Barbara D Alexander1, Frédéric Lamoth2,3, Claus Peter Heussel4,5,6, Cornelia Schaefer Prokop7,8, Sujal R Desai9, C Orla Morrissey10, John W Baddley11. 1. Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA. 2. Service of Infectious Diseases, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. 3. Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. 4. Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik gGmbH, Heidelberg, Germany. 5. Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research. 6. Diagnostic and Interventional Radiology, Ruprecht-Karls-University, Heidelberg, Germany. 7. Department of Radiology, Meander Medical Center. 8. Radboud University, Nijmegen, The Netherlands. 9. Department of Radiology, Royal Brompton and Harefield National Health Service Foundation Trust, London and National Heart and Lung Institute, Imperial College, London, United Kingdom. 10. Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia. 11. Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Abstract
BACKGROUND: Clinical imaging in suspected invasive fungal disease (IFD) has a significant role in early detection of disease and helps direct further testing and treatment. Revised definitions of IFD from the EORTC/MSGERC were recently published and provide clarity on the role of imaging for the definition of IFD. Here, we provide evidence to support these revised diagnostic guidelines. METHODS: We reviewed data on imaging modalities and techniques used to characterize IFDs. RESULTS: Volumetric high-resolution computed tomography (CT) is the method of choice for lung imaging. Although no CT radiologic pattern is pathognomonic of IFD, the halo sign, in the appropriate clinical setting, is highly suggestive of invasive pulmonary aspergillosis (IPA) and associated with specific stages of the disease. The ACS is not specific for IFD and occurs in the later stages of infection. By contrast, the reversed halo sign and the hypodense sign are typical of pulmonary mucormycosis but occur less frequently. In noncancer populations, both invasive pulmonary aspergillosis and mucormycosis are associated with "atypical" nonnodular presentations, including consolidation and ground-glass opacities. CONCLUSIONS: A uniform definition of IFD could improve the quality of clinical studies and aid in differentiating IFD from other pathology in clinical practice. Radiologic assessment of the lung is an important component of the diagnostic work-up and management of IFD. Periodic review of imaging studies that characterize findings in patients with IFD will inform future diagnostic guidelines.
BACKGROUND: Clinical imaging in suspected invasive fungal disease (IFD) has a significant role in early detection of disease and helps direct further testing and treatment. Revised definitions of IFD from the EORTC/MSGERC were recently published and provide clarity on the role of imaging for the definition of IFD. Here, we provide evidence to support these revised diagnostic guidelines. METHODS: We reviewed data on imaging modalities and techniques used to characterize IFDs. RESULTS: Volumetric high-resolution computed tomography (CT) is the method of choice for lung imaging. Although no CT radiologic pattern is pathognomonic of IFD, the halo sign, in the appropriate clinical setting, is highly suggestive of invasive pulmonary aspergillosis (IPA) and associated with specific stages of the disease. The ACS is not specific for IFD and occurs in the later stages of infection. By contrast, the reversed halo sign and the hypodense sign are typical of pulmonary mucormycosis but occur less frequently. In noncancer populations, both invasive pulmonary aspergillosis and mucormycosis are associated with "atypical" nonnodular presentations, including consolidation and ground-glass opacities. CONCLUSIONS: A uniform definition of IFD could improve the quality of clinical studies and aid in differentiating IFD from other pathology in clinical practice. Radiologic assessment of the lung is an important component of the diagnostic work-up and management of IFD. Periodic review of imaging studies that characterize findings in patients with IFD will inform future diagnostic guidelines.
Authors: Cara E Morin; Morgan P McBee; Lama Elbahlawan; Lindsay M Griffin; Gabriela M Maron; HaiThuy N Nguyen; Akshay Sharma; Elizabeth J Snyder; Jean Jeudy Journal: Pediatr Radiol Date: 2022-07-02