| Background and Purpose The number of patients suffered from pulmonary fungal disease has incresed over the recent years, mainly due to overusing of antibiotics, long term using of immunosuppressants, the worldwide solid organ and many other factors. Compared to bacteria infection, fungal infection has a higher mortality, and also antifungal drugs are limited and expensive. Pulmonary fungal disease exists not only in immunosupp-ressed and immunocompromised patients but also in non-immunosuppressed patients. It has become a prevalence study problem. Pulmonary fungal infection includes not only invasive pulmonary mycosis, but also disseminated pulmonary mycosis, parastism, commensnlism.etc. Now in our country diagnosis and treatment guide about fungal infection are mostly for immunosuppressed patients and invasive pulmonary mycosis. However, there is little definite guide about non-immunosuppressed patients and chronic pulmonary fungal disease. Besides, the radiology menifestations reffered in the guide such as nodules, halo sign and cavity/air-cresent for invasive pulmonary fungal infection or ground-glass opacity for pneumocystis pneumonia can not meet the demand of clinical. In addition to that, different types of pulmonary mycosis has different radiology menifestations according to the exsited study, which leading to different use of medcine for treatment. Serum(1,3)-β-D-Glucan test(G test) and serum galactomannan test(GM test) are important biological indicators for diagnosing invasive pullmonary mycosis and invasive pulmonary aspergillosis. But the sensitivity and specificity greatly vary in reports. Also this condition is often found in clinical that exact lesions in radiology findings but with negative value of G test or GM test. The relative studies are rare that investigating in the relationship between radiology findings and laboratory tests whether exsits or how in patients of pulmonary fungal disease. Our aim is to study radiology findings and meaningful signs for differentiating among different types of pulmonary fungal disease in non-immunosuppressed patients. Also we are going to discuss whether there is relationship between radiology menifestations and serum G test and GM test. Finally the awareness of pulmonary mycosis is raised.Materials and Methods We retrospectively collected and recorded 161 cases of pulmonary fungal disease who were conformed to our standards in the First Affiliated Hospital of Zhengzhou University from January 2011 to October 2015. Clinical datas, radiological information,value of serum(1,3)-β-D-Glucan test(G test) and serum Galactomannan test(GM test) were recorded. Two experienced radiologists analysesed films together and recorded distribution of lesions, CT findings and 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.Results 1 Clinical results 161 cases were involved in our study which were diagnosed pulmonary fungal disease with histopathological evidence. Among the 161 cases, pulmonary aspergillus was in 48 cases, pulmonary cryptococcal in 45 cases, pulmonary mucormycosis in 16 cases, pulmonary candidiasis in 3 cases, pathogens that were not clear in 49 cases. The sensitivity of CT-guided percutaneous lung biopsy was 94.1% and bronchoscopy biopsy 85.0%. 2 Distribution, CT findings and signs Lesions mainly distributed in lower lobes, peripheral, or radomly in unilateral pulmonary aspergillosis, pulmonary cryptococcosis and pulmonary mucormycosis. The differences of lesions’ distribution in unilateral or bilateral lungs in the three pulmonary fungal disease had statistically meaning(P=0.027). Lesions’ distribution: Multiple lesions in bilateral lung were mostly common seen in pulmonary aspergillosis. To pulmonary crytococcosis, lesions shared a similar proportion in the follow styles: single lesion in unilateral lung, multiple lesions in unilateral lung and multiple lesions in bilateral lungs. When it to pulmonary mucormycosis, single lesion happened in unilateral lung were overwhelming. Multiple lesions in bilateral lungs usually more often seen inpulmonary aspergillosis than in pulmonary mucormycosis(P = 0.004). The mostly common CT appearances of pulmonary aspergillus were nodules or masses with number more than 10(56.8%) and various sizes. Tree-in-bud accounted for 40.9%, cavity 43.2%, air-crescent 22.7%, halo sign 25.0%. The size of consolidation lesions varied. The mostly common CT findings of pulmonary crytococcosis were nodules or masses with signal(41.0%) or multiple lesions(number 2-10)(43.6%) and with size of 10-30 mm, followed by tree-in-bud(10.3%), cavity(15.4%) and air-crescent sign(0.0%). Halo sign was more common seen in pulmonary crytococcosis(59.0%). Small patches dominated in consolidation lesions(75.0%). The mainly CT manifestations of pulmonary mucormycosis were nodules or masses, but the rate was lower than pulmonary aspergillosis’ s(P=0.012). Nodular or mass lesions mostly were single(50.0%) with diameter larger than 30mm(80.0%) followed by reversed halo sign(60.0%). Air- crescent sign was rare(0.0%). Large patches dominated in consolidation lesions(100.0%).When compared nodular or mass lesions of pulmonary aspergillosis with pulmonary cryptococcosis’, the results showed that pulmonary aspergillosis had a higher number of lesions which usually more than 10(P=0.000) and irregular distributed while pulmonary cryptococcosis with less lesions( number 2-10)(P = 0.002) and occurring at the pleura(P = 0.013). Smaller nodules of which diameter less than 10 mm is mostly seen in pulmonary aspergillosis than in pulmonary cryptococcosis(P=0.014), which is vice versa for nodules with diameter 10-30mm(P = 0.009). It has a higher rate of tree-in-bud, cavity and air-crescent in pulmonary aspergillosis(P=0.002, P=0.006, P=0.001). However, halo sign often seen in pulmonary cryptococcosis(P=0.000). When refers to consolidation lesions, small patchy lesions often occured in pulmonary cryptococcosis instead of pulmonary mucormycosis(P=0.010), while nodular lesions with diameter larger than 30 mm were mostly seen in pulmonary mucormycosis(P = 0.008). Reversed halo sign had an imprtant meaning in differentiating for it appeared quitely often in pulmonary mucormycosis than in pulmonary aspergillosis and pulmonary cryptococcosis(P = 0.000, P = 0.000). 3 G test and CT findings There were 85 cases that had underwent serum G test among 161 proven cases. 42 cases were negative and 43 positive. Grouping the positive group agian based on results of G test: Group A(100-151pg/ml), Group B(151-500pg/ml), Group C(≥500pg/ml). Result: The incidence of nodules or masses with air-crescent sign is higher in negative group than in positive group(P=0.002). The result of our research is that the incidence of multiple lesions(number ≥10) is higer in Group C than that Group A and B(P=0.002, P=0.001), so was tree-in-bud sign(P=0.002,P=0.002). The rate of cavity is higher in Group A than Group B(P=0.008). 4 GM test and CT findings 37 patients had underwent serum galactomannan(GM Test) examination in 48 cases proven diagnosed with pulmonary fungal disease. 12 were negative and 25 positive. The result is that incidence of air crescent sign is statistically higher in negative group than in positive group(P = 0.000).Conclusion 1. CT-guided percutaneous lung biopsy and bronchoscopy biopsy has a high sensitivity for non-immunosuppressed pulmonary fungal disease patients in confirmed diagnose and offer a great help for clinical diagnosis. 2. It gives a help to the diagnosis of pulmonary fungal disease and differentiation that lesions’ distribution, sizes of nodules or masses, lesions’ number, with or without cavity, air-crescent sign, tree-in-bud sign, halo sign and reversed halo sign. 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. |
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