Serial assessment of pulmonary lesion volume by computed tomography allows survival prediction in invasive pulmonary aspergillosis.
Eur Radiol
; 27(8): 3275-3282, 2017 Aug.
Article
em En
| MEDLINE
| ID: mdl-28083695
ABSTRACT
BACKGROUND:
Serial chest CT is the standard of care to establish treatment success in invasive pulmonary aspergillosis (IPA). Data are lacking how response should be defined.METHODS:
Digital CT images from a clinical trial on treatment of IPA were re-evaluated and compared with available biomarkers. Total volume of pneumonia was added up after manual measurement of each lesion, followed by statistical analysis.RESULTS:
One-hundred and ninety CT scans and 309 follow-up datasets from 40 patients were available for analysis. Thirty-one were neutropenic. Baseline galactomannan (OR 4.06, 95%CI 1.08-15.31) and lesion volume (OR 3.14, 95%CI 0.73-13.52) were predictive of death. Lesion volume at d7 and trend between d7 and d14 were strong predictors of death (OR 20.01, 95%CI 1.42-282.00 and OR 15.97, 95%CI 1.62-157.32) and treatment being rated as unsuccessful (OR 4.75, 95%CI 0.94-24.05 and OR 40.69, 95%CI 2.55-649.03), which was confirmed by a Cox proportional hazards model using time-dependent covariates.CONCLUSION:
Any increase in CT lesion volume between day 7 and day 14 was a sensitive marker of a lethal outcome (>50%), supporting a CT rescan each one and 2 weeks after initial detection of IPA. The predictive value exceeded all other biomarkers. Further CT follow-up after response at day 14 was of low additional value. KEY POINTS ⢠CT evaluation offers good prediction of outcome for invasive pulmonary aspergillosis. ⢠Predictive capability exceeds galactomannan, blood counts, and lesion count. ⢠Any progression between day 7 and day 14 constitutes a high-risk scenario.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Tomografia Computadorizada por Raios X
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Aspergilose Pulmonar Invasiva
Tipo de estudo:
Guideline
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article