title: Computed tomographic pulmonary angiography for diagnosis of invasive mold diseases in patients with hematological malignancies.
abstract: BACKGROUND
  Invasive mold diseases (IMDs) of the lung remain a challenge for immunocompromised patients. Although timely diagnosis and treatment are crucial for the outcome of the infection, the poor sensitivity of microbiological techniques and the limited specificity of chest high-resolution computed tomography (HRCT) often delay definitive diagnosis of these infections.
  
  
  METHODS
  To explore the diagnostic utility of computed tomographic pulmonary angiography (CTPA) for detecting angioinvasive patterns of pulmonary infection, we performed a single-center, prospective, nonrandomized trial involving 36 patients with hematological malignancies who had clinical suspicion of IMD, as defined by European Organization for Research and Treatment of Cancer/Mycosis Study Group diagnostic criteria.
  
  
  RESULTS
  We found that 5 of 5 patients with proven IMD had CTPA-positive findings consistent with interruption of the arterial vessels (concordance, 100%). CTPA findings were positive in 5 of 7 patients with probable IMD (findings for 2 were considered false negative because lesions were too small or not evaluable). In 15 of 24 patients with a final diagnosis of possible IMD, CTPA findings were negative for 14 patients and were positive for 1 patient, who had septic emboli associated with Staphylococcus aureus bacteremia. CTPA findings were positive in the remaining 9 patients with a final diagnosis of possible IMD at the end of the study.
  
  
  CONCLUSIONS
  We conclude that CTPA appears to be a promising tool to exclude the diagnosis of IMD in high-risk patients without specific findings on HRCT scans, and it is most useful in the presence of well-circumscribed lesions in which there is suspicion for IMD.
authors.affiliation: Institute of Hematology Lorenzo e Ariosto Seràgnoli, Department of Hematology and Oncology, Sant'Orsola-Malpighi Hospital, University of Bologna, Italy. marta.stanzani2@unibo.it
authors.forename: Marta
authors.initials: M
authors.lastname: Stanzani
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Battista
authors.forename: Claudia
authors.initials: C
authors.lastname: Sassi
authors.forename: Russell E
authors.initials: RE
authors.lastname: Lewis
authors.forename: Giulia
authors.initials: G
authors.lastname: Tolomelli
authors.forename: Cristina
authors.initials: C
authors.lastname: Clissa
authors.forename: Rayka
authors.initials: R
authors.lastname: Femia
authors.forename: Alberto
authors.initials: A
authors.lastname: Bazzocchi
authors.forename: Fabio
authors.initials: F
authors.lastname: Tumietto
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Viale
authors.forename: Simone
authors.initials: S
authors.lastname: Ambretti
authors.forename: Michele
authors.initials: M
authors.lastname: Baccarani
authors.forename: Nicola
authors.initials: N
authors.lastname: Vianelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008172:Lung Diseases, Fungal / Q000150:complications* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult