Objective: The aim of this study was to optimize detection of angioinvasive pulmonary aspergillosis by showing direct vessel involvement at a peripheral level with high-resolution MDCT angiography in patients with antibiotic-resistant fever of unknown origin under immunosuppression. Twelve CT angiographic examinations were prospectively performed in 10 patients with an optimized CT angiography protocol with 16-MDCT after IV administration of contrast agent using care bolus (Siemens Medical Solutions). Axial images and maximum intensity projections were evaluated for vascular occlusion by an experienced radiologist blinded to the clinical histories. Results were correlated with histology and clinical follow-up data including follow-up CT. Fourteen focal pulmonary lesions were detected by CT in eight patients. Eight of 14 lesions were confirmed by histology. In the remaining six lesions, diagnosis was made by clinical and CT follow-up. In nine of nine lesions in which angioinvasive infection was excluded, CT angiography showed patent vessels. In four of five lesions with histologically proven fungal angioinvasion, vascular occlusion was detected on CT angiography.
Conclusion: High-resolution MDCT angiography has been shown to be a feasible technique to depict directly vessel occlusion in the setting of suspected fungal infections, especially for early diagnosis of angioinvasive pulmonary aspergillosis in immunosuppressed patients.