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Differential diagnosis of pulmonary infections in immunocompromised patients using high-resolution computed tomography

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Abstract

Objectives

The aims of this study were to compare the high-resolution computed tomography (HRCT) findings of pulmonary infections in immunocompromised patients and to assess the usefulness of HRCT in the differential diagnosis of these infections.

Methods

A total of 345 immunocompromised patients with pulmonary infections were included in this study. The diagnoses of the patients consisted of bacterial pneumonia (123 cases), pneumocystis pneumonia (PCP) (105 cases), fungal pneumonia (80 cases), tuberculosis (15 cases), cytomegalovirus pneumonia (11 cases), and septic embolism (11 cases). Two chest radiologists retrospectively evaluated the computed tomography (CT) images, which consisted of 22 findings including ground-glass attenuation, consolidation, nodules, and thickening of the bronchial wall and interlobular septum. Associations between the CT criteria and infections were investigated using χ2 test; multiple logistic regression analyses were conducted to identify the significant indicator for each infection. The area under the curve (AUC) of each model was calculated.

Results

Bronchial wall thickening was a significant indicator for bacterial pneumonia (p = 0.002; odds ratio [OR], 2.341; 95% confidence interval [CI], 1.378–3.978). The presence of a mosaic pattern and the absence of nodules were significant indicators for PCP (p < 0.001; OR, 9.808; 95% CI, 4.883–13.699, and p < 0.001; OR, 6.834; 95% CI, 3.438–13.587, respectively). The presence of nodules was a significant indicator for fungal infection (p = 0.005; OR, 2.531; 95% CI, 1.326–4.828). The AUC for PCP was the highest (0.904).

Conclusions

HRCT findings are potentially useful for the differential diagnosis of some pulmonary infections in immunocompromised patients.

Key Points

• Differential diagnosis of pulmonary infections in immunocompromised patients could be established with the help of high-resolution computed tomography.

• Bronchial wall thickening was a significant indicator for bacterial pneumonia.

• The presence of a mosaic pattern and the absence of nodules were significant indicators for pneumocystis pneumonia.

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Abbreviations

κ :

Kappa value

χ 2 :

Chi-square

AIDS:

Acquired immunodeficiency syndrome

AUC:

Area under the curve

BAL:

Bronchoalveolar lavage

CI:

Confidence interval

CMV-P:

Cytomegalovirus pneumonia

Cons:

Consolidation

CT:

Computed tomography

GGA:

Ground-glass attenuation

HRCT:

High-resolution computed tomography

HSCT:

Hematopoietic stem cell transplantation

ICC:

Intraclass correlation coefficient

ILS:

Interlobular septum

LN:

Lymph node

NPV:

Negative predictive value

OR:

Odds ratio

PACS:

Picture archiving and communication system

PCP:

Pneumocystis pneumonia

PPV:

Positive predictive value

S. aureus :

Staphylococcus aureus

SLB:

Surgical lung biopsy

TB:

Tuberculosis

TBLB:

Transbronchial lung biopsy

TIB:

Tree-in-bud

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, National Hospital Organization Yamaguchi - Ube Medical Center, 685 Higashikiwa, Ube, Yamaguchi, 755-0241, Japan

    Yoshie Kunihiro, Nobuyuki Tanaka & Tsuneo Matsumoto

  2. Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan

    Yoshie Kunihiro, Nobuyuki Tanaka & Taiga Kobayashi

  3. Center for Integrated Medical Research, Hiroshima University Hospital, Kasumi 1-2-3 Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan

    Reo Kawano

  4. Division of Endocrinology, Metabolism, Hematological Science and Therapeutics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan

    Toshiaki Yujiri

  5. Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan

    Makoto Kubo

  6. Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan

    Kazuhiro Ueda

  7. Division of Pathology, Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa, Kanagawa, 251-8550, Japan

    Toshikazu Gondo

Authors
  1. Yoshie Kunihiro
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  2. Nobuyuki Tanaka
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  3. Reo Kawano
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  4. Toshiaki Yujiri
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  5. Makoto Kubo
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  6. Kazuhiro Ueda
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  7. Toshikazu Gondo
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  8. Taiga Kobayashi
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  9. Tsuneo Matsumoto
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Corresponding author

Correspondence to Yoshie Kunihiro.

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Guarantor

The scientific guarantor of this publication is Nobuyuki Tanaka.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

One of the authors, Reo Kawano, has significant statistical expertise and provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board because this study was a retrospective study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• case–control study

• performed at one institution

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Kunihiro, Y., Tanaka, N., Kawano, R. et al. Differential diagnosis of pulmonary infections in immunocompromised patients using high-resolution computed tomography. Eur Radiol 29, 6089–6099 (2019). https://doi.org/10.1007/s00330-019-06235-3

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  • DOI: https://doi.org/10.1007/s00330-019-06235-3

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