title: Computed tomography findings in invasive pulmonary aspergillosis in non-neutropenic transplant recipients and neutropenic patients, and their prognostic value.
abstract: OBJECTIVE
  We evaluated CT findings and their prognostic value in non-neutropenic transplant recipients with invasive pulmonary aspergillosis (IPA) compared with neutropenic patients with IPA.
  
  
  METHODS
  All adult patients during a 27-month who met the criteria for proven or probable IPA according to the 2008 EORTC/MSG criteria were retrospectively enrolled. Initial CT findings were reviewed by two radiologists blinded to the patients' demographics and clinical outcomes.
  
  
  RESULTS
  A total of 50 non-neutropenic transplant recipients and 60 neutropenic patients were enrolled. Consolidation-or-mass, halo signs, and angio-invasive form were observed less often in non-neutropenic transplant recipients than in neutropenic patients: (56%, 26%, and 32%) versus (78%, 55%, and 60%, p = 0.01, p = 0.002, and p = 0.003, respectively). Multivariate analysis revealed that macronodules (HR 0.31, p = 0.001), multiple infarct-shaped consolidations (HR 4.26, p < 0.001), renal replacement therapy (HR 5.62, p < 0.001) and persistence of a positive serum galactomannan (HR 7.14, p < 0.001) were independently associated with 90-day mortality.
  
  
  CONCLUSIONS
  Our data indicate that CT findings in non-neutropenic transplant recipients with IPA are similar to those in neutropenic patients with IPA except that consolidation-or-mass, halo sings, and angio-invasive form are less frequent, and certain CT findings such as macronodules and multiple infarct-shaped consolidations have prognostic implications in IPA.
authors.affiliation: Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Seong Yeon
authors.initials: SY
authors.lastname: Park
authors.forename: Chaehun
authors.initials: C
authors.lastname: Lim
authors.forename: Sang-Oh
authors.initials: SO
authors.lastname: Lee
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Yang Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Jun Hee
authors.initials: JH
authors.lastname: Woo
authors.forename: Jae-Woo
authors.initials: JW
authors.lastname: Song
authors.forename: Mi Young
authors.initials: MY
authors.lastname: Kim
authors.forename: Eun Jin
authors.initials: EJ
authors.lastname: Chae
authors.forename: Kyung-Hyun
authors.initials: KH
authors.lastname: Do
authors.forename: Koun-Sik
authors.initials: KS
authors.lastname: Song
authors.forename: Joon Beom
authors.initials: JB
authors.lastname: Seo
authors.forename: Sung-Han
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000473:pathology; D008168:Lung / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced* / Q000150:complications; D011379:Prognosis; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014180:Transplantation