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

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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.

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References

  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 34:7–14

    Article  PubMed  CAS  Google Scholar 

  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 200:327–331

    PubMed  CAS  Google Scholar 

  3. Berrington de Gonzalez A, Darby S (2004) Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet 363:345–351

    Article  PubMed  Google Scholar 

  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 174:1033–1039

    PubMed  CAS  Google Scholar 

  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 106:1156–1161

    Article  PubMed  CAS  Google Scholar 

  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 11:99–109

    Article  PubMed  CAS  Google Scholar 

  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 241:880–891

    Article  PubMed  Google Scholar 

  8. Greene JN, Linch DC, Miller CB (2000) Current treatments for infection in neutropenic patients with hematologic malignancy. Oncology (Williston Park) 14:31–34

    CAS  Google Scholar 

  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 44:373–379

    Article  PubMed  Google Scholar 

  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 47:1202–1210

    Article  PubMed  Google Scholar 

  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 29:152–159

    Article  PubMed  CAS  Google Scholar 

  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 43:292–298

    Article  PubMed  CAS  Google Scholar 

  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 13:2323–2337

    Article  PubMed  Google Scholar 

  14. Herold CJ, Kramer J, Sertl K, Kalhs P, Mallek R, Imhof H, Tscholakoff D (1989) Invasive pulmonary aspergillosis: evaluation with MR imaging. Radiology 173:717–721

    PubMed  CAS  Google Scholar 

  15. Herzog P, Rieger CT (2004) Risk of cancer from diagnostic X-rays. Lancet 363:340–341

    Article  PubMed  Google Scholar 

  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 17:796–805

    PubMed  CAS  Google Scholar 

  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 175:391–397

    PubMed  CAS  Google Scholar 

  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 164:388–393

    PubMed  CAS  Google Scholar 

  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 30:730–737

    Article  PubMed  CAS  Google Scholar 

  20. Picazo JJ (2004) Management of the febrile neutropenic patient: a consensus conference. Clin Infect Dis 39(Suppl 1):S1–S6

    Article  PubMed  Google Scholar 

  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–S252

    Article  PubMed  Google Scholar 

  22. Sipsas NV, Bodey GP, Kontoyiannis DP (2005) Perspectives for the management of febrile neutropenic patients with cancer in the 21st century. Cancer 103:1103–1113

    Article  PubMed  Google Scholar 

  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–S245

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine III, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany

    C. Rieger, M. Fiegl & H. Ostermann

  2. Institute of Clinical Radiology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany

    P. Herzog & R. Eibel

Authors
  1. C. Rieger
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  2. P. Herzog
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  3. R. Eibel
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  4. M. Fiegl
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  5. H. Ostermann
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Correspondence to C. Rieger.

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Rieger, C., Herzog, P., Eibel, R. et al. Pulmonary MRI—a new approach for the evaluation of febrile neutropenic patients with malignancies. Support Care Cancer 16, 599–606 (2008). https://doi.org/10.1007/s00520-007-0346-4

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  • DOI: https://doi.org/10.1007/s00520-007-0346-4

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