Blum U, Windfuhr M, Buitrago-Tellez C, Sigmund G, Herbst E W, Langer M
Department of Diagnostic Radiology, University Hospital Freiburg, Germany.
Chest. 1994 Oct;106(4):1156-61. doi: 10.1378/chest.106.4.1156.
A prospective study was conducted in 38 patients with nodular lesions on plain chest radiographs and the clinical suspicion of invasive pulmonary aspergillosis (IPA) to assess the diagnostic accuracy of magnetic resonance imaging (MRI) and computed tomography (CT). For early diagnosis of IPA (clinical signs and symptoms < 10 days), CT scans with demonstration of the halo sign had a high sensitivity (16/22) and specificity (8/8). Magnetic resonance imaging performed at the same time revealed a relatively higher sensitivity (22/22), but a very poor specificity (0/8). Gadolinium-diethylene-triamine-pentaacetic acid (Gd-DTPA) enhanced images did not improve specificity. In the later course of infection (clinical signs and symptoms > 10 days), MRIs showed typical nodular target-like lesions with Gd-DTPA enhancement of the rim area that was not seen in the early course of the disease or in patients with Pseudomonas or staphylococcal infection. In conclusion, MRI findings are not as characteristic as the CT halo sign in diagnosing IPA in the early course of the disease, but the MRI target sign with Gd-DTPA enhancement of the rim area and the "reverse target" on T2-weighted images are strongly suggestive of IPA at a later stage of the disease.
对38例胸部X线平片有结节性病变且临床怀疑侵袭性肺曲霉病（IPA）的患者进行了一项前瞻性研究，以评估磁共振成像（MRI）和计算机断层扫描（CT）的诊断准确性。对于IPA的早期诊断（临床体征和症状<10天），显示晕征的CT扫描具有较高的敏感性（16/22）和特异性（8/8）。同时进行的磁共振成像显示敏感性相对较高（22/22），但特异性非常低（0/8）。钆-二乙烯三胺五乙酸（Gd-DTPA）增强图像并未提高特异性。在感染后期（临床体征和症状>10天），MRI显示典型的结节状靶样病变，Gd-DTPA增强边缘区域，这在疾病早期或假单胞菌或葡萄球菌感染患者中未见。总之，在疾病早期诊断IPA时，MRI表现不如CT晕征具有特征性，但Gd-DTPA增强边缘区域的MRI靶征和T2加权图像上的“反靶”在疾病后期强烈提示IPA。
