| Objective:This study is retrospective analysis of 69 cases of pulmonary infections after Hematopoietic stem cell transplantation (HSCT) clinical records and multislice spiral CT (MSCT) fingdings, in order to investigate the characteristics of clinical and imaging appearance and the diagnosis value of MSCT.Materials and methods:1. The’ clinical records and CT findings of pulmonary infections confirmed by clinical,laboratory culture or pathology in 69 recipients of HSCT between August 2003 and April 2010 were retrospectively reviewed.There were 44 men and 25 women;mean age,33 years;age range,2-56 years.In these patients,57 cases were fever,15 cases were cough or sputum,7 cases were polypnea,12 cases were two or beyond two above symptom.2. Diagnostic criteria of pulmonary infection after HSCT are consistent with "Hospital infection diagnostic criteria" formulated by Chinese Department of Health in 2001 and "Diagnostic criteria and treatment principle of invasive pulmonary fungal infections (draft)" in 2006.3. With SIMENSE Sensation 16 spiral CT machines and GE 64 Lightspeed spiral CT machines, scan range is from thoracic inlet to the diaphragm. The thickness and interval of scaning is 10 or 5 mm with routine exposure dosage. CT enhancement with total dosage of 60～100 m1 non-ion iodine (300 mgI/ml) agent was administered at a rate of 2.0～3.Oml/sec. The MPR and VR images were obtained by the workstation of SIMENSE Volume Wizard and GE AW4.3. The CT findings were analysed in PACS of SIMENSE and Qi zhiyuan.4. Including ground-glass attenuation, air space consolidation, nodule or mass, graticules or lines, cavitation and others, the CT characteristics of pulmonary infections in 69 recipients of HSCT were analysed,evaluating contents including the appearance, scope and distribution of the main pathological changes.5. Using SPSS 13.0, relative numbers are described by rate and ratio, measurement data among groups take χ2 test. a P value of less than 0.05 was considered statistically significant.Results1. The incidence rate of pulmonary infections after HSCT was 35.9%, the mortality was 8.3%. Among different kinds of etiological agents, the incidence of mixed infections was highest,which incidence and constituent ratio was 15.6% and 36.2% respectively. The incidence rate and mortality of pulmonary infections in non Consanguinity donor was higher than Consanguinity donor.2. Bacterium was the most common in all pathogenic bacterium examined,which occupied 82.9%. Gram-Negative bacillus occupied 60.3%,Escherichia and Klebsiella pneumoniae were the most common, Gram-Positive coccus occupied 17.6%, and Staphylococcus epidermidis was the most common; fungus occupied 17.1% of all pathogenic bacterium, of which Candida albicans was the most common.3. The constituent ratio of pulmonary infections was highest in early stage(1-30day) after HSCT which occupied 55.1%,and the constituent ratio of pulmonary infections in in middle stage(31-100day) and later stage(>100day) was 24.6% and 20.3% respectively.Bacterial infections, fungal infections and mixed infections were most common in early stage,their infection’s ratio in this stage was 78.6%,52.6%,56.7% respectively.Viral infections were more common in middle stage which infection’s ratio in this stage was 66.7%.There was not preponderant pathogenic bacterium in later stage.Infection’s ratio were undifferentiated in three stages between fungal infections and non fungal infections.4. Thoracic CT appearances(1) Common CT signs:The common CT signs consist of ground-glass attenuation, air space consolidation, nodules or masses, graticules or lines and cavitation. All no significant differences in the incidence rate of ground-glass attenuation, air space consolidation,graticules or lines and cavitation in three groups of bacterial infection, fungus infection and virus infection was found (p>0.05),but the incidence rate of nodules or masses in fungus infection was significantly higher than in bacterial infection and virus infection(P< 0.05).(2) CT appearances of pulmonary infections after HSCT:bacterial infections(n=14), The most common CT findings were air space consolidation (n=7) and ground-glass attenuation(n=6), mainly diffusely distribute(n=7); fungal infections(n=19), the most frequent features were nodules or masses(n=15), air space consolidation (n=10), ground-glass attenuation(n=6), graticules or lines(n=4),5 cases had Air Crescent Sign,8 cases had Halo Sign,10 cases have fruits-on-branch sign, mainly distribute subpleural (n=11); viral infections(n=6), The most common CT findings were ground-glass attenuation(n=3), nodules or masses(n=2), graticules or lines(n=1), mainly diffusely distribute(n=4); mixed infections(n=30), The most common CT findings were ground-glass attenuation(n=15), nodules or masses(n=15), mainly diffuse or subpleural distribute.ConclusionThe incidence of mixed infections was highest in all different kinds pulmonary infections after HSCT aroused by various kinds pathogenic bacterium, next fungal infections, bacterial infections and viral infections respectively.In all pathogenic bacterium examined, Candida albicans was the most common in fungus and Escherichia and Klebsiella pneumoniae were the most common in Gram-Negative bacillus which more common than Gram-Positive bacillus. The incidence rate of pulmonary infections after HSCT in non Consanguinity donor was higher than Consanguinity donor and the mortality pulmonary infections after HSCT in non Consanguinity donor was higher than Consanguinity donor,also.The former had not statistical significance(P> 0.05) but the latter had statistical significance(P< 0.05). Of pulmonary infections after HSCT,bacterial infections, fungal infections and mixed infections were most common in early stage(1～30day), fungal infections and viral infections were most common in middle stage(31～100day),and preponderant pathogenic bacterium infections were not seen in later stage(>100day) when the incidence of infections dropped. CT was important method of examination in pulmonary infections after HSCT,it can reveal imaging appearance characteristics of infections, such as shape and distribution of lesion. Nodules or masses, "Halo sign", "Air crescent sign" and "Fruit-on-branch sign" were more common in patient with fungus infections.The appearance of CT was various, so time of pulmonary infections after HSCT, the shape and distribution of lesion, the’ clinical and laboratorial records must be combined with in order to accurately diagnosis. |
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