| Objectives:To analyse the clinical data and imaging data of patients with invasive pulmonary fungal infection(IPFI),and study the characteristics, synthesis diagnosis and explore the relationship between image with prognosis of disease.Methods:1. The patient data:Clinical and radiological data was from patients with definite diagnosis or clinical diagnosis of IPFI in respiratory, transplantation, ICU and onset in December 2013 to January 2016:70 cases of IPFI,43 cases of male,27 cases of female, mean age,53.16 years (±15.36 years).75 cases of bacteria infection,40cases of male,35 cases of female, mean age,55.16 years (±16.39 years). A total of 145 cases.2. Groups(1).Early IPFI group and early bacteria group:patients were selected who had CT examination with symptoms in 7 days.33 cases as early IPFI group in the 70 patients of IPFI; 31 cases as early bacterial group in the 75 bacterial infection patients.(2).True positive group and true negative group:145 cases in which the G test and PCT test and CT test data were selected.19 cases of IPFI in 70 patients of IPFI; 14 cases of bacterial infection in 75 bacterial infection patients. With IPFI infection was true positive, bacterial infection as true negative.(3).Non-neutropenic group (39 cases) and neutropenic group:granulocyte level 0.5 x 109/L is bounded in the 70 patients of IPFI, neutrophil≥0.5×109/L for non-neutropenic group; neutrophil<0.5×109/L for neutropenic group.(4).cure or improvement group and deterioration or death group:patients had CT examine at least 3 weeks and once a week for CT in the 70 patients of IPFI.Cure or improvement group:1 clinical symptoms, signs and symptoms were relieved or disappeared; 2 the lung CT signs of the disease showed that the lesion was reduced or absorption decreased before leave hospital.Deterioration or death group:1 clinical symptoms, signs and symptoms did not improve or worsen, even to death; 2 the lungs CT signs of the disease showed increased, growing or bloom into the cavity suggesting the deterioration of the disease before leave hospital.3. CT image analysis:2 Chest physician radiologists read films respectively.When opinions are different, coincidence was reached after negotiation.the evaluating contents including:the main lesion nature, size, shape, distribution, abundance, internal structure, the outer periphery of the performance, the way the invasion.4. The laboratory results interpretation:G test results:G test positive defined value> 100pg/ml according to the provisions of G kit test. PCT positive:procalcitonin ≥0.5μg/LResults:1.Common CT signs:The most common CT appearances of IPFI were solitary or multiple nodules or mass which found in 42 cases (60.00%);followed by consolidation in 40 cases (57.14%) and ground glass opacity (GGO) in29 patients(41.43%). With the signs, the more common unilateral or bilateral pleural effusion (25 cases,32.86%); mediastinal or hilar lymphadenopathy rare (2 cases, 2.86%). Mixed lesions (41 cases,58.57%) more common in simple lesions (29 cases 41.43%). Halo sign and empty/air crescent sign had low occurrence rate (5 cases,8 cases, accounting for 7.14%,11.43%.). Nodules/mass,consolidation and GGO tend to distributed in low lung and peripheral zone (P<0.05); Single or double side pulmonary distribution had no significant difference (P>0.05).2.Early IPFI group (n=33) and early bacterial group (31 cases):significance signs were tree in bud sign, nodules or masses and mixed lesions in the early differential diagnosis of IPFI and bacterial; while wedge-shaped consolidation and GGO had little significance (P>0.05) in the early differential diagnosis of IPFI and bacterial infection. In order to further verify the early identification of IPFI and bacteria in the tree bud sign, nodule/mass and mixed lesions and other signs, then two Logistic regression analysis was performed. CT signs were successively removed including multiple miliary nodules, GGO, lobe or lung segment wedge consolidation and nodules/mass. The significance of CT findings in the diagnosis of IPFI was halo sign, tree bud sign, air crescent sign, cavity and mixed lesion. The arrangement according to the weight from the size were mixture of lesions, halo sign, air crescent sign/ cavity and tree bud sign.3.True positive group (19 cases) and true negative group (14 cases):the CT sensitivity was 84.21% and the specificity was 35.71%. The sensitivity and specificity of G test were 52.63% and 28.57%. The sensitivity and specificity of PCT test were 68.42% and 57.14%. The positive sensitivity of CT and G test was 47.37%, the specificity was 64.29%, the positive sensitivity was 57.89%, the specificity was 71.43%, CT and PCT.4.Non-neutropenic group (39 cases) and neutropenic group (31 cases) CT classification comparison:nodules/mass type(P= 0.031) and mainly consolidation type(P=0.031)were significant difference (P all< 0.05). Non-neutropenic group in consolidation performance-based (20/39,51.28%), neutropenic group with nodules/ lumps performance-based (18/31,58.06%). GGO predominant was no significant difference Invasion mode comparison:vascular invasion and airway invasion difference were significant difference (P all< 0.05), vascular invasion more accure in neutropenic patients, airway invasion more accure in non-neutropenic patients.Mixed and undifferentiated invasion were no significant difference (P all> 0.05).5.Cure improvement group (18 cases) and deterioration of the death group (11 cases): exudative lesions was significant difference in tow groups (P=0.048), cure improved group (14/18,77.78%), the deterioration of the death group (4/11,36.36%). Nodules/mass lesions was no significant difference in cure improvement group, and deterioration of the death group (P>0.05).Small nodules and small nodules were found (33.33%,33.33%) in cure improvement group, while deterioration death group with large nodules (63.64%). There was no significant difference in the number of nodules group (P>0.05). There was a significant difference in the first week and third weeks in the treatment of the patients with the disease, and There was significant difference (P<0.05), indicating a good prognosis. The number and size of the lesions were in the 2nd week reached peak.Tthe cure improvement group and pulmonary lesions in the 3 weeks showed by absorption or tends to be stable, a decrease in the number of lesions at week 4, range is reduced to deteriorate and die group of lung lesions in the 3 weeks showed for absorption was not obvious or range increase than before, in week 4 lesions were compared with no obvious change before. The pathological changes of the inflammatory lesions (P<0.05). Lung lesions was absorbed or stabilizaed in third week,and numbers of lesions reduced in fourth week in cure improvement group. Lung lesions was not obviously absorbed or range increase from the previous in third week, lesion no obvious changes.in fourth week in deterioration of the death group.Conclusions:1.Pulmonary invasive fungal infection of CT performance is more complex, can have a variety of manifestations, with nodules/masses and real change as the main. Can be pure or mixed lesions, mixed lesions more common. Shadow with two nodules or masses and peripheral lung in distribution. Pleural effusion can be complicated, but the chest lymph node enlargement is rare.2.Pulmonary invasive fungal infections is different from bacterial pneumonia imaging in mixed lesions, halo sign, where in the mixing lesions to distinguish between the two is important.3.Pulmonary invasive fungal infection G test and PCT test specificity is low, the sensitivity is medium; CT sensitivity is higher, the specificity is low. G test or PCT combined with CT imaging method, can take into account the sensitivity of the same time improve the diagnostic specificity, for the differential diagnosis may have a certain value.4.Non neutropenia and neutropeniapatients have different CT findings with invasive pulmonary fungal infection. Non-neutropenic patients is given priority to with consolidation, neutropenic patients is given priority to with nodules/mass. Non-neutropenic patients with airway invasion is more common, while neutropenic patients with airway invasion is more common.5.CT finds with invasive pulmonary fungal infection were related to the prognosis. CT showed a good prognosis in the patients with effusion and small nodules. If lesion evolution of exudative lesions indicates good prognosis in the third week.After 4 weeks and pathological changes of imaging improved the prognosis is good, if progress is poor prognosis.6.Invasive pulmonary fungal infection CT examination should be early and dynamic follow-up. Lesions in the second week of the fastest growing disease progression, it is recommended in patients with symptoms 7 days to 14 days to review CT. The third week and the fourth week of CT examination is mainly used to judge prognosis. |
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