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Yan Y, Shi Y, Wang Y, Yuan X, He W. Pulmonary acute graft-versus-host disease and infections after allogeneic hematopoietic stem cell transplantation in pediatric recipients: A comparative study on CT. Transpl Infect Dis 2020; 22:e13285. [PMID: 32329139 DOI: 10.1111/tid.13285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/09/2020] [Accepted: 03/31/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To compare the chest CT patterns of acute graft-versus-host disease (aGVHD) and infections within 100 days after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in pediatric recipients to help hematologist make definitive diagnosis as early as possible. METHODS A total of 143 pediatric recipients from January 2015 to June 2019 who were diagnosed pulmonary aGVHD or infections within 100 days after allo-HSCT were enrolled in this study. Two observers evaluated the extent and distribution (unilateral, bilateral) of the CT patterns. The patterns were then classified as ground-glass opacity (GGO) (localized, patchy, diffuse), consolidation (localized, patchy, diffuse), reticulation (localized, patchy, diffuse), nodules (localized, multiple), bronchiectasis, pleural effusion, air trapping, tree-in-bud sign, and pneumomediastinum. The onset time and radiological patterns of the two cohorts were statistically compared. RESULTS The mean onset time of aGVHD (n = 85) and infections group (viral n = 29, bacterial n = 22, fungal n = 7, total n = 58) was 36.89 ± 24.34 (range, 10-99 days) and 23.48 ± 20.65 days (range, 4-94 days) with a significant difference (P = .001). The top three underlying diseases were acute lymphoblastic leukemia (ALL) (n = 49, 57.6%); acute myeloid leukemia (AML) (n = 24, 28.2%); and aplastic anemia (AA) (7.1%) in aGVHD group and hemophagocytic syndrome (HPS) (n = 33, 56.9%); AA (n = 9, 15.5%); and ALL (n = 6, 10.3) in infection group. GGO (41.2%) in aGVHD prevailed on CT, whereas GGO (53.4%) and consolidations (43.1%) were more prevalent in infections. The distribution of GGO showed more diffuse in aGVHD (P = .031) and symmetric while patchier GGO prefers infections (P < .001). No differences were found in the reticulation. Nodules were more common in infections (P = .004) while pleural effusion was more common in aGVHD group (P < .035). CONCLUSION Imaging patterns of aGVHD on CT differ substantially from that of infections. Physicians and radiologists should be aware of such radiological differences in order to give accurate treatment. Notably, definite diagnosis should be made in combination with clinical manifestations, signs, and laboratory tests.
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Affiliation(s)
- Yuchun Yan
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Department of Radiology, The Affiliated Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Yuzhu Shi
- Department of Radiology, Beijing Ludaopei Hospital, Beijing, China.,Beijing Ludaopei Institute of Hematology, Beijing, China
| | - Yao Wang
- Department of Radiology, Beijing Jingdu Children's Hospital, Beijing, China
| | - Xinyu Yuan
- Department of Radiology, The Affiliated Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Wen He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Shroff GS, Truong MT, Carter BW, Benveniste MF, Kanagal-Shamanna R, Rauch G, Viswanathan C, Boddu PC, Daver N, Wu CC. Leukemic Involvement in the Thorax. Radiographics 2020; 39:44-61. [PMID: 30620703 DOI: 10.1148/rg.2019180069] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Leukemias are malignancies in which abnormal white blood cells are produced in the bone marrow, resulting in compromise of normal bone marrow hematopoiesis and subsequent cytopenias. Leukemias are classified as myeloid or lymphoid depending on the type of abnormal cells produced and as acute or chronic according to cellular maturity. The four major types of leukemia are acute myeloid leukemia, chronic myeloid leukemia, acute lymphoblastic leukemia, and chronic lymphocytic leukemia. Clinical manifestations are due to either bone marrow suppression (anemia, thrombocytopenia, or neutropenia) or leukemic organ infiltration. Imaging manifestations of leukemia in the thorax are myriad. While lymphadenopathy is the most common manifestation of intrathoracic leukemia, leukemia may also involve the lungs, pleura, heart, and bones and soft tissues. Myeloid sarcomas occur in 5%-7% of patients with acute myeloid leukemia and represent masses of myeloid blast cells in an extramedullary location. ©RSNA, 2019.
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Affiliation(s)
- Girish S Shroff
- From the Departments of Diagnostic Radiology (G.S.S., M.T.T., B.W.C., M.F.B., G.R., C.V., C.C.W.), Hematopathology (R.K.S.), and Leukemia (P.C.B., N.D.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Mylene T Truong
- From the Departments of Diagnostic Radiology (G.S.S., M.T.T., B.W.C., M.F.B., G.R., C.V., C.C.W.), Hematopathology (R.K.S.), and Leukemia (P.C.B., N.D.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Brett W Carter
- From the Departments of Diagnostic Radiology (G.S.S., M.T.T., B.W.C., M.F.B., G.R., C.V., C.C.W.), Hematopathology (R.K.S.), and Leukemia (P.C.B., N.D.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Marcelo F Benveniste
- From the Departments of Diagnostic Radiology (G.S.S., M.T.T., B.W.C., M.F.B., G.R., C.V., C.C.W.), Hematopathology (R.K.S.), and Leukemia (P.C.B., N.D.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Rashmi Kanagal-Shamanna
- From the Departments of Diagnostic Radiology (G.S.S., M.T.T., B.W.C., M.F.B., G.R., C.V., C.C.W.), Hematopathology (R.K.S.), and Leukemia (P.C.B., N.D.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Greg Rauch
- From the Departments of Diagnostic Radiology (G.S.S., M.T.T., B.W.C., M.F.B., G.R., C.V., C.C.W.), Hematopathology (R.K.S.), and Leukemia (P.C.B., N.D.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Chitra Viswanathan
- From the Departments of Diagnostic Radiology (G.S.S., M.T.T., B.W.C., M.F.B., G.R., C.V., C.C.W.), Hematopathology (R.K.S.), and Leukemia (P.C.B., N.D.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Prajwal C Boddu
- From the Departments of Diagnostic Radiology (G.S.S., M.T.T., B.W.C., M.F.B., G.R., C.V., C.C.W.), Hematopathology (R.K.S.), and Leukemia (P.C.B., N.D.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Naval Daver
- From the Departments of Diagnostic Radiology (G.S.S., M.T.T., B.W.C., M.F.B., G.R., C.V., C.C.W.), Hematopathology (R.K.S.), and Leukemia (P.C.B., N.D.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Carol C Wu
- From the Departments of Diagnostic Radiology (G.S.S., M.T.T., B.W.C., M.F.B., G.R., C.V., C.C.W.), Hematopathology (R.K.S.), and Leukemia (P.C.B., N.D.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
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