Computer tomography in pulmonary invasive aspergillosis in hematological patients with neutropenia: an useful tool for diagnosis and assessment of outcome in clinical trials.
OBJECTIVE
The exact timing of the evolution of lesion volumes of invasive pulmonary aspergillosis (IPA) on CT scan images could be helpful in the management of hematological patients but has never been evaluated in a prospective study. We analyzed the CT scan data from the prospective Combistrat trial.


METHODS
Volumes of aspergillosis lesions from 30 patients (including 24 acute myeloid leukaemia) with probable (n=26) or proven (n=4) IPA according to the EORTC-MSG modified criteria, were measured prospectively on the thoracic CT scans at the enrolment in the study on day 0 (D0), D7, D14 and end of treatment (EOT).


RESULTS
For the overall population, the volume of pulmonary aspergillosis lesions increased significantly from D0 to D7 (1.6 fold; p=0.003). Then this volume decreased significantly from D7 to D14 (1.36 fold at D14 with p=0.003 for D14 vs. D7, but with p=0.56 for D14 vs. D0). At EOT (= D17, median value), the volume of lesions was significantly lower than D14 (0.76 fold the initial volume; p<0.001) but it was not significantly different when compared to D0 (p=0.11).


CONCLUSIONS
The results of this prospective study suggest that the sequential analysis of CT scan in neutropenic patients with IPA depicts more precisely the evolution of lesion volumes than comparison to baseline images. Moreover, the systematic use of chest CT appears to be a useful tool for diagnosis and outcome evaluation of IPA in clinical trials.
Caillot
Denis
D
Dijon University Hospital Center, Dijon, France. denis.caillot@chu-dijon.fr
Latrabe
Valérie
V
Thiébaut
Anne
A
Herbrecht
Raoul
R
De Botton
Stéphane
S
Pigneux
Arnaud
A
Monchecourt
Françoise
F
Mahi
Lamine
L
Alfandari
Serge
S
Couaillier
Jean-François
JF
D000328:Adult; D000368:Aged; D002986:Clinical Trials as Topic / Q000379:methods*; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000150:complications* / Q000000981:diagnostic imaging*; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications* / Q000000981:diagnostic imaging*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*