Imaging Manifestations And Laboratory Test Of Invasive Pulmonary Fungal Disease In Hematological Patients

Background and Purpose The incidence of invasive fungal infection increased year by year, especially the incidence rate of invasive pulmonary fungal infection was 50%-60%. This ratio is higher in patients with hematologic diseases. At the same time, the treatment cost is high because of the invasive pulmonary fungal infection, and the late mortality is high.At present, the early diagnosis of invasive pulmonary fungal infection in the blood system disease has become the focus and hot spot of the scholars.Although serum beta glucan(1-3)-D test(G test) and serum galactomannan test(GM test) for Microbiology index for the diagnosis of invasive pulmonary fungal disease and invasive pulmonary aspergillosis, early diagnosis of certain suggestive invasive pulmonary fungal infection. However, due to the differences in the species,quantity and infection of pulmonary fungal infection, the sensitivity and specificity of the lung fungal infection were greatly different. Many diseases of the blood system were found to have the exact lesion, while the G test and the GM test were negative.With the development of image science, especially the great progress of the CT equipment hardware and software in recent years, doctors use a variety of image postprocessing function(including MPR, VRT, etc.) can not only show the subtle lesions, more accurately describe the characteristic and range of lesions, CT examination has become an important means of diagnosis of lung disease. This study retrospectively analyzed blood diseases with invasive early and advanced performance and serum CT, epidemiological characteristics of patients with pulmonary fungal infection(1-3) beta glucan-D test(G test) and serum galactomannan test(GM test) test to check, from the aspects of improvingunderstanding of invasive fungal infection of the lungs patients with blood diseases,improve the accuracy of early diagnosis.Materials and Methods Collection of the First Affiliated Hospital of Zhengzhou University from December 2014 to October 2015 39 cases of confirmed or clinically diagnosed hematological diseases with invasive pulmonary fungal infection in hospitalized patients, record the clinical data, imaging data, serum(1,3) beta glucan-D test(G test)and serum galactomannan test(GM test) results. By 2 senior radiologists read the CT data analysis and record the distribution of lesions, CT signs. Statistical analysis was get from SPSS 17.0 software with rate, ratio, mean±standard deviation, chi-square test,continuous chi-square correction method and Fisher’s exact method and so on.Results1 Clinical results39 cases of hematological diseases and secondary invasive pulmonary fungal infection, 24 cases of confirmed cases: the sputum culture confirmed 12 cases, 8cases of bronchial lavage confirmed, CT guided percutaneous lung biopsy in 4 cases;clinical diagnosis of 10 cases, 5 cases of suspected.2 Distribution, CT findings and signs The blood system disease complicated with invasive pulmonary fungal infection in patients with chest CT is the most common signs of nodule / mass(Dan Chunxing),the incidence of infection is the most common type of 66.6%. for invasive pulmonary aspergillosis, invasive pulmonary cryptococcosis. Distribution of lesions: invasive pulmonary aspergillosis in two pulmonary multiple; invasive pulmonary cryptococcosis in a single solitary lung disease, multiple lung similar. The proportion of invasive pulmonary aspergillosis in the periphery, random distribution.Invasive pulmonary aspergillosis with nodule or mass lesions, with diameter10mm to 30 mm.(62.5%), halo sign(63.2%). Pleural effusion and real change rare(6.2%).Invasive pulmonary cryptococcosis with nodule / mass type, consolidation,nodules or mass diameter to 10-30 mm mainly(57.1%).Invasive pulmonary aspergillosis and invasive pulmonary cryptococcosis,invasive pulmonary aspergillosis nodule / mass type(P=0.05), the high incidence of invasive pulmonary cryptococcosis real high incidence(P=0.001).3 G test and CT findings39 cases of hematological diseases and secondary invasive pulmonary fungal infection in patients with serum G test for the first time for a total of 27 cases,positive G test(more than 100pg/ml) in 16 cases, 11 cases were negative. In the 7 day follow-up, 14 cases were positive for G test, 13 cases were negative. 14 days of serum G test was positive in 12 cases, negative in 15 cases. 30 days of serum G test was positive in 6 cases, negative in 21 cases. Results: compared with the positive group,the incidence of nodule / mass type was higher in the negative group(P=0.008).4 GM test and CT findings39 cases of hematological diseases and secondary invasive pulmonary fungal infection, first blood galactomannan test(GM test) were examined in 27 cases,positive GM test(more than 0.85) in 23 cases, 4 cases were followed up for 7 days.The G test negative serum GM test was positive in 18 cases, 9 cases were negative.14 serum positive GM test in 17 cases, 10 cases were negative.30 serum GM test was positive in 15 cases, 12 cases were negative.Statistically significant difference between the positive rate of GM test and G test, the positive rate of GM test for detection of pulmonary aspergillosis is higher than that of the G test.G test for pulmonary aspergillosis sensitivity of 27.0%.GM test for pulmonary aspergillosis sensitivity was 67.6%, the difference was statistically significant(P=0.000). Results: compared with the positive group, negative group,positive the air crescent sign high incidence group(P=0.012).Conclusion1.Patients with secondary pulmonary blood disease invasion first signs of CT infection of Aspergillus, the nodule / mass type(CT features simple nodules or masses), with small nodules, nodules, nodules are common manifestations of CT,respectively in the peripheral lung nodules with bilateral distribution.2.Follow up CT signs changes in the early diagnosis of hematological disease secondary to pulmonary invasive aspergillus infection has a high sensitivity, could provide help for clinical treatment.3. The values of G test and GM test have a relationship with CT menifestations as lesions’ number, air-crescent sign, cavity, tree-in-bud sign.