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Invasive pulmonary aspergillosis: evaluation with MR imaging
C J Herold1, J Kramer, K Sertl
1Department of Radiology, University of Vienna, Austria.
Abstract:
Eleven patients with suspected invasive pulmonary aspergillosis underwent magnetic resonance (MR) imaging. Images were obtained with standard spin-echo sequences and electrocardiographic triggering before and after intravenous administration of gadolinium diethylenetriaminepentaacetic acid. Thirty-seven of 48 lesions seen on MR images were nodular infiltrates; 34 of these had a targetlike appearance, with hypointense centers and iso- or hyperintense rims. Twenty-three of 37 nodular lesions contained areas of hyperintensity on T1-weighted images. All 37 had enhanced rims on postcontrast MR images. The remaining 11 lesions were segmental infiltrates, seven of which were predominantly hyperintense on T1-weighted images. In one patient with nodular lesions, MR imaging findings were correlated with those from pathologic analysis of a resected upper lobe. Areas of hyperintensity corresponded to subacute hemorrhage permeated by Aspergillus organisms. The authors believe that the typical targetlike appearance of nodular lesions on MR images and the potential that MR imaging has to reveal hemorrhagic content will prove useful in the early diagnosis of invasive pulmonary aspergillosis.
Insights
Magnetic resonance (MR) imaging reveals a target-like appearance in most nodular lesions associated with invasive pulmonary aspergillosis. This imaging technique may aid in the early diagnosis of this serious fungal infection.
Area of Science:
- Radiology
- Medical Imaging
- Infectious Diseases
Background:
- Invasive pulmonary aspergillosis is a serious fungal infection, often difficult to diagnose early.
- Accurate imaging is crucial for timely diagnosis and treatment of pulmonary aspergillosis.
Purpose of the Study:
- To evaluate the utility of magnetic resonance (MR) imaging in diagnosing invasive pulmonary aspergillosis.
- To characterize the MR imaging findings of pulmonary aspergillosis lesions.
Main Methods:
- MR imaging was performed on 11 patients with suspected invasive pulmonary aspergillosis.
- Standard spin-echo sequences and contrast-enhanced scans with gadolinium were utilized.
- Imaging findings were correlated with pathological analysis in one case.
Main Results:
- Nodular infiltrates (37/48 lesions) often exhibited a target-like appearance (hypointense center, hyperintense rim).
- Hyperintense areas within nodular lesions correlated with subacute hemorrhage and Aspergillus organisms.
- Contrast-enhanced MR imaging showed enhanced rims in all 37 nodular lesions.
Conclusions:
- The characteristic target-like appearance on MR imaging is a key finding for diagnosing invasive pulmonary aspergillosis.
- MR imaging's ability to detect hemorrhagic content aids in early diagnosis.
- MR imaging shows promise as a valuable tool for the early detection of invasive pulmonary aspergillosis.