Escuissato Dante L, Gasparetto Emerson L, Marchiori Edson, Rocha Gabriela de Melo, Inoue César, Pasquini Ricardo, Müller Nestor L
Department of Diagnostic Radiology, the University of Parana, Curitiba, Brazil.
AJR Am J Roentgenol. 2005 Sep;185(3):608-15. doi: 10.2214/ajr.185.3.01850608.
The purpose of this study was to review the high-resolution CT findings in patients with pulmonary infection after bone marrow transplantation and to determine distinguishing features among the various types of infection.
This study included 111 consecutive bone marrow transplant recipients who had documented pulmonary infection, high-resolution CT of the chest performed within 24 hr of the beginning of symptoms, and proven diagnosis within 1 week of the onset of symptoms. Two radiologists analyzed the CT scans and reached final decisions regarding the findings by consensus. Statistical analysis was performed using the Fisher's exact test and multivariate analysis; a p value of less than 0.05 was considered statistically significant.
The pulmonary infections were due to viruses (n = 57), bacteria (n = 26), fungi (n = 21), and protozoa (n = 1). Six patients had more than one organism responsible for the infection. Nodules that were 1 cm or more in diameter were seen in 13 (62%) of 21 patients with fungal pneumonia, five (19%) of 26 patients with bacterial pneumonia (p = 0.0059), three (10%) of 30 with respiratory syncytial virus (RSV) pneumonia (p = 0.0001), and three (14%) of 22 with cytomegalovirus pneumonia (p = 0.0016). The halo sign was present in 10 of 21 patients with fungal pneumonia, two of 26 with bacterial pneumonia (p = 0.0026), three of 30 with RSV pneumonia (p = 0.0036), and one of 22 with cytomegalovirus pneumonia (p = 0.0015). There was no statistically significant difference in the prevalence of the other CT patterns including small nodules, ground-glass attenuation, and air-space consolidation among viral, bacterial, and fungal infections (all p > 0.05).
The presence of large nodules and visualization of the halo sign are most suggestive of fungal infection. Other high-resolution CT patterns are not helpful in distinguishing among the various types of infection seen in bone marrow transplant recipients.
本研究旨在回顾骨髓移植后肺部感染患者的高分辨率CT表现，并确定不同类型感染的鉴别特征。
本研究纳入了111例连续的骨髓移植受者，这些患者有记录的肺部感染，在症状出现后24小时内进行了胸部高分辨率CT检查，并在症状发作后1周内确诊。两名放射科医生分析了CT扫描结果，并通过共识达成关于检查结果的最终决定。采用Fisher精确检验和多变量分析进行统计分析；p值小于0.05被认为具有统计学意义。
肺部感染由病毒（n = 57）、细菌（n = 26）、真菌（n = 21）和原生动物（n = 1）引起。6例患者有不止一种病原体导致感染。直径1 cm或更大的结节在21例真菌性肺炎患者中的13例（62%）、26例细菌性肺炎患者中的5例（19%）（p = 0.0059）、30例呼吸道合胞病毒（RSV）肺炎患者中的3例（10%）（p = 0.0001）以及22例巨细胞病毒肺炎患者中的3例（14%）（p = 0.0016）中可见。晕征在21例真菌性肺炎患者中的10例、26例细菌性肺炎患者中的2例（p = 0.0026）、30例RSV肺炎患者中的3例（p = 0.0036）以及22例巨细胞病毒肺炎患者中的1例（p = 0.0015）中出现。在病毒、细菌和真菌感染中，包括小结节、磨玻璃影和实变等其他CT表现的发生率无统计学差异（所有p > 0.05）。
大结节的存在和晕征的显示最提示真菌感染。其他高分辨率CT表现无助于区分骨髓移植受者中所见的不同类型感染。
