Computed tomography findings in invasive pulmonary aspergillosis in non-neutropenic transplant recipients and neutropenic patients, and their prognostic value

Objectives: We evaluated CT findings and their prognostic value in non-neutropenic transplant recipients with invasive pulmonary aspergillosis (IPA) compared with neutropenic patients with IPA. Methods: All adult patients during a 27-month who met the criteria for proven or probable IPA according to the 2008 EORTC/MSG criteria were retrospectively enrolled. Initial CT findings were reviewed by two radiologists blinded to the patients' demographics and clinical outcomes. Results: A total of 50 non-neutropenic transplant recipients and 60 neutropenic patients were enrolled. Consolidation-or-mass, halo signs, and angio-invasive form were observed less often in non-neutropenic transplant recipients than in neutropenic patients: (56%, 26%, and 32%) versus (78%, 55%, and 60%, p = 0.01, p = 0.002, and p = 0.003, respectively). Multivariate analysis revealed that macronodules (HR 0.31, p = 0.001), multiple infarct-shaped consolidations (HR 4.26, p < 0.001), renal replacement therapy (HR 5.62, p < 0.001) and persistence of a positive serum galactomannan (HR 7.14, p < 0.001) were independently associated with 90-day mortality. Conclusions: Our data indicate that CT findings in non-neutropenic transplant recipients with IPA are similar to those in neutropenic patients with IPA except that consolidation-or-mass, halo sings, and angio-invasive form are less frequent, and certain CT findings such as macronodules and multiple infarct-shaped consolidations have prognostic implications in IPA.