{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T14:01:02Z","timestamp":1781272862710,"version":"3.54.1"},"reference-count":20,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T00:00:00Z","timestamp":1728432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Invasive pulmonary mucormycosis (IPM) is a deadly opportunistic mold infection in patients with hematological malignancies (HM). Radiologic imaging is essential for its timely diagnosis. Here, we compared IPM lesions visualized by chest computed tomography (CCT) and chest X-ray (CXR) and determined the prognostic significance of discordant imaging. Therefore, we reviewed 44 consecutive HM patients with probable\/proven IPM at MD Anderson Cancer Center in 2000\u20132020 who had concurrent CCT and CXR studies performed. All 44 patients had abnormal CCTs and 39 (89%) had anormal CXR findings at IPM diagnosis. However, only 26 patients (59%) showed CCT-matching IPM-suspicious lesions on CXR. Acute Physiology and Chronic Health Evaluation II score &gt; 18 at IPM diagnosis and breakthrough infection to Mucorales-active antifungals were the only independent risk factors for 42-day and\/or 84-day mortality. Absence of neutropenia at IPM diagnosis, neutrophil recovery in neutropenic patients, and surgical revision of mucormycosis lesions were protective factors. Although not reaching significance on multivariable analysis, visualization of CCT-matching lesions on CXR was associated with significantly increased 84-day mortality (log-rank test, p = 0.033), possibly as a surrogate of extensive lesions and tissue necrosis. This observation supports the exploration of radiologic lesion kinetics as a prognostic staging tool in IPM patients.<\/jats:p>","DOI":"10.3390\/jof10100703","type":"journal-article","created":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T07:39:52Z","timestamp":1728459592000},"page":"703","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Concordance of Chest Radiography and Chest Computed Tomography Findings in Patients with Hematologic Malignancy and Invasive Mucormycosis: What Are the Prognostic Implications?"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7784-7256","authenticated-orcid":false,"given":"Sebastian","family":"Wurster","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung-Yeon","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA"},{"name":"Division of Infectious Diseases, Department of Internal Medicine, Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"},{"name":"Catholic Hematology Hospital, Seoul St. Mary\u2019s Hospital, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazim","family":"Allos","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Franklin","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA"},{"name":"Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dierdre B.","family":"Axell-House","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8051-2940","authenticated-orcid":false,"given":"Dimitrios P.","family":"Kontoyiannis","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.1093\/cid\/cir866","article-title":"Epidemiology and clinical manifestations of mucormycosis","volume":"54","author":"Petrikkos","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1097\/QCO.0000000000000937","article-title":"Radiology-based diagnosis of fungal pulmonary infections in high-risk hematology patients: Are we making progress?","volume":"36","author":"Lewis","year":"2023","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Stemler, J., Bruns, C., Mellinghoff, S.C., Alakel, N., Akan, H., Ananda-Rajah, M., Auberger, J., Bojko, P., Chandrasekar, P.H., and Chayakulkeeree, M. (2020). Baseline Chest Computed Tomography as Standard of Care in High-Risk Hematology Patients. J. Fungi, 6.","DOI":"10.3390\/jof6010036"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e405","DOI":"10.1016\/S1473-3099(19)30312-3","article-title":"Global guideline for the diagnosis and management of mucormycosis: An initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium","volume":"19","author":"Cornely","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1097\/QCO.0b013e328348b2e1","article-title":"Imaging studies for diagnosing invasive fungal pneumonia in immunocompromised patients","volume":"24","author":"Marom","year":"2011","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"742","DOI":"10.2214\/AJR.17.18792","article-title":"Pulmonary Mucormycosis: Radiologic Features at Presentation and Over Time","volume":"210","author":"Hammer","year":"2018","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1148\/rg.2020190156","article-title":"Pulmonary Mucormycosis: Risk Factors, Radiologic Findings, and Pathologic Correlation","volume":"40","author":"Agrawal","year":"2020","journal-title":"Radiographics"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1093\/cid\/cit929","article-title":"The reversed halo sign: Pathognomonic pattern of pulmonary mucormycosis in leukemic patients with neutropenia?","volume":"58","author":"Legouge","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Axell-House, D.B., Wurster, S., Jiang, Y., Kyvernitakis, A., Lewis, R.E., Tarrand, J.J., Raad, I.I., and Kontoyiannis, D.P. (2021). Breakthrough Mucormycosis Developing on Mucorales-Active Antifungals Portrays a Poor Prognosis in Patients with Hematologic Cancer. J. Fungi, 7.","DOI":"10.3390\/jof7030217"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1093\/cid\/ciz1008","article-title":"Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium","volume":"71","author":"Donnelly","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1055\/s-0031-1295717","article-title":"Pulmonary mucormycosis","volume":"32","author":"Hamilos","year":"2011","journal-title":"Semin. Respir. Crit. Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.idc.2006.06.003","article-title":"Invasive zygomycosis: Update on pathogenesis, clinical manifestations, and management","volume":"20","author":"Kontoyiannis","year":"2006","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.2214\/ajr.168.6.9168721","article-title":"Pulmonary mucormycosis: Radiologic findings in 32 cases","volume":"168","author":"McAdams","year":"1997","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3275","DOI":"10.1007\/s00330-016-4717-4","article-title":"Serial assessment of pulmonary lesion volume by computed tomography allows survival prediction in invasive pulmonary aspergillosis","volume":"27","author":"Vehreschild","year":"2017","journal-title":"Eur. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.ajem.2012.08.041","article-title":"High discordance of chest X-ray and computed tomography for detection of pulmonary opacities in ED patients: Implications for diagnosing pneumonia","volume":"31","author":"Self","year":"2013","journal-title":"Am. J. Emerg. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.jemermed.2007.11.042","article-title":"Chest radiograph vs. computed tomography scan in the evaluation for pneumonia","volume":"36","author":"Hayden","year":"2009","journal-title":"J. Emerg. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.chest.2017.07.035","article-title":"Community-Acquired Pneumonia Visualized on CT Scans but Not Chest Radiographs: Pathogens, Severity, and Clinical Outcomes","volume":"153","author":"Upchurch","year":"2018","journal-title":"Chest"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1093\/cid\/ciab1066","article-title":"Evaluation of Serum Mucorales Polymerase Chain Reaction (PCR) for the Diagnosis of Mucormycoses: The MODIMUCOR Prospective Trial","volume":"75","author":"Millon","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Alqarihi, A., Kontoyiannis, D.P., and Ibrahim, A.S. (2023). Mucormycosis in 2023: An update on pathogenesis and management. Front. Cell. Infect. Microbiol., 13.","DOI":"10.3389\/fcimb.2023.1254919"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e01896-18","DOI":"10.1128\/AAC.01896-18","article-title":"Preexposure to Isavuconazole Increases the Virulence of Mucorales but Not Aspergillus fumigatus in a Drosophila melanogaster Infection Model","volume":"63","author":"Wurster","year":"2019","journal-title":"Antimicrob. Agents Chemother."}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/10\/10\/703\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:09:31Z","timestamp":1760112571000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/10\/10\/703"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,9]]},"references-count":20,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["jof10100703"],"URL":"https:\/\/doi.org\/10.3390\/jof10100703","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,9]]}}}