Abstract— Early clinical recognition of Aspergillosis

infection is difficult yet crucial to prevent fatal complications.

Various investigations play important role to confirm the

diagnosis. Positron Emission Tomography Computed

Tomography using flourodeoxy glucose (FDG) as biomarker

has a new role in imaging infection. In this study, we highlight

the potential role of this modality in the diagnosis of lung

aspergillosis infection. Methodology This retrospective study

highlights the semiquantifying value of aspergillosis lung

lesions through FDG PET/CT findings of 10 patients. The

final goldstandard in diagnosis is isolation of aspergillus sp

and/or a positive anti-aspergillus serological test. Results We

observed the findings from 7 males and 3 female patients

between the age of 48-80 (mean 66.8 SD ±9.3). Half of them

are elderly patients aged > 65 year old (range 48-80 year-old).

6 patients demonstrated underlying respiratory diseases like

chronic obstructive airway diseases, carcinoma of the lung and

chronic granulomatous infection like tuberculosis. Eventually,

the diagnosis of 8 patients were confirmed through isolation

of aspergillus sp while the other 2 final diagnosis were

confirmed through positive serological test. From the PET/CT

study, the mean semiquantification value of all lung

aspergillosis lesions by means of mean maximum Standardized

Uptake Value (mean SUVmax) is 4.25 (n=10; SD±1.904)

ranging between 1.64 to 8.30. Conclusion Pulmonary

aspergillosis infection demonstrate high metabolic activity

with SUVmax > 2.5 during FDG PET/CT study. The imaging

characteristic of lung aspergillosis infection in this study is

useful to navigate the clinical management.

I. INTRODUCTION

spergillosis lung infection can be contained where early

prompt treatment remains the critical prognostic factor

Abdul Jalil Nordin1, Noraini Abdul Rahim2, Zaid Fatah Azman1,3

C.E.Popescu4, G.Cabrini5, L.Minniti5, E.Gay4, C.Rossetti4 1Diagnostic Nuclear Imaging Centre , Universiti Putra Malaysia, Serdang,

Malaysia 2Radiology Department , Serdang Hospital , Malaysia 3Faculty Medicine Health Sciences , Universiti Putra Malaysia, Serdang,

Malaysia 4Ospedale Niguarda Ca’Granda, Milan Italy 5Centre of Molecular Bioimaging, University of Milano-Bicocca , Milan ,

Italy

(1). The common route for infection is through the respiratory

system where it can begin initially as lung infiltrates.

Aspergillus fumigatus and Aspergillus niger are the two most

common species causing lung aspergillosis infection (2). They

are often found to be complicating patients with underlying

immunocompromised situations or prolonged debilitating

disorders (3). Upon successful invasion, over a period of time,

aspergillosis lung infiltrate may advance into a fatal form of

angioinvasion and/or disseminated form. Thus early and

accurate diagnosis is desireable in arresting its progression.

Unfortunately, there is no single definitive test in establishing

the diagnosis. Combination of clinical informations and results

from laboratory studies are common management strategy but

time consuming and may be life treatening. Often, routine

serological tests for early detection not very useful due to its

low sensitivity (4). Positive yield from sputum cultures are as

low as 10%. Laboratory studies using biological and body

samples require invasive procedures and may be unsuitable for

chronically ill patients. Currently, non invasive cross sectional

imaging technique computed tomography has been the

mainstay imaging tool in the diagnostic work up of

aspergillosis infection (5,6,7). Recent effort in fine tuning its

performance by innovating an integrated system PETCT, a

combined modality has resulted in superior capability in

providing useful diagnostic informations from different

perspectives in a single seating. This technology advancement

improved the clinical management of patients with

malignancies resulting in effective treatment deliveries and

economy improvement. The initial course of direction for

clinical utility of PETCT in oncology is now widened into the

field of infections and inflammations (8,9,10). Thus the

established morphological appearance of lung aspergillosis

infection on CT may further benefit from additional metabolic

information provided by FDG tracer uptake.

This study tend to highlight the characteristic of aspergillosis

lung lesions in integrated Positron Emission Tomography

Computed Tomography using FDG as the biomarker.

II. METHODOLOGY

This study was conducted at The Department of Advanced

Technology, Ospedale Niguarda , Milan, Italy.

Retrospectively, 10 patients with discharge records confirmed

diagnosis of pulmonary aspergillosis infection between 2004

till 2009 were evaluated. During hospital admission, prior to

Imaging pulmonary aspergillosis using 18F-

Flourodeoxyglucose biomarker in Positron

Emission Tomography Computed Tomography

Abdul Jalil Nordin, Noraini Abdul Rahim, Zaid Fatah Azman, C. E. Popescu,

G. Cabrini, L. Minniti, E. Gay, C.Rossetti

A

Proceedings of the World Medical Conference

ISBN: 978-1-61804-036-7 210

antifungal treatment, all patients were thoroughly investigated

in confirming the diagnosis. Isolation of Aspergillus sp

organisme attempted in all patients from blood, tissue samples

and sputum. All patients underwent anti-aspergillosis

serological tests . Patients also underwent integrated diagnostic

imaging study using Positron Emission Tomography

Computed Tomography (PET/CT) with flourodeoxyglucose

(FDG) as tracer. A standard protocol prior to PET/CT image

acquisition was strictly followed. All patients were instructed

to be fasted for at least 6 hours prior to examination. Fasting

blood sugar level was ensured to be below 8 mmol/L for non

diabetic patients and 10mmol/L for diabetic patients prior to

intravenous injection of 8-10mCi of 18F-FDG. Image

acquisition was performed after not less than 45 minutes

duration of complete resting. This is to avoid soft tissue and

background FDG uptake which can reduce the sensitivity of

the study.

Studies were conducted using PET/CT Biograph equipment

with 4 slice multidetector ring. Imaging started with whole

body scanogram for planning. Low dose fine axial CT

transmission scan was first performed from the eyes to the

thigh for attenuaton correction and anatomical correlation.

This was followed by PET emission study 3 minutes per bed

position for 5-7 positions.

The results of FDG PET/CT studies were read by at least by

two experience specialists in PETCT . First, the MIP images

were analysed looking for focal areas of increase metabolic

activity on PET. This will be followed by detail analysis of

lesions found in 3-D reconstructed and CT attenuation

corrected axial, sagittal and coronal images. Concurrent

morphological CT changes on lesions were recorded. A region

of interest was manually drawn over any lesions found with

focal increase in metabolic activity to record the

semiquantification value. The above mentioned observed

parameters were tabled (table 1). The results were compared

with gold standard final diagnosis of aspergillosis infection by

isolation of Aspergillus sp including fumigatus, terreus, flavus

and or niger singly or in combination. Alternative confirmatory

test was achieved through one of the immunological study

including anti fungal antibody, PCE and/or PRIST studies.

III. RESULTS

All 10 patients who underwent FDG PET/CT study which

were conducted within 2 weeks of hospital admission. There

were 7 males and 3 female patients between the age of 37-80

(mean 66.8 ; SD ± 9.3). 60% of them had underlying

respiratory disease while the remaining 40% with no

underlying lung pathology.

Finally, the concluding diagnosis in all patients were

accomplished through isolation of aspergilus sp organisme or

positive serological test. Aspergillus fumigatus is the

commonest pathogen isolated observed in our study. No

organisme isolated in 2 patients. The final diagnosis were

ascertained through positive serological tests (table 1).

Figure 1 and figure 2 demonstrating two 18F-FDG PETCT

study with a foci of high metabolic activity in the posterior

segment (figure 1) and anterior segment (figure 2) of the left

upper lobe. The metabolic activity of the lesions matching the

upper colour scale in the left border of the images. White

arrows indicating the centre of lesion with raised metabolic

activity. 7 months following antimycotic treatment (image b),

a repeat 18F-FDG PETCT revealed partial (figure 1) and

complete (figure 2) metabolic response in PET with persistent

morphological CT appearance. The final outcome was

validated by negative serological test result.

Statistic analysis

From the results of lab and imaging investigations, there are

variety of observed parameters (table 1).

We devide our analysis into two catagories. In the first

category, we use the result of isolation of aspergillosis sp as

the “gold standard” (Table 2). In the second category, we

utilize the result of SUVmax for active lung aspergillosis

lesions where 2.5 was used as cut-off point (Table 3) .

Activities above the selected point were classified as ‘present

of infection’ while activities below the point were classified as

‘non infected lesion’. As a result, there were 9 concordant and

1 discordant findings in relation to the first category for

analysis. Aspergillus fumigatus isolated from 60% of cases

and Aspergillus terraus in 30%.

The mean maximum Standardized Uptake Value (SUVmax)

from our results of FDG PET/CT study is 4.25 (n=10) ranging

between 1.64 to 8.30 with a standard deviation of 1.90 (Figure

3). When we analysed the values of SUVmax based on

Aspergillus sp Isolation, there is no rank-difference in SUVmax

between those positive and negative cases (Table 2). Similarly,

when we analysed classification of SUVmax (cut-off value

>2.5) with Aspergillus sp isolation, we also fail to find

statistical agreement between the two (Table 3).

The SUVmax values were not normally distributed due to the

small sample size.

IV. DISCUSSION

The role of integrated functional and morphological imaging

modality Positron Emission Tomography and Computed

Tomography (PET/CT) using flourodeoxy glucose (FDG) as

biomarker is expanding into infections and

inflammation(8,9,10). Experiment conducted by Kubota

demonstrated in vivo high accumulation of macrophages and

granulation tissues as the reason for increased 18F-FDG

intratumoral distribution (11). Increased local hyperemia and

capillary permeability at the initial point of infection lead to

aegragation of inflammatory cells like granulocytes, leucocytes

and macrophage at the entry point. The resulting increased in

local glucose consumption is reflected by raised

semiquantitative uptake value (SUV) of all aspergillosis

infected foci except in one of our patients. In the evaluation of

FDG avid lesions, in addition to qualitative assessment

through visual intensity, lesional activity can be semiquantify

using standardized uptake value (SUV). The maximum SUV

or SUVmax is commonly employed in recording the metabolic

activity of FDG avid lesions. In our institution, like others , a

cutt off point of 2.5 is taken to differentiate between benign

and malignant condition. However, SUVmax should be use with

caution as it only indicate the ratio of FDG uptake in the whole

body and dependant on multifactorial parameters including

Proceedings of the World Medical Conference

ISBN: 978-1-61804-036-7 211

blood sugar, insulin level, body weight and tracer activities.

The detail is discussed elsewhere (12,13).

It is well known fact that fluorodeoxyglucose, being an

analogue of glucose molecule is a non-specific malignant

tracer. Avid FDG activity can be seen in benign and

inflammatory conditions. Chronic granulomatous infection

recently being proven to demonstrate intense 18F-FDG uptake

with SUVmax exceeding 2.5 mimicking malignant lesions

(14,15,16,17,18,19,20). Our findings further support previous

studies aiming at validating the quantification value of

SUVmax > 2.5 in active lung aspergillosis infection. We

validated our visually intense lesional activity in our patients

through positive isolation of aspergillus sp organism from

blood products and tissue samples and positive serological

studies. The metabolic information from combined PETCT

study using FDG as tracer can be an additional feature of

importance. An active aspergillus foci which show FDG-avid

activity can be an invaluable guidance for interventional tissue

sampling procedure avoiding wrong sampling sites for

isolation and cellular characterization (21,22,23,24).

In the past, Caillot D and his team (5) observed the usefulness

of CT in 36 netropenic patients with Invasive pulmonary

aspergillosis infection and found CT allow earlier diagnosis

thus developing a new strategy in clinical management of

pulmonary aspergillosis infection. His work was supported by

Kami M and his collegue (6) who concluded that chest CT

scan to be more beneficial than blood tests and X-ray for early

diagnosis of invasive pulmonary aspergillosis infection

through their study involving 215 patients 3 years later. The

result of our study has potential positive impact in amplifying

the present value of CT in the investigation of pulmonary

aspergillosis infection. Diagnostic CT can be performed as

part of integrated PETCT study to detect invasive ‘halo’ sign

which is proven to improved success rate up to 80% where

patients can be subjected to emergency pulmonary surgical

resection to avoid massive hemoptysis (25,26). With adequate

supporting evidence from clinical history and lab

investigations, the metabolic information gained during an

integrated PETCT study using FDG as metabolic marker, can

be utilized in guiding antifungal treatment . Initial SUVmax can

be used in evaluating treatment response (10,27,28). In

another study, Horger (29) observed that none of the early

HRCT manifestation of lung aspergillosis can predict

outcome. By incorporating metabolic information of FDG

PET into CT, the clue to outcome prediction can be resolved

and warrants future studies involving larger group of patients.

Our study has several limitations. It appears that, from our

preliminary findings, SUVmax fails to discriminate aspergillosis

infection from malignancy. This is apparent from analyses of

SUVmax in both rank and classified forms. However, low

power of observation is the main limitation of our study in

view of inadequate sample size. Thus, larger sample is needed

to address this problem. Another issue is that all analyses were

carried out in a pre-determined “gold-standard” . The

appropriateness of using our definition of ‘gold-standard” is a

clinical decision and is up for debate.

V. CONCLUSION

Active pulmonary aspergillosis infections is FDG avid on 18F-

FDG PET/CT examination. In an appropriatte clinical setting,

the metabolic information from combined PETCT study using

FDG as tracer can be an additional feature of importance to

guide interventionist during tissue sampling, navigating

clinicians in treatment and in future can be useful information

for outcome prediction.

Referrences

1.Invasive pulmonary aspergillosis in chronic obstructive pulmonary disease:

an emerging fungal pathogen

F. Ader, S. Nseir, R. Le Berre, S. Leroy, I. Tillie-Leblond, C. H. Marquette

and A. Durocher

Clin Microbiol Infect 2005; 11: 427–429

2.Pulmonary Aspergillosis: A Clinical Update,

Zmeili O. S., Soubani A. O.

Q. J. Med. 2007;100: 317-334.

3. Role of early diagnosis and aggressive surgery in the management of

invasive pulmonary aspergillosis in neutropenic patients.

Caillot D, Mannone L, Cuisenier B, Couaillier JF.

Clin Microbiol Infect. 2001;7 Suppl 2:54-61. Links

4. Computed tomographic scan of the chest, latex agglutination test and

plasma (1AE3)-beta-D-glucan assay in early diagnosis of invasive pulmonary

aspergillosis: a prospective study of 215 patients.

Kami M, Tanaka Y, Kanda Y, Ogawa S, Masumoto T, Ohtomo K,

Matsumura T, Saito T, Machida U, Kashima T, Hirai H.

Haematologica. 2000 Jul;85(7):745-52. Links

5. Improved management of invasive pulmonary aspergillosis in neutropenic

patients using early thoracic computed tomographic scan and surgery.

Caillot D, Casasnovas O, Bernard A, Couaillier JF, Durand C, Cuisenier B,

Solary E, Piard F, Petrella T, Bonnin A, Couillault G, Dumas M, Guy H.

J Clin Oncol. 1997 Jan;15(1):139-47.

6. The value of the chest computed tomography halo sign in the diagnosis of

invasive pulmonary aspergillosis. An autopsy-based retrospective study of 48

patients.

Kami M, Kishi Y, Hamaki T, Kawabata M, Kashima T, Masumoto T, Oki Y,

Tanaka Y, Sawada S, Machida U, Ohtomo K, Kanda Y, Hirai H, Mutou Y.

Mycoses. 2002 Oct;45(8):287-94.

7. The Value of the Chest Computed Tomography ‘Halo’ Sign in the

Diagnosis of Invasive Pulmonary Aspergillosis: An Autopsy-based

Retrospective Study of 48 Patients,

Kami M., Kishi Y., Hamaki T., Kawabata M., Kashima T., Masumoto T., Oki

Y., Tanaka Y., Sawada S., Machida U., Ohtomo K., Kanda Y., Hirai H.,

Mutou Y.

Radiology 1987, 165(1), 123-128.

8. Clinical value of FDG PET in patients with fever of unknown origin and

patients suspected of focal infection or inflammation

Chantal P. Bleeker-Rovers, ElisabethM. H. A. deKleijn, FransH. M. Corstens,

JosW. M. van derMeer, WimJ. G. Oyen

Eur J Nucl Med Mol Imaging (2004) 31:29–37

9. Focal Pulmonary Abnormalities: Evaluation with F-18

Fluorodeoxyglucose PET

Scanning,

Patz E. F., Lowe V. J., Hoffman J. M., Paine S. S., Burrowes P., Coleman R.

E.

Radiology 1993, 188, 487-490.

10. F-18 FDG PET/CT as a Valuable Imaging Tool for Assessing Treatment

Efficacy in Inflammatory and Infectious Diseases

Alessio Imperiale, Laure Federici, Nicolas Lefebvre, Jean-Jacques Braun,

Francis Pfumio, MD,O Romain Kessler, Yves Hansmann, Emmanuel Andres,

and Andre´ Constantinesco

Clin Nucl Med 2010;35: 86 –90.

11. Intratumoral Distribution of Fluorine-18 Fluorodeoxyglucose In Vivo:

High

Accumulation in Macrophages and Granulation Tissues Studied by

Microautoradiography

Kubota R., Yamada S., Kamada K., Ishiwata K., Tamahashi N., Tatsuo, I.

J. Nucl. Med. 1992, 33, 1972-1980.

Proceedings of the World Medical Conference

ISBN: 978-1-61804-036-7 212

12. Standardized Uptake Value Atlas: Characterization of Physiological 2-

Deoxy-2-[18F]fluoro-d -glucose Uptake in Normal Tissues.

Wang Y, Chiu E, Rosenberg J, Gambhir S.

Mol Imaging Biol. 2007; 9: 83-90.

13. Measuring Response with FDG-PET: Methodological Aspects

Martin A-A, Wolfgang A. W.

The Oncologist 2009;14:369 –377

14. Intense uptake of [F-18]-fluoro-2 deoxy-D-glucose in active pulmonary

tuberculosis

Che-Ming Yanc, Chung-Huei Hsu, Chi-Ming Lee and Fong-Chieh Wan

Annals of Nuclear Medicine 2003;17 (5):407-410

15. F-18 FDG PET/CT Findings in Pulmonary Necrotizing Sarcoid

Granulomatosis

Julia Arfi, Khaldoun Kerrou, , Samba Traore,Virginie Huchet, Antoine Bolly,

Martine Antoine, Luc Delaunois,,Thierry Vander Borght, Jean-No el Talbot

Clin Nucl Med 2010;35: 697–700

16. PET Scanning Used for Monitoring Treatment Response in

Mycobacterium avium Complex Infection Mimicking Malignancy

Jesse Drijkoningen, Harry van der Pol, Michiel de Vries

Clin Nucl Med 2009;34: 818 – 82

17. Invasive Aspergillosis Mimicking Stage IIIA Non-Small-Cell Lung

Cancer on FDG Positron Emission Tomography.

Mark D Wilkinson, Michael J Fulham, Brian C Mc Caughan, Christ J

Constable

Clinical Nuclear Medicine 2003; 28(3):234-235.

18. F-18 FDG PET/CT Imaging of Disseminated Coccidioidomycosis

Ba D. Nguyen, MD

Clin Nucl Med 2006;31: 568 –571

19. A case of cryptococcal pneumonia with false-positive [18F]fluoro-2-

deoxy-D-glucose positron emission tomography (FDG-PET) image

mimicking lung metastatic cancer

Cheng Ji , Chunhua Ling, Bin Zhang, Haodong Xu

Respiratory Medicine 2010; 93–94

20. F-18 Fluorodeoxyglucose Positron Emission Tomography in Pulmonary

Cryptococcoma

Chung-Huei Hsu,Chi-Ming Lee,Fong-Chieh Wang, and Yun-Ho Lin,

Clin Nucl Med 2003;28: 791–793

21. Mediastinal Histoplasmosis: F-18 FDG PET and CT Findings Simulating

Malignant Disease

Gavin C. Mackie, Judith M. Pohlen

Clin Nucl Med 2005;30: 633– 635

22. Localization of F-18 FDG in Nocardia Lung Infection

Aju Thomas, Amolak Singh, Ben Greenspan

Clin Nucl Med 2004;29: 834 – 835

23. 18[F] FDG-PET/CT is a useful molecular marker in evaluating thymoma

aggressiveness

Ahmad S. Fathinul Fikri, Abdul J Nordin, Norhafizah Mohtarudin, Hemalata,

W.F.Eddie Lau

European Journal Radiology Extra 2011;78(2):e89-e92

24. Investigation of FDG-PET/CT Imaging to guide biopsies in the detection

of histological transformation of indolent lymphoma

Stevens Le Gouill

Haematologica 2008;93(3):471

25. Invasive Pulmonary Aspergillosis: Frequency and Meaning of the

‘Hypodense’ Sign on Unenhanced CT

Horger M., Einsele H., Schumacher U., Wehrmann M., Hebart H., Lengerke

C., Vonthein R., Claussen C. D., Pfannenberg C.

Br. J. Radiol. 2005, 78(932), 697-703.

26. Imaging findings in acute invasive pulmonary aspergillosis: clinical

significance of the halo sign.

Greene R. E., Schlamm H. T., Oestmann J. W., Stark P., Durand C.,

Lortholary O., Wingard J.

R., Herbrecht R., Ribaud P., Patterson, T. F., Troke P. F., Denning D. W.,

Bennett J. E., de

Pauw B. E., Rubin, R. H.

Clin. Infect. Dis. 2007, 44(3), 373-379.

27. Therapy Monitoring in Aspergillosis Using F-18 FDG Positron Emission

Tomography

Christiane Franzius, Martin Biermann, Georg Hulskamp, Michael

Frosch,Johannes Roth, Joachim Schiuk, Otmar Schober

Clinical Nuclear Medicine, ? ; 26(3):232–275

28. Utility of FDG PET/CT in Guiding Antifungal Therapy in Acute

Leukemia Patients With Chronic Disseminated Candidiasis

Bing Xu, Pengcheng Shi, Hubing Wu, Xutao Guo, Quanshi Wang, Shuyun

Zhou

Clin Nucl Med 2010;35: 567–570

29. Initial CT manifestations of invasive pulmonary aspergillosis in 45 non-

HIV immunocompromised patients: association with patient outcome?

Horger M, Hebart H, Einsele H, Lengerke C, Claussen CD, Vonthein R,

Pfannenberg C.

Eur J Radiol. 2005 Sep;55(3):437-44.

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Table 1. Tabulation of demography data, underlying diseases and results of investigations

M: male; F:femae; TB:Tuberculosis; COPD:chronic obstructive pulmonary disease;p

Table 1. Tabulation of demography data, underlying diseases and results of investigations

Figure 1. A 52 year-old man diagnosed chronic pulmonary aspergillosis infection (image a) presented with recurrent dyspnea and cough. He showed positive serologic test to aspergillus specific Ig E aAnti mycotic treatment started and a repeat

No

Sex

Age

Predisposed

disease

1 M 77 Lung TB

2 F 48 COPD

3 M 60 nil

4 M 66 Asthma

5 M 67 Diabetes

6 M 64 nil

7 F 80 Lung TB

8 F 62 nil

9 M 70 Carc lungs

10

M

74

nil

Table 1. Tabulation of demography data, underlying diseases and results of investigations

COPD:chronic obstructive pulmonary disease;pos:positive;neg:negative:na:not available;

Table 1. Tabulation of demography data, underlying diseases and results of investigations

old man diagnosed chronic pulmonary aspergillosis infection (image a) presented with recurrent dyspnea and cough. He showed positive serologic test to aspergillus specific Ig E aAnti mycotic treatment started and a repeat 18F-FDG PETCT study was done after 7 months (image b)

Isolation Aspergillus sp

Immunology

Blood /

tissue/sputum Proven organism

anti AF

PCE/PRIST

pos/neg/pos Fumigatus pos/pos/neg

neg/pos/neg Neg pos/pos/pos

neg/neg/neg Neg pos/neg

neg/neg/pos Fumigatus pos/neg/neg

pos/neg/neg Fumigatus pos/neg

pos/neg/neg Terreus/Fumigatus pos/neg

pos/neg/neg Fumigatus pos/neg/neg

pos/neg/neg Terreus/Fumigatus pos/neg/neg

pos/neg/neg Fumigatus pos/neg

pos/neg/neg

Fumigatus

pos/neg

Table 1. Tabulation of demography data, underlying diseases and results of investigations

Table 1. Tabulation of demography data, underlying diseases and results of investigations

old man diagnosed chronic pulmonary aspergillosis infection (image a) presented with

recurrent dyspnea and cough. He showed positive serologic test to aspergillus specific Ig E and IgA antibodies. FDG PETCT study was done after 7 months (image b).

Immunology test FDG PET CT

anti AF ab /

PCE/PRIST SUV max

/pos/neg 6.16

pos/pos/pos 3.27

neg/neg 4.81

pos/neg/neg 3.26

pos/neg/neg 1.64

pos/neg/neg 3.81

pos/neg/neg 3.54

pos/neg/neg 2.73

pos/neg/pos 4.95

pos/neg/pos

8.3

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Figure 2. A 45 year-old man diagnosed Chronic Pulmonary Aspergillosis confirmed by positive Aspergillusspecific Ig E and Ig G tests. 18F-FDG PETCT showed focal high metabolic activity in the left upper lobe (white arrows in image a). 7 months following antimycotic treatment (image b), metabolic response on PET with persistent bullae formation on CT in reswas validated by negative serological test result.

Aspergillosis

SUVmax Positive

Negative *not statistically significant (alpha set at 0.05), MannTable 2: Bivariate Analysis of SUV

SUV Max(<2.5) Negative

Positive

**not statistically significant (p-value=0.725, Kappa = Table 3: Test of agreement between SUV

Figure 3

old man diagnosed Chronic Pulmonary Aspergillosis confirmed by positive AspergillusFDG PETCT showed focal high metabolic activity in the left upper lobe (white

arrows in image a). 7 months following antimycotic treatment (image b), 18F-FDG PETCT revealed complete metabolic response on PET with persistent bullae formation on CT in response to treatment. The final outcome was validated by negative serological test result.

Aspergillosis N Mean Rank Sum of Ranks

9 5.33 48

1 7.00 7 *not statistically significant (alpha set at 0.05), Mann-Whitney U test.

Bivariate Analysis of SUVmax values vs. Aspergillus sp Isolation

Aspergillosis Isolation

Negative Positive

Negative 0 (0%) 0 (100%)

Positive 1 (11%) 8 (89%)

1 (10%) 9 (90%) value=0.725, Kappa = -1.11)

Test of agreement between SUVmax (Cut-off value >2.5) and Aspergillosis Isolation

Figure 3 . Distribution of SUVmax (n=10).

old man diagnosed Chronic Pulmonary Aspergillosis confirmed by positive Aspergillus-

FDG PETCT showed focal high metabolic activity in the left upper lobe (white FDG PETCT revealed complete

ponse to treatment. The final outcome

p-value

0.602*

1 (100%

9 (100%)

10 (100%)

Proceedings of the World Medical Conference

ISBN: 978-1-61804-036-7 215