ArticleThe British journal of radiology2018
The utility of contrast-enhanced hypodense sign for the diagnosis of pulmonary invasive mould disease in patients with haematological malignancies.
Article in The British journal of radiology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 18 citations in OpenAlex.
- The Unnoticed Threat: Clinical Characteristics, Risk Factors, and Outcome of Mucormycosis in Solid Organ Transplantation.Journal of fungi (Basel, Switzerland) · 2025Review
- Pulmonary Fungal Infections in a Tertiary Cancer Center: A Morphological Correlation of 160 Cases with CT and PET Imaging.Diagnostics (Basel, Switzerland) · 2025Article
- Diagnosis and management of invasive fungal infections due to non-Aspergillus moulds.The Journal of antimicrobial chemotherapy · 2025Review
- Atypical imaging patterns during lung invasive mould diseases: lessons for clinicians.European respiratory review : an official journal of the European Respiratory Society · 2023Review
- Hypodense Sign in Lungs on CT in Immunocompromised Patient.The Indian journal of radiology & imaging · 2023Article
- Sensitivity and specificity of computed tomography hypodense sign when differentiating pulmonary inflammatory and malignant mass-like lesions.Quantitative imaging in medicine and surgery · 2022Article
- A clinical approach to respiratory disease in patients with hematological malignancy, with a focus on respiratory infection.Medical mycology · 2019Article
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe hypodense sign (HyS) on CT imaging is highly suggestive of pulmonary invasive mould disease (IMD) in patients with haematological malignancies, but its diagnostic utility has not been systematically evaluated on contrast-enhanced CT. The objective of this study was to compare the diagnostic performance of the HyS to other common CT findings in a cohort of haematology patients with proven, probable or possible IMD based on European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria.
methodsWe analysed the diagnostic performance of the HyS to other common CT signs among 127 neutropenic patients with haematological malignancies submitted to both non-contrast-enhanced and contrast-enhanced CT scans of the lungs, including CT pulmonary angiography.
resultsThe HyS was detected in 15.7% of patients imaged without contrast, and 44.1% after contrast administration. A contrast-aided HyS was detected in 86.6, 78.0 and 15.5% of patients with European Organization for Research and Treatment of Cancer/Mycoses Study Group proven, probable and possible IMD, respectively. When analysed per clinical diagnosis (proven, probable and highly possible IMD-i.e. no alternative diagnosis to mould disease reached), the contrast-enhanced HyS was as sensitive as the halo sign but significantly more specific [halo sign 0.56, 95% CI (0.39-0.71) vs HyS 0.98, 95% CI (0.87-1.00)]. Only the vessel occlusion sign was more sensitive [0.97, 95% CI (0.91-0.99)] and specific [0.97, 95% CI (0.86-0.99)] than the HyS for IMD diagnosis.
conclusionThe high specificity of the HyS strongly supports the diagnosis of pulmonary IMD in neutropenic patients, and is highly suggestive breakthrough fungal disease in patients on mould-active antifungal prophylaxis. Advances in knowledge: This is the first systematic analysis of the hypodense sign on contrast-enhanced CT; the sign can support the diagnosis of IMD when other CT signs are uncertain.
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