Concordance of Chest Radiography and Chest Computed Tomography Findings in Patients with Hematologic Malignancy and Invasive Mucormycosis: What Are the Prognostic Implications?

IF 4.2 2区 生物学 Q2 MICROBIOLOGY Journal of Fungi Pub Date : 2024-10-09 DOI:10.3390/jof10100703
Sebastian Wurster, Sung-Yeon Cho, Hazim Allos, Alexander Franklin, Dierdre B Axell-House, Ying Jiang, Dimitrios P Kontoyiannis
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Abstract

Invasive pulmonary mucormycosis (IPM) is a deadly opportunistic mold infection in patients with hematological malignancies (HM). Radiologic imaging is essential for its timely diagnosis. Here, we compared IPM lesions visualized by chest computed tomography (CCT) and chest X-ray (CXR) and determined the prognostic significance of discordant imaging. Therefore, we reviewed 44 consecutive HM patients with probable/proven IPM at MD Anderson Cancer Center in 2000-2020 who had concurrent CCT and CXR studies performed. All 44 patients had abnormal CCTs and 39 (89%) had anormal CXR findings at IPM diagnosis. However, only 26 patients (59%) showed CCT-matching IPM-suspicious lesions on CXR. Acute Physiology and Chronic Health Evaluation II score > 18 at IPM diagnosis and breakthrough infection to Mucorales-active antifungals were the only independent risk factors for 42-day and/or 84-day mortality. Absence of neutropenia at IPM diagnosis, neutrophil recovery in neutropenic patients, and surgical revision of mucormycosis lesions were protective factors. Although not reaching significance on multivariable analysis, visualization of CCT-matching lesions on CXR was associated with significantly increased 84-day mortality (log-rank test, p = 0.033), possibly as a surrogate of extensive lesions and tissue necrosis. This observation supports the exploration of radiologic lesion kinetics as a prognostic staging tool in IPM patients.

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血液恶性肿瘤和侵袭性黏液瘤病患者的胸部 X 光检查和胸部计算机断层扫描结果的一致性:预后意义何在?
侵袭性肺粘孢子菌病(IPM)是血液恶性肿瘤(HM)患者中一种致命的机会性霉菌感染。放射成像对于及时诊断至关重要。在此,我们比较了胸部计算机断层扫描(CCT)和胸部 X 光片(CXR)显示的 IPM 病变,并确定了成像不一致的预后意义。因此,我们回顾了 2000-2020 年期间在 MD 安德森癌症中心连续接受 CCT 和 CXR 检查的 44 例疑似/确诊 IPM 的 HM 患者。在 IPM 诊断时,所有 44 例患者的 CCT 均异常,39 例(89%)患者的 CXR 结果异常。然而,只有 26 名患者(59%)在 CXR 上发现了与 CCT 相匹配的 IPM 可疑病灶。IPM 诊断时急性生理学和慢性健康评估 II 评分大于 18 分以及对黏菌类活性抗真菌药物的突破性感染是 42 天和/或 84 天死亡率的唯一独立风险因素。IPM 诊断时无中性粒细胞减少、中性粒细胞减少患者的中性粒细胞恢复以及粘孢子菌病病灶的手术修补是保护因素。虽然在多变量分析中未达到显著性,但在 CXR 上看到与 CCT 匹配的病变与 84 天死亡率显著增加有关(对数秩检验,p = 0.033),这可能是广泛病变和组织坏死的代用指标。这一观察结果支持将放射学病灶动力学作为 IPM 患者预后分期工具的探索。
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来源期刊
Journal of Fungi
Journal of Fungi Medicine-Microbiology (medical)
CiteScore
6.70
自引率
14.90%
发文量
1151
审稿时长
11 weeks
期刊介绍: Journal of Fungi (ISSN 2309-608X) is an international, peer-reviewed scientific open access journal that provides an advanced forum for studies related to pathogenic fungi, fungal biology, and all other aspects of fungal research. The journal publishes reviews, regular research papers, and communications in quarterly issues. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. Therefore, there is no restriction on paper length. Full experimental details must be provided so that the results can be reproduced.
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