Routine pre- and post-hematopoietic stem cell transplant computed tomography of the abdomen for detecting invasive fungal infection has limited value.
The diagnostic utility of obtaining chest and abdomen computed tomography (CT) to evaluate for invasive fungal infection (IFI) before and after hematopoietic stem cell transplant (HSCT) remains unclear. The study was conducted as a quality improvement project. Chest and abdomen CT of patients who underwent an allogeneic HSCT over a 13-month period were reviewed. Scans included those performed pretransplant in all patients and days 0 to 100 post-transplant in selected patients. Sixty-six patients had chest and abdomen CT scans pretransplant. Chest CT was suggestive of IFI in 9 patients (13.6%), including 3 patients with prior history of IFI. After transplant, 37 patients had an initial chest CT and 14 patients an initial abdominal CT. The first chest CT post-transplant was suggestive of IFI in 3 patients; all had an abnormal CT pretransplant. After the initial post-transplant evaluation, 15 patients had 28 additional CT scans of the chest and 12 patients 19 additional CT scans of the abdomen. An abnormal chest CT with proven evidence of IFI was seen in only 1 patient. None of the 99 abdominal CT scans performed pre- or post-transplant had evidence of IFI. There is little benefit in obtaining abdominal CT scans in HSCT patients for detecting IFI either pre- or post-transplant.
Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee; Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee.
Sue C
SC
Kaste
Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee; Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee.
Robert A
RA
Kaufman
Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.
Anusha
A
Sunkara
Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.
Guolian
G
Kang
Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee.
Cynthia
C
Morris
Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee.
Wing
W
Leung
Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee. Electronic address: ashok.srinivasan@stjude.org.
Ashok
A
Srinivasan
D000293:Adolescent; D000935:Antifungal Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000000981:diagnostic imaging* / Q000276:immunology / Q000473:pathology / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000000981:diagnostic imaging* / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D009181:Mycoses / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D019653:Myeloablative Agonists / Q000627:therapeutic use; D011379:Prognosis; D011860:Radiography, Abdominal; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D019653:Myeloablative Agonists
Abdominal; Allogeneic; Computed tomography; Stem cell transplantation