PREDICTION AT THIN-SECTION CT IN PATIENTS WITH NEUTROPENIA - A PROSPECTIVE-STUDY

PURPOSE: To evaluate prospectively the usefulness of thin-section comp uted tomography (CT) in the prediction of biopsy-proved invasive pulmo nary aspergillosis in patients with neutropenia. MATERIALS AND METHODS : In 11 consecutively seen neutropenic patients, 12 open-lung biopsies were performed prospectively for suspected angioinvasive (n = 10) or airway-invasive (n=2) pulmonary aspergillosis. Thin-section CT finding s in the patients with angioinvasive pulmonary aspergillosis were revi ewed, and the findings were compared with those of other diseases. RES ULTS: Five of 12 biopsy specimens:were positive for angioinvasive pulm onary aspergillosis; none was positive for airway-invasive pulmonary a spergillosis. in five (50%) of 10 cases, suspicion of angioinvasive pu lmonary aspergillosis proved to be correct. The most common CT finding s were segmental areas of consolidation plus ground-glass attenuation (four of five cases [80%]) and at least one nodule surrounded by a hal o (two of five cases [40%]). Segmental areas of consolidation plus gro und-glass attenuation were seen as isolated findings in three and mixe d findings with nodules that have a surrounding halo in one case. In t wo patients, at least one nodule with a halo was an isolated finding i n one patient and a mixed finding in one patient. Mucormycosis, organi zing pneumonia, and pulmonary hemorrhage produced similar findings. CO NCLUSION: At thin-section CT, segmental areas of consolidation plus gr ound-glass attenuation or at least one nodule with the halo sign were seen in patients with invasive pulmonary aspergillosis. The findings w ere nonspecific, however, and can be seen in neutropenic patients with mucormycosis, organizing pneumonia, or pulmonary hemorrhage.