The Role of Multidetector Computed Tomography in the Early Diagnosis of Invasive Pulmonary Aspergillosis in Patients with Febrile Neutropenia Undergoing Hematopoietic Stem Cell Transplantation

Objective: To evaluate vessel involvement and the role of multidetector computed tomography (MDCT) in the early diagnosis of invasive pulmonary aspergillosis (IPA) in patients with febrile neutropenia and antibiotic-resistant fever undergoing autologous bone morrow transplantation. Material and Methods: In all, 74 pulmonary MDCT examinations in 37 consecutive hematopoietic stem cell transplantation patients with febrile neutropenia and clinically suspected IPA were retrospectively evaluated. Results: Diagnosis of IPA was based on Fungal Infections Cooperative Group, and National Institute of Allergy and Infectious Diseases Mycoses Study Consensus Group criteria. In all, 0, 14, and 11 patients were diagnosed as proven, probable, and possible IPA, respectively. Among the 25 patients accepted as probable and possible IPA, all had pulmonary MDCT findings consistent with IPA. The remaining 12 patients were accepted as having fever of unknown origin (FUO) and had patent vessels based on MDCT findings. In the patients with probable and possible IPA, 72 focal pulmonary lesions were observed; in 41 of the 72 (57%) lesions vascular occlusion was noted and the CT halo sign was observed in 25 of these 41 (61%) lesions. Resolution of fever occurred following antifungal therapy in 19 (76%) of the 25 patients with probable and possible IPA. In all, 6 (25%) of the patients diagnosed as IPA died during follow-up. Transplant-related mortality 100 d post transplant in patients with IPA and FUO was 24% and 0%, respectively. Conclusion: In conclusion, MDCT has a potential role in the early diagnosis of IPA via detection of vessel occlusion.