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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Cereser L, Zuiani C, Graziani G, et al. Impact of clinical data on chest radiography sensitivity in detecting pulmonary abnormalities in immunocompromised patients with suspected pneumonia. Radiol Med. 2010;115(2):205-214. Observational-Dx 64 CXR, 2 independent reviewers To retrospectively evaluate whether the knowledge of clinical data improves the diagnostic sensitivity of CXR in immunocompromised patients after hematopoietic stem cell transplantation. Chest CT was standard of reference. Readers showed sensitivity of 39% and 58.5% for the first reading, and 43.9% and 41.5% for the second reading, respectively. For both readers, these values were not significantly different from those obtained at first reading (McNemar’s test, P>0.05). Interobserver agreement at second reading was fair (Cohen test, k=0.33). Sensitivity of CXR is too low to consider it a stand-alone technique for the evaluation of immunocompromised patients after hematopoietic stem cell transplantation with suspected pneumonia, even if the radiologist knows detailed clinical data. For these patients, an early chest CT evaluation is therefore recommended. 3
2. Safadi AR, Soubani AO. Diagnostic approach of pulmonary disease in the HIV negative immunocompromised host. Eur J Intern Med. 2009;20(3):268-279. Review/Other-Dx N/A To review the major conditions causing pulmonary symptoms in the HIV negative immunocompromised host and the role of the different diagnostic methods, including the recent advances in non-invasive studies, in reaching a diagnosis of pulmonary disease in this patient population. The advances in medicine have resulted in increasing number of immunocompromised patients with complications related to their underlying disease or the treatment of these conditions. Pulmonary infectious and non-infectious conditions are a major cause of morbidity and mortality in these patients, and represent a diagnostic challenge. 4
3. Reynolds JH, Banerjee AK. Imaging pneumonia in immunocompetent and immunocompromised individuals. Curr Opin Pulm Med. 2012;18(3):194-201. Review/Other-Dx N/A To indicate the current role of radiological imaging in immune competent and immunocompromised patients with pneumonia. Three basic patterns of radiographic abnormality are recognized: lobar (nonsegmental) pneumonia; bronchopneumonia (lobular pneumonia); and interstitial pneumonia. The chest radiograph remains the initial radiological investigation. Computed tomography (CT) is more sensitive than the chest radiograph. The appearances on CT with certain infections such as mycoplasma, invasive aspergillosis, and pneumocystis, in the appropriate clinical setting, may allow a treatment decision to be made when obtaining fluid or tissue for culture is problematical. MRI technology is advancing and this technique may provide an option for follow-up of chronic disease in younger patients in whom radiation exposure is a concern, but MRI does not yet match CT as a diagnostic test in this field. 4
4. Franquet T. High-resolution computed tomography (HRCT) of lung infections in non-AIDS immunocompromised patients. Eur Radiol. 2006;16(3):707-718. Review/Other-Dx N/A Review HRCT of lung infections in non-AIDS immunocompromised patients. Imaging plays an important role in the detection and management of patients with pulmonary infectious diseases. When pulmonary infection is suspected, knowledge of the varied radiographic manifestations will narrow the differential diagnosis, helping to direct additional diagnostic measures and serving as an ideal tool for follow-up examinations. Combination of pattern recognition with knowledge of the clinical setting is the best approach to pulmonary infection occurring in the immunocompromised patients. 4
5. Kisembo HN, Boon SD, Davis JL, et al. Chest radiographic findings of pulmonary tuberculosis in severely immunocompromised patients with the human immunodeficiency virus. Br J Radiol. 2012;85(1014):e130-139. Observational-Dx 403 patients To describe chest radiograph (CXR) findings in a population with a high prevalence of human immunodeficiency virus (HIV) and tuberculosis (TB) in order to identify radiological features associated with TB; to compare CXR features between HIV-seronegative and HIV-seropositive patients with TB; and to correlate CXR findings with CD4 T-cell count. Smear or culture-positive TB was diagnosed in 214 of 403 (53%) patients. Median CD4+ T-cell count was 50 cells mm(-3) [interquartile range (IQR) 14-150]. TB patients were less likely than non-TB patients to have a normal CXR (12% vs 20%, p = 0.04), and more likely than non-TB patients to have a diffuse pattern of opacities (75% vs 60%, p = 0.003), reticulonodular opacities (45% vs 12%, p < 0.001), nodules (14% vs 6%, p = 0.008) or cavities (18% vs 7%, p = 0.001). HIV-seronegative TB patients more often had consolidation (70% vs 42%, p = 0.007) and cavities (48% vs 13%, p < 0.001) than HIV-seropositive TB patients. TB patients with a CD4+ T-cell count of 3
6. Heussel CP, Kauczor HU, Heussel G, Fischer B, Mildenberger P, Thelen M. Early detection of pneumonia in febrile neutropenic patients: use of thin-section CT. AJR Am J Roentgenol. 1997;169(5):1347-1353. Observational-Dx 87 patients underwent 146 prospective examinations To evaluate the usefulness of thin-section CT for early detection of pneumonia in neutropenic patients with an unknown site of infection and normal or nonspecific findings on CXR. Thin-section CT scans show findings suggestive of pneumonia about 5 days earlier than CXR show suggestive findings. When thin-section CT scans show findings suggestive of pneumonia, the probability of pneumonia being detected on CXRs during the 7-day follow-up is 31%, whereas the probability is only 5% when the findings on the prior thin-section CT scan were normal (P<.005). All neutropenic patients with fever of unknown origin and normal findings on CXRs should be examined with thin-section CT. 3
7. Aderaye G, Bruchfeld J, Assefa G, et al. The relationship between disease pattern and disease burden by chest radiography, M. tuberculosis Load, and HIV status in patients with pulmonary tuberculosis in Addis Ababa. Infection. 2004;32(6):333-338. Observational-Dx 168 patients To evaluate impact of HIV infection on CXR pattern and extent of disease in patients with pulmonary tuberculosis. HIV+ patients had lower colony count of M. tuberculosis than HIV negative patients. 3
8. Kanne JP, Yandow DR, Meyer CA. Pneumocystis jiroveci pneumonia: high-resolution CT findings in patients with and without HIV infection. AJR Am J Roentgenol. 2012;198(6):W555-561. Review/Other-Dx N/A To review the spectrum of high-resolution CT findings of Pneumocystis jiroveci pneumonia in immunocompromised patients with and without HIV infection. Pneumocystis jiroveci pneumonia is a common opportunistic infection affecting immunosuppressed patients. High-resolution CT may be indicated for evaluation of immunosuppressed patients with suspected pneumonia and normal chest radiographic findings. The most common high-resolution CT finding of Pneumocystis jiroveci pneumonia is diffuse ground-glass opacity. Consolidation, nodules, cysts, and spontaneous pneumothorax also can develop. 4
9. Ekinci A, Yucel Ucarkus T, Okur A, Ozturk M, Dogan S. MRI of pneumonia in immunocompromised patients: comparison with CT. Diagn Interv Radiol. 23(1):22-28, 2017 Jan-Feb. Experimental-Dx 40 patients To investigate the utility of magnetic resonance imaging (MRI) in the diagnosis and surveillance of immunocompromised patients with pneumonia. Infection was determined in 36 patients (90%), while the causative organism remained unknown in four patients (10%). In all the patients, the CT findings were consistent with infection, although three patients showed no abnormal findings on MRI. CT was superior to MRI in the detection of the tree-in-bud nodules, centrilobular nodules, and halo sign (P < 0.001, for all). A significant difference was observed between the MRI sequences and CT in terms of the number of detected nodules (P < 0.001). The nodule detection rate of MRI significantly increased in proportion to the size of the nodule (P < 0.001). All MRI sequences had almost perfect agreement with CT for the detection of consolidation (small ka, Cyrillic=0.950, P < 0.001), patchy increased density (small ka, Cyrillic=1, P < 0.001), pleural effusion (small ka, Cyrillic=0.870, P < 0.001), pericardial effusion (small ka, Cyrillic=1, P < 0.001), reverse halo sign, (small ka, Cyrillic=1 P < 0.001), 10-20 mm, nodules (small ka, Cyrillic=0.896, P < 0.001 for CT and B-FFE; small ka, Cyrillic=0.948, P < 0.001 for CT and T1- or T2-weighted imaging) 10-20 mm, >20 mm nodules (small ka, Cyrillic=0.844, P < 0.001). 2
10. Sartori A, Souza A, Zanon M, et al. Performance of magnetic resonance imaging in pulmonary fungal disease compared to high-resolution computed tomography. Mycoses. 60(4):266-272, 2017 Apr. Observational-Dx 21 patients To evaluate the performance of magnetic resonance imaging (MRI) compared to computed tomography (CT) in patients diagnosed with pulmonary mycosis No results stated 2
11. Nagel SN, Wyschkon S, Schwartz S, Hamm B, Elgeti T. Can magnetic resonance imaging be an alternative to computed tomography in immunocompromised patients with suspected fungal infections? Feasibility of a speed optimized examination protocol at 3 Tesla. Eur J Radiol. 85(4):857-63, 2016 Apr. Observational-Dx 13 patients To prospectively evaluate a short MRI examination protocol for the detection of nodular pulmonary infiltrates in immunocompromised patients with hematologic diseases and suspected invasive fungal infections. In all 13 patients MRI examinations were completed successfully (average examination time 12 min and maximum breath-hold time of 8s). CT detected 409 nodules. Sensitivity of MRI was 93.2% when using all sequences in combination; considering nodules >5mm, sensitivity increased to 97.9%. Reliability analysis showed excellent correlations with an intra-class correlation coefficient of at least 0.89 for T2 FSE (95% CI 0.79-0.93, p<0.01) images for the intra-, and the lowest of 0.77 for T2 FSE (95% CI 0.55-0.89, p<0.01) images for the inter-reader comparison. Agreement on nodule visibility was at least kappa=0.95 (p<0.01) for the intra- and 0.72 (p<0.01) for the inter-reader analysis. 2
12. Rieger C, Herzog P, Eibel R, Fiegl M, Ostermann H. Pulmonary MRI--a new approach for the evaluation of febrile neutropenic patients with malignancies. Support Care Cancer. 16(6):599-606, 2008 Jun. Observational-Dx 50 patients To determine the feasibility and sensitivity of magnetic resonance imaging (MRI) of the lung compared to HR-CT in immunocompromised patients with persistent fever in neutropenia and suspected pneumonia. Of 50 patients, 35 had pulmonary infiltration according to HR-CT; these were examined with MRI of the lungs. MRI showed a high correlation (91%) with the findings in HR-CT. Both HR-CT and MRI were feasible in 94% of the examined patients. In 12 of 35 patients, fungal pathogens were identified in microbiological testing. 2
13. Wang SY, Chen G, Luo DL, et al. 18F-FDG PET/CT and contrast-enhanced CT findings of pulmonary cryptococcosis. Eur J Radiol. 89:140-148, 2017 Apr. Observational-Dx 42 patients To review the 18F-fluorodeoxyglucose-positron emission tomography (18F-FDG PET/CT) and contrast-enhanced CT (CE-CT) findings of 42 patients with pulmonary cryptococcosis. The results of the PET scans revealed that 37 (88%) of 42 patients showed higher FDG uptake, and 5 (12%) patients demonstrated lower FDG uptake than the mediastinal blood pool. The maximum standardized uptake value (SUV) of pulmonary cryptococcosis ranged from 1.4 to 13.0 (average: 5.7±3.3, median 4.9). A single nodular pattern was the most prevalent pattern observed and was found in 29 (69%) patients. This pattern was followed by scattered nodular (n=4, 10%), clustered nodular (n=3, 7%), mass-like (n=3, 7%), and bronchopneumonic (n=3, 7%) patterns. The most frequent pattern of immunocompetent patients was the single nodular pattern (29 of 33, 88%). Immunocompromised patients most frequently pattern exhibited mass-like (3 of 9, 33%) and bronchopneumonic (3 of 9, 33%) patterns. 2
14. Ketai L, Jordan K, Marom EM. Imaging infection. Clin Chest Med. 2008;29(1):77-105, vi. Review/Other-Dx N/A To review the role of thoracic imaging in normal or minimally compromised hosts, particularly on combinations of imaging and clinical characteristics that may suggest bacterial, fungal, or viral pathogens. Diagnostic imaging of the thorax is routinely used among both immunocompetent and immunosuppressed patients to detect infection, identify its complications, and aid in differentiating infectious from noninfectious intrathoracic disease. Imaging is more effective in suggesting specific types of infection in immunocompromised hosts where imaging findings can be combined with information on the patient's immune status, which in some cases allows treatment to be initiated without a pathologic diagnosis. CT imaging is particularly useful in immunosuppressed hosts with symptoms and minimally abnormal radiographs, such as those patients afflicted with bacterial airway infections. 4
15. Demirkazik FB, Akin A, Uzun O, Akpinar MG, Ariyurek MO. CT findings in immunocompromised patients with pulmonary infections. Diagn Interv Radiol. 2008;14(2):75-82. Review/Other-Dx 57 immunocompromised patients To evaluate computed tomography (CT) findings of pulmonary infections in immunocompromised patients with hematologic malignancies, and to detect the accuracy of first-choice diagnoses. Nineteen patients had a bacterial infection, 20 patients had a fungal infection, 8 patients had a cytomegalovirus (CMV) infection, 8 patients had Pneumocystis jiroveci pneumonia (PCP) and 2 patients had a Mycobacterium tuberculosis infection. There were consolidations in 13 patients (68.4%) and areas of ground-glass attenuation and ground-glass nodules in 6 patients (31.6%) with bacterial infection. Six of 8 eight patients (75%) with CMV infection had centrilobular nodules associated with bronchial wall thickening and ground-glass areas and nodules. There were parenchymal nodules in 18 of 20 patients (90%) who had a fungal infection. All 8 patients who had PCP had bilateral areas of ground-glass densities on CT scans. The first-choice diagnosis was accurate in most of the fungal infections (95.0%) and PCP (87.5%), but was less accurate for bacterial and viral infections (73.7% and 75.0%, respectively). Neither of the 2 tuberculous infections was identified on the basis of CT findings. 4
16. Hardak E, Brook O, Yigla M. Radiological features of Pneumocystis jirovecii Pneumonia in immunocompromised patients with and without AIDS. Lung. 2010;188(2):159-163. Observational-Dx 38 consecutive patients: (9 with AIDS and 29 with other causes of immunosuppression) Retrospective study to compare chest CT findings of PCP in immunocompromised patients with and without AIDS. From a radiographic point of view, non-AIDS patients had a significantly higher proportion of diffuse ground glass lesions, 86% vs 44% (P=0.02), and a lower proportion of cystic lesions, 3% vs 56% (P=0.015). The two subgroups did not differ in smoking status and the number of pack-years. On multivariate analysis, only the presence of AIDS was found to be a risk factor for the formation of pulmonary cystic lesions. Different immune reactions to the parasite PCP in immunocompromised patients with and without AIDS results in a different time lag between symptoms and a correspondingly different radiographic pattern: widespread ground glass opacities in the former and cystic lesions in the latter. 3
17. Park YS, Seo JB, Lee YK, et al. Radiological and clinical findings of pulmonary aspergillosis following solid organ transplant. Clin Radiol. 2008;63(6):673-680. Review/Other-Dx 13 consecutive patients: (5 liver, 4 kidney, and 4 heart transplant), 2 reviewers To retrospectively evaluate the radiological and clinical findings in patients with pulmonary aspergillosis after solid organ transplantation. The most common radiographic and CT findings were pulmonary nodules or masses (n=12). The number of nodules or masses was <10 in 8 patients. Associated findings were surrounding ground-glass opacity (n=4), central low density (n=8), central air cavity (n=5), and air bronchogram (n=3). Follow-up radiographs and/or CT after treatment showed improvement in 8 patients, persistence in two, and deterioration in three. The onset time of pulmonary aspergillosis was a median of 32 days (range 15-165 days). The most common symptom at diagnosis was fever (n=6). Ten of 13 patients did not have leucopaenia. There were two aspergillosis-associated deaths during the follow-up period. The most common radiological finding of pulmonary aspergillosis after solid organ transplantation is multiple nodules or masses, which commonly appear within 1 month following transplantation. 4
18. Lim C, Seo JB, Park SY, et al. Analysis of initial and follow-up CT findings in patients with invasive pulmonary aspergillosis after solid organ transplantation. Clin Radiol. 67(12):1179-86, 2012 Dec. Observational-Dx 46 patients To assess initial and follow-up CT findings of invasive pulmonary aspergillosis (IPA) in solid organ transplant (SOT) recipients using new diagnostic criteria, and to compare initial CT findings of survivors with those of patients who died. Consolidation or mass was the most common finding, observed in 33 of 46 patients (72%), followed by large nodules (59%), ground-glass opacity (50%), and infarcted consolidation (48%). Consolidation or mass was significantly less frequent in survivors than in patients who died (62% versus 93%). Cavitation was more common (43% versus 13%), and significantly smaller (7.5 cm(2) versus 19 cm(2), p = 0.014) in survivors. Follow-up CT in survivors showed that the halo sign resolved rapidly within 4 weeks. The extent of consolidation, infarcted consolidation, and internal low-density area decreased gradually with time to reduce to half the size in 3 weeks. Large nodules persisted for the first 7 days (84%), followed by slow regression. 3
19. Brook O, Guralnik L, Hardak E, et al. Radiological findings of early invasive pulmonary aspergillosis in immune-compromised patients. Hematol Oncol. 2009;27(2):102-106. Observational-Dx 144 patients To describe the radiological features of early stages of IPA. Chest computerized tomography (CT) films of 22 consecutive immune-compromised patients with IPA diagnosed with the aid of ASP PCR testing from BAL fluid were characterized and compared to that of 18 similar patients diagnosed with traditional bacteriological methods and to data from the literature. It was found that patients diagnosed with the aid of ASP PCR testing tended to have focal disease as manifested by more 11-30 mm nodules with halo (68% vs. 33%, p = 0.04), more focal ground glass (single area 32% vs. 6%, p = 0.05, patchy 32% vs. 0%, p = 0.01) and less diffuse ground glass (0% vs. 22%, p = 0.03), less cavitations (5% vs. 28%, p = 0.05) and less consolidations (segmental 14% vs. 50%, p = 0.02 and diffuse 14% vs. 67%, p = 0.001). 2
20. Qin J, Xu J, Dong Y, et al. High-resolution CT findings of pulmonary infections after orthotopic liver transplantation in 453 patients. Br J Radiol. 2012;85(1019):e959-965. Observational-Dx 453 patients To review the high-resolution CT (HRCT) findings in patients with pulmonary infection after orthotopic liver transplantation (OLT) and to determine distinguishing findings among the various types of infection. Bacterial and viral pneumonia made up the bulk of infections (63.4% and 29.4%, respectively), followed by fungal infiltrates (24.5%). Large nodules were most common in patients with fungal pneumonia, having been seen in 38 (54%) of the 70 patients with fungal pneumonia, 22 (10%) of 220 with bacterial pneumonia (p=0.0059) and 6 (8%) of 78 with viral pneumonia (p=0.0011). The halo sign was also more frequent in patients with fungal pneumonia, having been seen in 38 (54%) of the 70 patients with fungal pneumonia, 17 (8%) of 220 with bacterial pneumonia (p=0.0026) and 7 (9%) of 78 with viral pneumonia (p=0.0015). There was no statistically significant difference in the prevalence of the other HRCT patterns including air-space consolidation, ground-glass attenuation and small nodules among bacterial, viral and fungal infections (all p>0.05). 4
21. Nam BD, Kim TJ, Lee KS, Kim TS, Han J, Chung MJ. Pulmonary mucormycosis: serial morphologic changes on computed tomography correlate with clinical and pathologic findings. Eur Radiol. 28(2):788-795, 2018 Feb. Observational-Dx 20 patients To evaluate serial computed tomography (CT) findings of pulmonary mucormycosis correlated with peripheral blood absolute neutrophil count (ANC). All patients were immunocompromised. On initial CT scans, nodule (=3cm)/mass (>3cm) or consolidation with surrounding ground-glass opacity halo (18/20, 90%)) was the most common pattern. On follow-up CT, morphologic changes (13/15, 87%) could be seen and they included reversed halo (RH) sign, central necrosis, and air-crescent sign. Although all cases did not demonstrate the regular morphologic changes at the same timeline, various combinations of pattern change could be seen in all patients. Sequential morphologic changes were related with recovering of ANC in 13 of 15 patients. 4
22. Franquet T, Gimenez A, Hidalgo A. Imaging of opportunistic fungal infections in immunocompromised patient. Eur J Radiol. 2004;51(2):130-138. Review/Other-Dx N/A To assess CXR and CT imaging features of different opportunistic fungal infections in immunocompromised patients. Radiographic appearances of the opportunistic fungal infections in immunocompromised patients overlap significantly. The relatively low diagnostic accuracy of CXR can be improved through familiarity with the clinical settings in which specific infections are likely to occur. CT is helpful in the characterization of parenchymal lung diseases in immunocompromised patients but is of limited value in making a specific diagnosis. Recognition of the various radiologic manifestations of fungal infection in conjunction with patient’s immunologic status is vital for narrowing the differential diagnosis. 4
23. Althoff Souza C, Muller NL, Marchiori E, Escuissato DL, Franquet T. Pulmonary invasive aspergillosis and candidiasis in immunocompromised patients: a comparative study of the high-resolution CT findings. J Thorac Imaging. 2006;21(3):184-189. Observational-Dx 54 total patients Aspergillus (n=32) or Candida (n=22) pulmonary infection Retrospective study to compare the HRCT findings of pulmonary invasive aspergillosis and candidiasis in immunocompromised patients. Nodules were the most common finding, present in 84% (27/32) of patients with aspergillosis and 95% (21/22) of patients with candidiasis (P>0.3, Fisher exact test). Centrilobular nodules were more common in patients with aspergillosis (26/27, 96%) than in those with candidiasis (11/21, 52%) (P<0.001) and random nodules more common in candidiasis (10/21, 48%) than in aspergillosis (1/27, 4%) (P<0.001). Presence of the CT halo sign, cavitation, and ground-glass opacities was similar in both groups. Pulmonary aspergillosis and candidiasis in immunocompromised patients manifest with similar HRCT findings. Centrilobular nodules and consolidation are more common in aspergillosis. The presence of halo sign or cavitation is not helpful in the differential diagnosis. 3
24. Franquet T, Lee KS, Muller NL. Thin-section CT findings in 32 immunocompromised patients with cytomegalovirus pneumonia who do not have AIDS. AJR Am J Roentgenol. 2003;181(4):1059-1063. Review/Other-Dx 32 patients, 2 reviewers To retrospectively review the thin-section CT findings in immunocompromised patients without AIDS who had proven CMV pneumonia. Causes of immunocompromised included; bone marrow (n = 25) or solid organ transplantation (n = 5) and corticosteroid therapy (n = 2). Bilateral abnormalities were seen in all patients. Areas of ground-glass opacification were seen in 21 (66%) of 32 patients. Ground-glass opacification was the predominant CT feature in nine cases (28%). In 19/32 patients, ground-glass attenuation was associated with other abnormalities. Multiple nodules were identified in 19 patients (59%). Nodules were bilateral in 15 patients and unilateral in 4 patients. Nodules were the only CT finding in 3 patients (9%). Areas of air-space consolidation were identified in 19 patients (59%). Air-space consolidation was the only CT finding in one patient (3%). Other less common CT findings included thickening of the bronchovascular bundles (n = 7) and the tree-in-bud appearance (n = 4). Pleural effusions were seen in 7 patients. The thin-section CT manifestations of CMV pulmonary infection usually consist of a mixture of patterns, most commonly ground-glass attenuation, areas of consolidation, and small nodules. 4
25. Vogel MN, Brodoefel H, Hierl T, et al. Differences and similarities of cytomegalovirus and pneumocystis pneumonia in HIV-negative immunocompromised patients thin section CT morphology in the early phase of the disease. Br J Radiol. 2007;80(955):516-523. Observational-Dx 58 patients: (31 with CMV pneumonia and 27 with PCP), CT - 2 reviewers Retrospective study to determine which patterns typical of CMV pneumonia or PCP in patients without AIDS were actually noticeable with varying frequency by means of an early thin section CT. Also, authors looked for significant morphological differences in both of these entities in order to expedite diagnosis for impact on patient management. 18 CT morphological criteria were evaluated for presence or absence. Only 5 of the 18 features were found to have significantly different frequencies in the two entities. Apical distribution (P<0.01), mosaic pattern (P<0.01) and homogeneous structure of ground-glass opacities (P<0.05) were found more frequently in PCP (each K: 0.7-0.9), whereas small nodules or unsharp demarcation of ground-glass opacities and consolidation were typical of CMV pneumonia (P<0.05). Peripheral sparing, consolidation and septal thickening inter alia were found equally in both groups. In conclusion analysis of craniocaudal distribution, demarcation and structure of infiltrates may be helpful in prioritizing differential diagnosis of CMV pneumonia or PCP. However, some features thought typical for one or the other entities appear with similar frequency in both groups in HIV-negative patients. 4
26. Godet C, Le Goff J, Beby-Defaux A, et al. Human metapneumovirus pneumonia in patients with hematological malignancies. J Clin Virol. 61(4):593-6, 2014 Dec. Review/Other-Dx 54 patients To characterize the clinical and radiographic presentation and outcome of Human metapneumovirus (HMPV) pneumonias diagnosed in hematological patients. Among the 54 patients with several underlying hematological conditions who were positive for HMPV, we found 13 cases of HMPV pneumonias. HMPV could be the cause of pneumonia as a single pathogen without associated upper respiratory infection. Centrilobular nodules were constant on lung computed tomography scans. No patients died despite the absence of administration of antiviral treatments. 4
27. Egli A, Bucher C, Dumoulin A, et al. Human metapneumovirus infection after allogeneic hematopoietic stem cell transplantation. Infection. 2012;40(6):677-684. Observational-Tx 8 patients To describe the clinical course in eight HSCT recipients suffering from hMPV infection. Eight patients with hMPV-associated LRTI were identified from 93 BAL samples. Three of the eight patients had co-infections with other pathogens. The median age of the patients was 45 years [interquartile range (IQR) 36.8-53.5], the median time posttransplant was 473 days (IQR 251-1,165), 5/8 patients had chronic graft-versus-host disease (cGvHD), and 6/8 patients received immunosuppression. Chest computed tomography (CT) scanning showed a ground-glass pattern in 7/8 patients. Seven of eight patients required hospitalization due to severe symptoms and hypoxemia. All were treated with intravenous immunoglobulin (IVIG), which was combined with oral ribavirin in six patients. The mortality rate was 12.5 % (1/8). 2
28. Syha R, Beck R, Hetzel J, et al. Human metapneumovirus (HMPV) associated pulmonary infections in immunocompromised adults--initial CT findings, disease course and comparison to respiratory-syncytial-virus (RSV) induced pulmonary infections. Eur J Radiol. 2012;81(12):4173-4178. Observational-Dx 10 patients To describe computed tomography (CT)-imaging findings in human metapneumovirus (HMPV)-related pulmonary infection as well as their temporal course and to analyze resemblances/differences to pulmonary infection induced by the closely related respiratory-syncytial-virus (RSV) in immunocompromised patients. In HMPV, 8/10 patients showed asymmetric pulmonary findings, whereas 13/13 patients with RSV-pneumonia presented more symmetrical bilateral pulmonary infiltrates. Image analysis yielded in HMPV patients following results: ground-glass-opacity (GGO) (n=6), parenchymal airspace consolidations (n=5), ill-defined nodular-like centrilobular opacities (n=9), bronchial wall thickening (n=8). In comparison, results in RSV patients were: GGO (n=10), parenchymal airspace consolidations (n=9), ill-defined nodular-like centrilobular opacities (n=10), bronchial wall thickening (n=4). In the course of the disease, signs of acute HMPV interstitial pneumonia regressed transforming temporarily in part into findings compatible with bronchitis/bronchiolitis. 4
29. Huang LK, Wu MH, Chang SC. Radiological manifestations of pulmonary tuberculosis in patients subjected to anti-TNF-alpha treatment. Int J Tuberc Lung Dis. 18(1):95-101, 2014 Jan. Observational-Dx 23 cases and 46 controls patients To evaluate the impact of anti-tumour necrosis factor (TNF) treatment on radiological manifestations of pulmonary tuberculosis (PTB) Compared with the controls, fibronodular lesions were less common on CXR in the anti-TNF group (P < 0.001). In contrast, lymphadenopathy (P < 0.001), pleural effusion (P = 0.015) and pericardial effusion (P = 0.02) were more common, while tree-in-bud appearance (P = 0.017) was less commonly depicted on chest CT in the anti-TNF group. Although there was no significant difference in zonal predilection and laterality of the lesions between the two groups, diffuse lesions (P = 0.004) on chest CT scans were more frequent in the anti-TNF group. 2
30. Pereira M, Gazzoni FF, Marchiori E, et al. High-resolution CT findings of pulmonary Mycobacterium tuberculosis infection in renal transplant recipients. Br J Radiol. 89(1058):20150686, 2016. Observational-Dx 40 patients To assess high-resolution CT (HRCT) findings in renal transplantation recipients diagnosed with pulmonary tuberculosis (TB). The sample comprised 40 patients [26 males, 14 females; median age, 45 years (range, 12–69 years)]. The main HRCT pattern was miliary nodules (40%), followed by cavitation and centrilobular tree-in-bud nodules (22.5%), ground-glass attenuation and consolidation (15%), mediastinal lymph node enlargement (12.5%) and pleural effusion (10%). The distribution of findings in patients with miliary nodules was random. In patients with cavitation and centrilobular tree-in-bud nodules, 66.6% of abnormalities were found in the upper lobes. Pleural effusion was unilateral in 75% of cases. The overall mortality rate was 27.5%. This rate was 50% in patients with miliary nodules, and 72.6% of all deaths occurred in this group. Thus, mortality was increased significantly in patients with miliary nodules (p<0.05). 2
31. Jung JI, Lee DG, Kim YJ, Yoon HK, Kim CC, Park SH. Pulmonary tuberculosis after hematopoietic stem cell transplantation: radiologic findings. J Thorac Imaging. 2009;24(1):10-16. Review/Other-Dx 10 patients To determine the radiologic features of pulmonary tuberculosis in hematopoietic stem cell transplant (HSCT) recipients. On chest radiography (n=10), the most common abnormalities were air-space consolidation (100%) and nodules (80%). Parenchymal lesions appeared mixed with other findings (80%). The most common mixed pattern was nodules with consolidations (80%). Parenchymal lesions were multilobar (80%), patchy (70%), or bilateral (80%). Evidence of a zonal predominance was not seen. On chest CT scans (n=7), the most common parenchymal lesions were consolidation (100%), nodules (71%), tree-in-bud appearance (43%), and ground-glass opacity (43%). Parenchymal lesions seen on CT scans also appeared mixed (86%) and multilobar in distribution (100%). Significant zonal predominance was not noted on CT scans. Cavity was noted in 14% of the study patients and lymphadenopathy was noted in 71% of these patients on CT scans. 4
32. Lee Y, Song JW, Chae EJ, et al. CT findings of pulmonary non-tuberculous mycobacterial infection in non-AIDS immunocompromised patients: a case-controlled comparison with immunocompetent patients. Br J Radiol. 86(1024):20120209, 2013 Apr. Observational-Dx 369 patients To describe CT findings of non-tuberculous mycobacteria (NTM) pulmonary infection in non-AIDS immunocompromised patients (ICPs) and to compare these findings with those in immunocompetent patients. A total of 287 lobes were evaluated in ICPs and the control group. The ICPs showed a higher prevalence of ill-defined nodules, with cavities and large opacity >2 cm with/without cavity (p=0.03, 0.04 and 0.02, respectively). Regardless of the immune status, the most common CT findings were bronchiectasis and ill-defined nodules without cavity. 3
33. Attenberger UI, Morelli JN, Henzler T, et al. 3 Tesla proton MRI for the diagnosis of pneumonia/lung infiltrates in neutropenic patients with acute myeloid leukemia: initial results in comparison to HRCT. Eur J Radiol. 83(1):e61-6, 2014 Jan. Experimental-Dx 19 patients To evaluate the diagnostic accuracy of 3 Tesla proton MRI for the assessment of pneumonia/lung infiltrates in neutropenic patients with acute myeloid leukemia. Pulmonary abnormalities were characterized by 3 Tesla MRI with a sensitivity of 82.3% and a specificity of 78.6%, resulting in an overall accuracy of 88% (NPV/PPV 66.7%/89.5%). In 51 lobes (19 of 19 patients), pulmonary abnormalities visualized by MR were judged to be concordant in their location and in the lesion type identified by both readers. In 22 lobes (11 of 19 patients), no abnormalities were present on either MR or HRCT (true negative). In 6 lobes (5 of 19 patients), ground glass opacity areas were detected on MRI but were not visible on HRCT (false positives). In 11 lobes (7 of 19 patients), MRI failed to detect ground glass opacity areas identified by HRCT. However, since the abnormalities were disseminated in these patients, accurate treatment decisions were possible in every case based on MRI. In one case MRI showed a central area of cavitation, which was not visualized by HRCT. 1
34. Nagel SN, Kim D, Penzkofer T, et al. Pulmonary MRI at 3T: Non-enhanced pulmonary magnetic resonance Imaging Characterization Quotients for differentiation of infectious and malignant lesions. Eur J Radiol. 89:33-39, 2017 Apr. Observational-Dx 29 patients To investigate 3T pulmonary magnetic resonance imaging (MRI) for characterization of solid pulmonary lesions in immunocompromised patients and to differentiate infectious from malignant lesions. Infectious pulmonary lesions showed a higher T2-NICQmean (40.1 [14.6–56.0] vs. 20.9 [2.4–30.1], p < 0.05) and T2-NICQ90th (74.3 [43.8–91.6] vs. 38.5 [15.8–8.1], p < 0.01) than malignant lesions. T1-Qmean was higher in malignant lesions (0.85 [0.68–0.94] vs. 0.93 [0.87–1.09], p < 0.05). Considering infectionsonly, T2-NICQ90th was lower when anti-infectious treatment was administered >24 h prior to MRI (81.8 [71.8–97.6] vs. 41.4 [26.6–51.1], p < 0.01). Using Youden’s index (YI), the optimal cutoff to differentiate infectious from malignant lesions was 43.1 for T2-NICQmean (YI = 0.42, 0.47 sensitivity, 0.95 specificity)and 55.5 for T2-NICQ90th (YI = 0.61, 0.71 sensitivity, 0.91 specificity). Combining T2-NICQ90th and T1-Qmean increased diagnostic performance (YI = 0.72, 0.77 sensitivity, 0.95 specificity). 2
35. Yan C, Tan X, Wei Q, et al. Lung MRI of invasive fungal infection at 3 Tesla: evaluation of five different pulse sequences and comparison with multidetector computed tomography (MDCT). Eur Radiol. 25(2):550-7, 2015 Feb. Observational-Dx 34 patients To evaluate the diagnostic performance of five MR sequences to detect pulmonary infectious lesions in patients with invasive fungal infection (IFI), using multidetector computed tomography (MDCT) as the reference standard. A total of 84 lesions including nodules (n=44) and consolidation (n=40) were present in 75 lobes. selective attenuated inversion recovery (SPAIR) and T1-weighted high resolution isotropic volume excitation (e-THRIVE) images achieved high overall lesion related sensitivities for the detection of pulmonary abnormalities (90.5 % and 86.9 %, respectively). Short-tau inversion recovery (STIR) showed the highest lesion-to-lung contrast ratio for nodules (21.8) and consolidation (17.0), whereas T2-weighted turbo spin echo (TSE) had the fewest physiological artefacts. 2
36. Haas BM, Clayton JD, Elicker BM, Ordovas KG, Naeger DM. CT-Guided Percutaneous Lung Biopsies in Patients With Suspicion for Infection May Yield Clinically Useful Information. AJR Am J Roentgenol. 208(2):459-463, 2017 Feb. Observational-Dx 21 patients To assess the frequency and time frame with which CT-guided lung biopsies for suspected infection yield information that can affect patient management. Twenty-one biopsies were performed to identify a specific organism causing infection in patients with suspected infection; all patients were receiving antibiotics, 20 (95%) were immunocompromised, and 15 (71%) had undergone a prior bronchoscopy. Material collected from the biopsy provided a diagnosis in nine (43%) patients, whereas the biopsy results were nondiagnostic in the remaining 12 (57%). Of the nine patients for whom the biopsy yielded a diagnosis, eight biopsies revealed the species causing an infection (38%) and one biopsy (5%) detected posttransplant lymphoproliferative disease. Of the nine diagnoses, management was changed as a result of the biopsy in six patients (29% of all patients). The organisms identified by CT-guided lung biopsy in eight patients were fungi of the order Mucorales (i.e., mucormycosis) (n = 3), Aspergillus (n = 3), Pseudomonas (n = 1), and Nocardia (n = 1). The mean elapsed time between biopsy and pathologic diagnosis was 4 days (median, 3 days). There was no association between prior bronchoscopy and nondiagnostic biopsy results. 3
37. Kothary N, Bartos JA, Hwang GL, Dua R, Kuo WT, Hofmann LV. Computed tomography-guided percutaneous needle biopsy of indeterminate pulmonary pathology: efficacy of obtaining a diagnostic sample in immunocompetent and immunocompromised patients. CLIN LUNG CANCER. 11(4):251-6, 2010 Jul 01. Observational-Dx 262 patients To evaluate the efficacy of CT-guided percutaneous lung biopsy of pulmonary nodules with indeterminate radiologic characteristics in patients at risk for malignant and nonmalignant processes such as infection or inflammation. Of the entire cohort, 166 patients (63.4%) had a nonmalignant process, and 96 patients (36.6%) had a malignancy. CT-guided percutaneous lung biopsy established a diagnosis in 166 patients (63.4%). Of the 166 patients with a nonmalignant etiology and 96 patients with malignancy, it provided a definitive diagnosis in 91 patients (54.8%) and 75 patients (78.1%), respectively, a difference that was statistically significant (P=.0001). Overall diagnostic efficacy between immunocompetent and immunocompromised patients was comparable (P=.2); however, detection of infection or inflammation in individual groups was lower compared with detection of malignancy (P=.002 and P=.06, respectively). CT-guided percutaneous lung biopsy in patients who are clinically at risk for both nonmalignant and malignant processes continues to be a challenge. Although CT-guided percutaneous biopsy can establish an accurate diagnosis in a large majority of patients with malignancy, it is significantly less sensitive for infectious or inflammatory processes. 3
38. Lass-Florl C, Aigner M, Nachbaur D, et al. Diagnosing filamentous fungal infections in immunocompromised patients applying computed tomography-guided percutaneous lung biopsies: a 12-year experience. Infection. 45(6):867-875, 2017 Dec. Observational-Dx To evaluate the clinical utility of computed tomography (CT)-guided percutaneous lung biopsies in diagnosing Invasive fungal diseases (IFD) 127 (81%) specimens were microscopically positive for any fungal elements, 30 (19%) negative. Aspergillus and non-Aspergillus like hyphae were obtained in 85 (67%) and 42 (33%) specimens, respectively. CFWS positivity was defined as proof of infection. Sensitivity, specificity, and positive (PPV) and negative predictive (NPV) values for CT scan were 100, 44, 80, and 100%, for Aspergillus PCR 89, 58, 88, and 58%, for broad-range fungal PCR 90, 83, 95, and 90%, and for GM 94, 83, 95, and 90%. The most common CT features were patchy opacifications with central necrosis (78%) or cavern defects (50%), less common were air bronchograms (39%) or ground glass halos (39%), and all other features were rare. The overall pneumothorax rate subsequent to biopsy was 19%, but in only 2% of all cases the placement of a chest tube was indicated. One case of fatal air embolism occurred. 4
39. Shi JM, Cai Z, Huang H, et al. Role of CT-guided percutaneous lung biopsy in diagnosis of pulmonary fungal infection in patients with hematologic diseases. Int J Hematol. 2009;89(5):624-627. Review/Other-Dx 16 patients To evaluate the efficiency and safety of CT-guided percutaneous lung biopsy for the diagnosis of pulmonary fungal infection in patients with hematologic disease. Of the 16 patients, 10 were diagnosed fungal infection (8 aspergillus, 2 mold fungus), 4 chronic organizing pneumonitis, 1 tuberculosis, and 1 Pneumocystis carinii through histological examination after percutaneous lung biopsy. However, the results of blood culture and sputum culture were negative. CT-guided biopsy showed 100% overall accuracy and 62.5% (10/16) fungal infection rate. The biopsy-induced complications encountered were pneumothorax in 3/16 (18.75%) and hemoptysis in 1/16 (6.25%). No serious complication was found in this series. CT-guided percutaneous lung biopsy is an effective and safe method for the diagnosis of pulmonary fungal infection in patients with hematologic diseases. 4
40. Rossi SE, Erasmus JJ, McAdams HP, Sporn TA, Goodman PC. Pulmonary drug toxicity: radiologic and pathologic manifestations. [Review] [33 refs]. Radiographics. 20(5):1245-59, 2000 Sep-Oct. Review/Other-Dx N/A To review the most common histopathologic and radiologic manifestations of pulmonary drug toxicity and the agents that typically cause pulmonary drug toxicity No results stated in the abstract 4
41. Schwaiblmair M, Behr W, Haeckel T, Markl B, Foerg W, Berghaus T. Drug induced interstitial lung disease. Open Respir Med J. 2012;6:63-74. Review/Other-Dx N/A To review drug-induced interstitial lung disease(DILD). With an increasing number of therapeutic drugs, the list of drugs that is responsible for severe pulmonary disease also grows. Many drugs have been associated with pulmonary complications of various types, including interstitial inflammation and fibrosis, bronchospasm, pulmonary edema, and pleural effusions. Drug-induced interstitial lung disease (DILD) can be caused by chemotherapeutic agents, antibiotics, antiarrhythmic drugs, and immunosuppressive agents. There are no distinct physiologic, radiographic or pathologic patterns of DILD, and the diagnosis is usually made when a patient with interstitial lung disease (ILD) is exposed to a medication known to result in lung disease. Other causes of ILD must be excluded. Treatment is avoidance of further exposure and systemic corticosteroids in patients with progressive or disabling disease. 4
42. Krishnam MS, Suh RD, Tomasian A, et al. Postoperative complications of lung transplantation: radiologic findings along a time continuum. Radiographics. 27(4):957-74, 2007 Jul-Aug. Review/Other-Dx N/A To describe the salient radiologic features of lung transplantation complications at postoperative chest radiography, computed tomography (CT), and highresolutionCT. No results stated in the abstract 4
43. Logan PM, Miller RR, Muller NL. Cryptogenic organizing pneumonia in the immunocompromised patient: radiologic findings and follow-up in 12 patients. Can Assoc Radiol J. 46(4):272-9, 1995 Aug. Observational-Dx 7 male patients and 5 female patients To assess the radiographic, computed tomography (CT) and pathologic findings and response to therapy of cryptogenic organizing pneumonia in immunocompromised patients. The findings of chest radiography included consolidation (in 10 patients), reticulation (in 3) and small nodules (in 2). None of the radiographic abnormalities were localized to particular zones of the lung. The CT findings included ground-glass attenuation (in nine patients), consolidation (in six), small nodules (in five) and reticulation (in two). In 8 of the 12 patients (67%) these abnormalities were most marked in the subpleural and peribronchovascular regions. The follow-up radiographs showed improvement in 11 (92%) of the patients. 3
44. Pena E, Souza CA, Escuissato DL, et al. Noninfectious pulmonary complications after hematopoietic stem cell transplantation: practical approach to imaging diagnosis. [Review]. Radiographics. 34(3):663-83, 2014 May-Jun. Review/Other-Dx N/A To provide a practical approach to guides radiologists with imaging interpretation and diagnosis of noninfectious pulmonary complications after hematopoietic stem cell transplantation (HSCT). No results stated in abstract. 4
45. Blom JW, Doggen CJ, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA. 2005;293(6):715-722. Observational-Tx 3220 consecutive patients To identify individuals with cancer with an increased thrombotic risk, evaluating different tumor sites, the presence of distant metastases, and carrier status of prothrombotic mutations. The overall risk of venous thrombosis was increased 7-fold in patients with a malignancy (odds ratio [OR], 6.7; 95% confidence interval [CI], 5.2-8.6) vs persons without malignancy. Patients with hematological malignancies had the highest risk of venous thrombosis, adjusted for age and sex (adjusted OR, 28.0; 95% CI, 4.0-199.7), followed by lung cancer and gastrointestinal cancer. The risk of venous thrombosis was highest in the first few months after the diagnosis of malignancy (adjusted OR, 53.5; 95% CI, 8.6-334.3). Patients with cancer with distant metastases had a higher risk vs patients without distant metastases (adjusted OR, 19.8; 95% CI, 2.6-149.1). Carriers of the factor V Leiden mutation who also had cancer had a 12-fold increased risk vs individuals without cancer and factor V Leiden (adjusted OR, 12.1; 95% CI, 1.6-88.1). Similar results were indirectly calculated for the prothrombin 20210A mutation in patients with cancer. 2
46. Liu Y.. Demonstrations of AIDS-associated malignancies and infections at FDG PET-CT. [Review]. Ann Nucl Med. 25(8):536-46, 2011 Oct. Review/Other-Dx N/A To review and illustrate the role of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET-CT) in the most common acquired immunodeficiency syndrome (AIDS)-associated malignancies and infections. No results stated in abstract. 4
47. Noraini AR, Gay E, Ferrara C, et al. PET-CT as an effective imaging modality in the staging and follow-up of post-transplant lymphoproliferative disorder following solid organ transplantation. Singapore Med J. 50(12):1189-95, 2009 Dec. Observational-Dx 30 patients To establish the role of positron-emission tomography (PET)-computed tomography (CT) in post-transplant lymphoproliferative disorder (PTLD) patients, compared to conventional imaging (ultrasonography/CT/magnetic resonance imaging) in relation to its accuracy, sensitivity and specificity. In 41 of 49 examinations performed for staging and on follow-up, PET -CT and conventional imaging findings were concordant. Compared to conventional imaging, PET -CT showed comparable sensitivity (75 percent vs. 83 percent), similar specificity (100 percent in both modalities) and comparable accuracy (77 percent vs. 85 percent) during staging at diagnosis. PET -CT was found to be superior to conventional imaging modalities at followup, with greater sensitivity (100 percent vs. 81 percent), specificity (80 percent vs. 100 percent) and accuracy (97 percent vs. 83 percent). 3
48. Gupta S, Sultenfuss M, Romaguera JE, et al. CT-guided percutaneous lung biopsies in patients with haematologic malignancies and undiagnosed pulmonary lesions. Hematological Oncology. 28(2):75-81, 2010 Jun. Observational-Dx 213 patients To determine if CT-guided lung biopsy has a high diagnostic yield in patients with haematologic malignancies that present with unexplained pulmonary lesions and provides a specific diagnosis in a majority of these patients, leading to therapeutic changes. We analysed the biopsy results for diagnostic yield, factors affecting diagnostic yield and effect on treatment. Of 213 procedures, 191 (89.7%) yielded sufficient material for pathologic analysis; 130 (60%) yielded specific diagnoses, while 61 (28.6%) yielded nonspecific benign diagnoses. Lesions larger than 1 cm, cavitary lesions and lung masses were more likely to yield a specific diagnosis than were lesions smaller than 1 cm, lung nodules and consolidations. The most common specific diagnoses were malignancy (62.8%) and infection (34.3%). The latter was more common in patients with leukaemia, cavitary lung lesions or consolidations, active underlying malignancy, neutropenia, respiratory signs and symptoms and/or fever, bone marrow transplant recipients, and in patients receiving chemotherapy. Lung lesions discovered upon follow-up imaging in patients who did not have any respiratory signs/symptoms or fever were mostly malignant. Therapeutic changes were more likely after a specific diagnosis than after a nonspecific diagnosis or a nondiagnostic biopsy (88.4% vs. 18.1%; p<0.0001). 3
49. Pathak V, Rendon IS, Hasalla I, Tsegaye A. Evaluation of solitary pulmonary nodule in human immunodeficiency virus infected patients. Respir Care. 57(7):1115-20, 2012 Jul. Observational-Dx 10 patients To define the etiology of solitary pulmonary nodule (SPN) in human immunodeficiency virus (HIV)-infected patients and to examine efficacy of diagnostic testing for SPN. During the 10-year observational period, 10 of 5,000 HIV-infected patients admitted to the hospital were diagnosed with SPN via chest radiography or computed tomography (CT). Among these 10 patients, 6 had a definitive diagnosis. Underlying etiologies included infection (5/10) and lung adenocarcinoma (1/10); none were identified in the remaining 4 subjects. Sputum analysis provided no diagnostic value in discovering pathogenesis in any of these cases. Fiberoptic bronchoscopy with bronchoalveolar lavage and transbronchial biopsy were diagnostic in 3 cases, while CT-guided percutaneous transthoracic needle biopsy (PTNB) was diagnostic in 2 cases. One patient required open lung biopsy. 4
50. Carrafiello G, Lagana D, Nosari AM, et al. Utility of computed tomography (CT) and of fine needle aspiration biopsy (FNAB) in early diagnosis of fungal pulmonary infections. Study of infections from filamentous fungi in haematologically immunodeficient patients. Radiol Med (Torino). 111(1):33-41, 2006 Feb. Observational-Dx 18 patients To evaluate the sensitivity of percutaneous CT-guided lung biopsy in the early diagnosis of fungal pulmonary infections. The sensitivity of percutaneous CT-guided biopsy was 80% and its PPV was 100%. Percutaneous CT-guided lung biopsy is an easy, safe and reliable procedure to obtain diagnostic material. Histological discrimination between Aspergillus and Mucor is important in order to plan the correct therapeutic protocols, as Mucor is usually resistant to azoles. 3
51. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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