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Supportive Care in Cancer

, Volume 16, Issue 6, pp 599–606 | Cite as

Pulmonary MRI—a new approach for the evaluation of febrile neutropenic patients with malignancies

  • C. RiegerEmail author
  • P. Herzog
  • R. Eibel
  • M. Fiegl
  • H. Ostermann
Original Article

Abstract

Goals of work

Immunocompromised patients with malignant diseases often suffer from pulmonary infections. Early detection of these life-threatening infections is crucial to start effective treatment. The gold standard for the diagnosis of these disorders is high-resolution computed tomography (HR-CT) of the chest. This method, however, has limitations, for instance, in the discrimination of early interstitial infiltrates and the use of X-rays. We conducted a study to determine the feasibility and sensitivity of magnetic resonance imaging (MRI) of the lung compared to HR-CT in immunocompromised patients with persistent fever in neutropenia and suspected pneumonia.

Materials and methods

Between January 2003 and July 2004, 50 consecutive neutropenic patients with fever of unknown origin and negative chest X-ray were examined with HR-CT of the lungs. Patients with pulmonary infiltrates were further examined with MRI of the chest within 24 h after HR-CT using a specific lung protocol. In addition, microbiological testing was performed for the characterization of the causative pathogen.

Results

Of 50 patients, 35 had pulmonary infiltration according to HR-CT; these were examined with MRI of the lungs. MRI showed a high correlation (91%) with the findings in HR-CT. Both HR-CT and MRI were feasible in 94% of the examined patients. In 12 of 35 patients, fungal pathogens were identified in microbiological testing.

Conclusions

MRI of the lungs is feasible in neutropenic patients with suspected pulmonary infection. Compared to HR-CT, MRI displays a high sensitivity in the detection of pulmonary infiltrates. MRI offers the opportunity of follow-up examinations without repeated X-ray exposure to the patient.

Keywords

Neutropenia Malignancy Pneumonia High-resolution computed tomography Magnetic resonance imaging 

References

  1. 1.
    Ascioglu S, Rex JH, de Pauw B, Bennett JE, Bille J, Crokaert F, Denning DW, Donnelly JP, Edwards JE, Erjavec Z, Fiere D, Lortholary O, Maertens J, Meis JF, Patterson TF, Ritter J, Selleslag D, Shah PM, Stevens DA, Walsh TJ (2002) Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 34:7–14PubMedCrossRefGoogle Scholar
  2. 2.
    Austin JH, Muller NL, Friedman PJ, Hansell DM, Naidich DP, Remy-Jardin M, Webb WR, Zerhouni EA (1996) Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society. Radiology 200:327–331PubMedGoogle Scholar
  3. 3.
    Berrington de Gonzalez A, Darby S (2004) Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet 363:345–351PubMedCrossRefGoogle Scholar
  4. 4.
    Biederer J, Busse I, Grimm J, Reuter M, Muhle C, Freitag S, Heller M (2002) Sensitivity of MRI in detecting alveolar infiltrates: experimental studies. Rofo 174:1033–1039PubMedGoogle Scholar
  5. 5.
    Blum U, Windfuhr M, Buitrago-Tellez C, Sigmund G, Herbst EW, Langer M (1994) Invasive pulmonary aspergillosis. MRI, CT, and plain radiographic findings and their contribution for early diagnosis. Chest 106:1156–1161PubMedCrossRefGoogle Scholar
  6. 6.
    Bodey G, Bueltmann B, Duguid W, Gibbs D, Hanak H, Hotchi M, Mall G, Martino P, Meunier F, Milliken S et al (1992) Fungal infections in cancer patients: an international autopsy survey. Eur J Clin Microbiol Infect Dis 11:99–109PubMedCrossRefGoogle Scholar
  7. 7.
    Eibel R, Herzog P, Dietrich O, Rieger CT, Ostermann H, Reiser MF, Schoenberg SO (2006) Pulmonary abnormalities in immunocompromised patients: comparative detection with parallel acquisition MR imaging and thin-section helical CT. Radiology 241:880–891PubMedCrossRefGoogle Scholar
  8. 8.
    Greene JN, Linch DC, Miller CB (2000) Current treatments for infection in neutropenic patients with hematologic malignancy. Oncology (Williston Park) 14:31–34Google Scholar
  9. 9.
    Greene RE, Schlamm HT, Oestmann JW, Stark P, Durand C, Lortholary O, Wingard JR, Herbrecht R, Ribaud P, Patterson TF, Troke PF, Denning DW, Bennett JE, de Pauw BE, Rubin RH (2007) Imaging findings in acute invasive pulmonary aspergillosis: clinical significance of the halo sign. Clin Infect Dis 44:373–379PubMedCrossRefGoogle Scholar
  10. 10.
    Griswold MA, Jakob PM, Heidemann RM, Nittka M, Jellus V, Wang J, Kiefer B, Haase A (2002) Generalized autocalibrating partially parallel acquisitions (GRAPPA). Magn Reson Med 47:1202–1210PubMedCrossRefGoogle Scholar
  11. 11.
    Hatabu H, Gaa J, Tadamura E, Edinburgh KJ, Stock KW, Garpestad E, Edelman RR (1999) MR imaging of pulmonary parenchyma with a half-Fourier single-shot turbo spin-echo (HASTE) sequence. Eur J Radiol 29:152–159PubMedCrossRefGoogle Scholar
  12. 12.
    Hauggaard A, Ellis M, Ekelund L (2002) Early chest radiography and CT in the diagnosis, management and outcome of invasive pulmonary aspergillosis. Acta Radiol 43:292–298PubMedCrossRefGoogle Scholar
  13. 13.
    Heidemann RM, Ozsarlak O, Parizel PM, Michiels J, Kiefer B, Jellus V, Muller M, Breuer F, Blaimer M, Griswold MA, Jakob PM (2003) A brief review of parallel magnetic resonance imaging. Eur Radiol 13:2323–2337PubMedCrossRefGoogle Scholar
  14. 14.
    Herold CJ, Kramer J, Sertl K, Kalhs P, Mallek R, Imhof H, Tscholakoff D (1989) Invasive pulmonary aspergillosis: evaluation with MR imaging. Radiology 173:717–721PubMedGoogle Scholar
  15. 15.
    Herzog P, Rieger CT (2004) Risk of cancer from diagnostic X-rays. Lancet 363:340–341PubMedCrossRefGoogle Scholar
  16. 16.
    Heussel CP, Kauczor HU, Heussel GE, Fischer B, Begrich M, Mildenberger P, Thelen M (1999) Pneumonia in febrile neutropenic patients and in bone marrow and blood stem-cell transplant recipients: use of high-resolution computed tomography. J Clin Oncol 17:796–805PubMedGoogle Scholar
  17. 17.
    Leutner CC, Gieseke J, Lutterbey G, Kuhl CK, Glasmacher A, Wardelmann E, Theisen A, Schild HH (2000) MR imaging of pneumonia in immunocompromised patients: comparison with helical CT. AJR Am J Roentgenol 175:391–397PubMedGoogle Scholar
  18. 18.
    Lutterbey G, Gieseke J, Sommer T, Keller E, Kuhl C, Schild H (1996) A new application of MR tomography of the lung using ultra-short turbo spin echo sequences. Rofo 164:388–393PubMedGoogle Scholar
  19. 19.
    Moody AR, Bolton SC, Horsfield MA (1995) Optimization of a breath-hold magnetic resonance gradient echo technique for the detection of interstitial lung disease. Invest Radiol 30:730–737PubMedCrossRefGoogle Scholar
  20. 20.
    Picazo JJ (2004) Management of the febrile neutropenic patient: a consensus conference. Clin Infect Dis 39(Suppl 1):S1–S6PubMedCrossRefGoogle Scholar
  21. 21.
    Rolston KV (2005) Challenges in the treatment of infections caused by gram-positive and gram-negative bacteria in patients with cancer and neutropenia. Clin Infect Dis 40(Suppl 4):S246–S252PubMedCrossRefGoogle Scholar
  22. 22.
    Sipsas NV, Bodey GP, Kontoyiannis DP (2005) Perspectives for the management of febrile neutropenic patients with cancer in the 21st century. Cancer 103:1103–1113PubMedCrossRefGoogle Scholar
  23. 23.
    Viscoli C, Varnier O, Machetti M (2005) Infections in patients with febrile neutropenia: epidemiology, microbiology, and risk stratification. Clin Infect Dis 40(Suppl 4):S240–S245PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • C. Rieger
    • 1
    Email author
  • P. Herzog
    • 2
  • R. Eibel
    • 2
  • M. Fiegl
    • 1
  • H. Ostermann
    • 1
  1. 1.Department of Internal Medicine IIIUniversity Hospital Grosshadern, Ludwig-Maximilians-University MunichMunichGermany
  2. 2.Institute of Clinical RadiologyUniversity Hospital Grosshadern, Ludwig-Maximilians-University MunichMunichGermany

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