Semelka R C, Kelekis N L, Sallah S, Worawattanakul S, Ascher S M
Department of Radiology, University of North Carolina, Chapel Hill 27599-7510, USA.
AJR Am J Roentgenol. 1997 Nov;169(5):1311-6. doi: 10.2214/ajr.169.5.9353448.
We describe our 6-year experience in the prospective examination of patients with suspected hepatosplenic fungal disease to show the diagnostic accuracy of MR imaging and the spectrum of appearances on MR images.
All patients who underwent MR examination for suspected hepatosplenic fungal disease from January 1990 to January 1997 in three university institutions were included in the study. Patients presented with persistent fever or no response to antibacterial antibiotics. Patients were grouped as acute, subacute treated, and chronic treated, according to the duration of their symptoms. Patients with 2 weeks or fewer of possible infection were acute presentation, patients on antifungal therapy longer than 2 weeks but shorter than 3 months were subacute treated presentation, and patients on antifungal therapy for 3 months or longer or who had completed antifungal therapy and had a history of hepatosplenic fungal disease were chronic treated presentation. MR studies were prospectively interpreted for the presence of hepatosplenic fungal lesions. The appearances of fungal lesions in patients in each category were determined. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for detecting lesions in patients with acute presentation were also determined.
Sixty-nine patients were included in the study. MR imaging revealed signs consistent with hepatosplenic fungal lesions in 22 (32%) of 69 patients and no demonstration of hepatosplenic lesions in 47 (68%) of 69 patients. In the 60 patients with acute presentation, MR imaging in 13 patients revealed hepatosplenic lesions that were interpreted as fungal disease. True-positive lesions were present in 11 of these 13 patients. These lesions measured less than 1 cm in diameter and were best shown as well-defined high-signal-intensity foci on T2-weighted images. The remaining two of the 13 patients had false-positive lesions; one was shown to have tuberculosis, and the other had graft-versus-host disease. For acute presentation, MR sensitivity was 100%, specificity was 96%, positive predictive value was 85%, negative predictive value was 100%, and accuracy was 97%. In the five patients with subacute presentation, lesions were present that measured less than 1 cm in diameter and were best shown as mildly hyperintense on T1-weighted images. A perilesional ring nearly void of signal intensity was seen on unenhanced and gadolinium-enhanced T1-weighted images in all five patients. The four patients with chronic healed lesions all had lesions that were 1-3 cm in diameter with irregular, angular polygonal margins. These lesions, which were best shown on images obtained immediately after gadolinium administration, appeared as regions of diminished enhancement with no perilesional changes.
MR imaging has high diagnostic accuracy for the diagnosis of acute hepatosplenic fungal disease. Patients with acute, subacute treated, and chronic healed presentations may have lesions that can be distinguished by their MR appearances.
我们描述了对疑似肝脾真菌病患者进行前瞻性检查的6年经验，以显示磁共振成像（MR）的诊断准确性以及MR图像上的表现谱。
纳入1990年1月至1997年1月在三家大学机构因疑似肝脾真菌病接受MR检查的所有患者。患者表现为持续发热或对抗菌抗生素无反应。根据症状持续时间将患者分为急性、亚急性治疗和慢性治疗组。可能感染2周或更短时间的患者为急性表现，接受抗真菌治疗超过2周但短于3个月的患者为亚急性治疗表现，接受抗真菌治疗3个月或更长时间或已完成抗真菌治疗且有肝脾真菌病病史的患者为慢性治疗表现。对MR研究进行前瞻性解读以确定是否存在肝脾真菌病变。确定了每类患者中真菌病变的表现。还确定了急性表现患者中检测病变的敏感性、特异性、阳性预测值、阴性预测值和准确性。
69例患者纳入研究。MR成像显示69例患者中有22例（32%）有与肝脾真菌病变一致的征象，47例（68%）未显示肝脾病变。在60例急性表现的患者中，13例患者的MR成像显示有被解读为真菌病的肝脾病变。这13例患者中有11例为真阳性病变。这些病变直径小于1 cm，在T2加权图像上最显示为边界清晰的高信号灶。13例患者中的另外2例有假阳性病变；1例显示为结核病，另1例有移植物抗宿主病。对于急性表现，MR敏感性为100%，特异性为96%，阳性预测值为85%，阴性预测值为100%，准确性为97%。在5例亚急性表现的患者中，病变直径小于1 cm，在T1加权图像上最显示为轻度高信号。在所有5例患者的未增强和钆增强T1加权图像上均可见几乎无信号强度的病灶周围环。4例慢性愈合病变的患者均有直径1 - 3 cm、边缘不规则、呈角形多边形的病变。这些病变在钆给药后立即获得的图像上最显示，表现为强化减弱区域且无病灶周围改变。
MR成像对急性肝脾真菌病的诊断具有较高的诊断准确性。急性、亚急性治疗和慢性愈合表现的患者可能有可通过其MR表现区分的病变。
