This article is more than 5 years old. Information may no longer be current.
Vessel occlusion using CTPA improves detection of invasive mold disease
Vessel occlusion detected via computed tomography pulmonary angiography was a more sensitive, and potentially more specific, radiographic sign of invasive mold disease than other common findings in patients with hematological malignancies, according to a recent study.
“Invasive mold disease is a serious infectious complication in patients with hematological malignancies that often delays the administration of life-saving chemotherapy resulting in lower rates of complete remission and increased mortality,” the researchers wrote. “Definitive diagnosis of invasive mold disease requires bronchoscopy and/or lung biopsy for culture or histological documentation of infection, which may be unfeasible in patients with severe thrombocytopenia.”
In the prospective study, researchers evaluated 100 patients with hematological malignancies and suspected invasive mold disease who underwent CT pulmonary angiography (CTPA) at a hospital at the University of Bologna, from March 2008 to June 2014. All patients met criteria of possible invasive mold disease at the time of CTPA. Patients also underwent extensive diagnostic and microbiologic work-ups to determine the cause of infection within 9 days of CTPA. Ninety-seven percent of the patients underwent screenings two to three times daily for serum galactomannan levels. Lavage fluid was tested for galactomannan during brochoscopy. Patients were upgraded to probable or proven mold disease based on galactomannan antigen, culture or histology, or remained as probable cases in the absence of an alternative diagnosis.
After excluding eight nonevaluable CTPA cases, 46 patients were upgraded to probable or proven mold disease after CTPA. Positive occlusion detected by CTPA was 100% sensitive for probable or confirmed mold disease. Among patients not identified with a possible mold disease classification, 49% showed signs of vessel occlusion by CTPA. Only one positive patient received an alternate diagnosis (Staphylococcus aureus-specific septic thrombosis). Patients with negative CTPA results discontinued intravenous and antifungal therapy earlier than those with positive CTPA results (P ≤ .001).
“CTPA improves the sensitivity, and possibility the specificity of [high-resolution CT] diagnosis of invasive mold diseases in the high-risk patients with hematological malignancies,” the researchers wrote. “CTPA may be especially useful as a complementary tool to rule out invasive mold disease in patients with suspicious high-resolution CT findings, facilitating pursuit of alternative diagnosis and earlier discontinuation of empiric antifungal therapy.”
Disclosure: The researchers report no relevant financial disclosures.