Learning objectives
1.
Describe imaging findings in hepatic candidiasis (ultrasound,
CT scan and MRI)
2.Determine the evolutionary aspects in MRI
3.
Review of spleen and kidneys candidiasis
Background
Candidosis:
Opportunistic infection
Hepatic candidosis is a severe form with significant mortality (33%)
Incidence :
Estimated between 3 to 29% in acute leukemia
Increasing recently
Population at risk is :
acute leukemia
prolonged neutropenia (>10 days)
broad spectrum antibiotics
total parenteral nutrition
multisite colonization by candida spp
Physiopathology (figure 1) :
2 gateways : vascular or digestive
Diagnostic (figure 2) :
Very difficult
EORTC/MSG Criteria
Findings and procedure details
Ultrasound (figure 3) :
Easy access particularly if aplasia in intensive care
Hepatomegaly
4 differents patterns :
aspecific abcess
bull's eye
wheel within wheel
wagon wheel
In chronic lesions,
calcifications may appear
CT-scan (figure 4) :
Sensibility > Ultrasound
3 differents patterns :
hypodense micronodular lesion with peripheral enhancement
hypodense without contrast,
non visibleat portal phase
double target
MRI :
Sensibility > CT-scan
3 phases are described :
acute (figure 6) : round lesion,
size < 1 cm,
hyposignal T1 and hypersignal T2,
hypersignal diffusion,...
Conclusion
MRI is a major criteria for the diagnosis of hepatic candidosis
MRI allows to assess the phase and treatment response
MRI allows the diagnosis and monitoring of associated abdominal lesions
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