title: The usefulness of a diagnostic method combining high-resolution CT findings and serum markers for cytomegalovirus pneumonia and pneumocystis pneumonia in non-AIDS patients.
abstract: BACKGROUND
  The combination of high-resolution computed tomography (HRCT) findings and serum markers would be of great value in diagnosing cytomegalovirus pneumonia (CMVP) and pneumocystis pneumonia (PCP) considering low invasiveness.
  
  
  OBJECTIVE
  To compare the HRCT findings of CMVP and PCP and to evaluate the differences in HRCT findings between patients diagnosed based on pathologic evidence and serum markers.
  
  
  METHODS
  Two radiologists retrospectively evaluated the HRCT findings of 21 patients with CMVP and 70 patients with PCP. Eight patients with CMVP and 32 patients with PCP were diagnosed based on pathologic evidence ("Path" group), while 13 patients with CMVP and 38 patients with PCP were diagnosed based on serum markers (CMV antigenemia, β-D-glucan) ("Serum-Marker" group). A total of 19 CT morphological criteria were evaluated, and the significance of the differences between the two diseases and between the "Path" and "Serum-Marker" groups with respect to each disease was calculated.
  
  
  RESULTS
  The presence of small nodules, the tree-in-bud pattern, and the halo sign was found more frequently in the CMVP group. Extensive ground-glass attenuation (GGA), a mosaic pattern, and a diffuse distribution were observed more frequently in the PCP group. There were significant differences between the "Path" and "Serum-Marker" groups in average extent of consolidation and distribution of consolidation in PCP, and the distribution of GGA in CMVP, respectively.
  
  
  CONCLUSIONS
  The combined use of HRCT findings and serum markers is useful for the diagnosis of CMVP and PCP in non-AIDS patients. The typical HRCT findings for the differential diagnosis included extensive GGA with mosaic pattern in PCP and nodules, nodules with or without the tree-in-bud pattern, and the halo sign in CMVP.
authors.affiliation: Department of Radiology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan kyoshie@yamaguchi-u.ac.jp.
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Kunihiro
authors.affiliation: Department of Radiology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Tanaka
authors.affiliation: Department of Clinical Research, National Hospital Organization, Yamaguchi Ube Medical Center, Yamaguchi, Japan.
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: Yamaguchi University Hospital Division of Laboratory, Yamaguchi, Japan.
authors.forename: Norihide
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Department of Radiology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
authors.forename: Naofumi
authors.initials: N
authors.lastname: Matsunaga
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications; D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002648:Child; D003586:Cytomegalovirus Infections / Q000097:blood / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis* / Q000209:etiology; D011024:Pneumonia, Viral / Q000175:diagnosis*; D012189:Retrospective Studies; D036542:Tomography, Spiral Computed / Q000379:methods*; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Cytomegalovirus; HRCT; antigenemia; pneumocystis pneumonia; β-D-glucan