title: Long-term CT follow-up in 40 non-HIV immunocompromised patients with invasive pulmonary aspergillosis: kinetics of CT morphology and correlation with clinical findings and outcome.
abstract: OBJECTIVE
  The aim of this study was to assess CT signs of invasive pulmonary aspergillosis (IPA) and their long-term kinetics in correlation with clinical findings and outcome.
  
  
  METHODS
  Three hundred ten serial CT scans (mean, 7.7) in 40 consecutive patients were reviewed retrospectively over a median follow-up of 112 days (range, 5-841 days). Along with underlying disease, hematopoietic stem cell transplantation, neutropenia, graft-versus-host disease or antifungal treatment, signs of IPA, and number or size of lesions were evaluated regarding outcome and radiologic dynamics.
  
  
  RESULTS
  On the day of IPA diagnosis, median lesion number and size were 3 or 3.1 cm(2), respectively. Irrespective of antifungal therapy, 90% of patients showed an increase in lesion size and number until day 9 (median and mean). Lesion size subsequently showed a median plateau phase of 3.5 days (mean, 7), during which median lesion numbers dropped by 17%. Consequently, 42.5% of patients showed a complete radiologic remission within a median 80 days. Of all parameters, formation of cavitation most strongly predicted time until radiologic remission, which was 2.5 times as long in patients with cavitary lesions. Likewise, cavitations were strong precursors of beneficial outcome (odds ratio, 8.4; confidence interval [CI], 1.07-176).
  
  
  CONCLUSIONS
  The kinetics of radiologic signs of IPA adheres to a distinctive pattern with initial rise in number and size, followed by a plateau phase of size and gradual reduction. Both time until complete radiologic remission and outcome are independent of initial or maximum lesion size and number yet strongly influenced by cavitation.
authors.affiliation: Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany. hbrodoefel@t-online.de
authors.forename: Harald
authors.initials: H
authors.lastname: Brodoefel
authors.forename: Monika
authors.initials: M
authors.lastname: Vogel
authors.forename: Holger
authors.initials: H
authors.lastname: Hebart
authors.forename: Hermann
authors.initials: H
authors.lastname: Einsele
authors.forename: Reinhard
authors.initials: R
authors.lastname: Vonthein
authors.forename: Claus
authors.initials: C
authors.lastname: Claussen
authors.forename: Marius
authors.initials: M
authors.lastname: Horger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000000981:diagnostic imaging* / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016867:Immunocompromised Host; D008172:Lung Diseases, Fungal / Q000000981:diagnostic imaging* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed