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Discrimination between invasive pulmonary aspergillosis and pulmonary lymphoma using CT


Kawel, Nadine; Schorer, Georg M; Desbiolles, Lotus; Seifert, Burkhardt; Marincek, Borut; Boehm, Thomas (2011). Discrimination between invasive pulmonary aspergillosis and pulmonary lymphoma using CT. European Journal of Radiology, 77(3):417-425.

Abstract

OBJECTIVE: The purpose was to assess the characteristic CT features of invasive pulmonary aspergillosis (IPA) and pulmonary lymphoma (PL) and to analyze the potential to distinguish the two entities using CT. METHODS: The CT images of 70 patients with either proven IPA (n=35) or PL (n=35) were evaluated retrospectively and independently by two radiologists (reader 1 [R1] and reader 2 [R2]), analyzing images for presence, number and characteristics of pulmonary nodules and masses, ground-glass opacities, consolidations and other interstitial changes. RESULTS: Interreader agreement was moderate (4/33 CT features), good (9/33) or excellent (20/33). Pulmonary nodules (P=0.045 [R1], P=0.001 [R2]), nodules with spiculated outer contours (P<0.001 [R1], P=0.001 [R2]), nodules with a halo sign (P<0.001 [R1+R2]), nodules with homogeneous (P=0.030 [R1], P=0.006 [R2]) and inhomogeneous (P=0.001 [R1], P<0.001 [R2]) attenuation patterns, nodules with cavitation (P=0.006 [R1], P=0.003 [R2]) and wedge-shaped, pleural-based consolidations (P<0.001 [R1+R2]) occurred significantly more often in patients with IPA, while masses without a halo sign (P=0.03 [R1], P=0.01 [R2]), lobar consolidations with bronchogram (P=0.02 [R1+R2]) and consolidations with homogeneous attenuation patterns (P<0.001 [R1+R2]) were found significantly more frequent in PL-patients. CONCLUSIONS: Those CT features can therefore be considered suggestive for either IPA or PL. However, in most cases the diagnosis cannot be made based on CT findings solely because no single feature gained a high sensitivity and specificity concomitantly. Furthermore, the logistic regression did not show a combination that was significantly better than the best univariate predictor.

Abstract

OBJECTIVE: The purpose was to assess the characteristic CT features of invasive pulmonary aspergillosis (IPA) and pulmonary lymphoma (PL) and to analyze the potential to distinguish the two entities using CT. METHODS: The CT images of 70 patients with either proven IPA (n=35) or PL (n=35) were evaluated retrospectively and independently by two radiologists (reader 1 [R1] and reader 2 [R2]), analyzing images for presence, number and characteristics of pulmonary nodules and masses, ground-glass opacities, consolidations and other interstitial changes. RESULTS: Interreader agreement was moderate (4/33 CT features), good (9/33) or excellent (20/33). Pulmonary nodules (P=0.045 [R1], P=0.001 [R2]), nodules with spiculated outer contours (P<0.001 [R1], P=0.001 [R2]), nodules with a halo sign (P<0.001 [R1+R2]), nodules with homogeneous (P=0.030 [R1], P=0.006 [R2]) and inhomogeneous (P=0.001 [R1], P<0.001 [R2]) attenuation patterns, nodules with cavitation (P=0.006 [R1], P=0.003 [R2]) and wedge-shaped, pleural-based consolidations (P<0.001 [R1+R2]) occurred significantly more often in patients with IPA, while masses without a halo sign (P=0.03 [R1], P=0.01 [R2]), lobar consolidations with bronchogram (P=0.02 [R1+R2]) and consolidations with homogeneous attenuation patterns (P<0.001 [R1+R2]) were found significantly more frequent in PL-patients. CONCLUSIONS: Those CT features can therefore be considered suggestive for either IPA or PL. However, in most cases the diagnosis cannot be made based on CT findings solely because no single feature gained a high sensitivity and specificity concomitantly. Furthermore, the logistic regression did not show a combination that was significantly better than the best univariate predictor.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2011
Deposited On:25 Nov 2009 08:50
Last Modified:06 Dec 2017 21:53
Publisher:Elsevier
ISSN:0720-048X
Publisher DOI:https://doi.org/10.1016/j.ejrad.2009.09.018
PubMed ID:19804951

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