TY - JOUR
T1 - Identifying the most infectious lesions in pulmonary tuberculosis by high-resolution multi-detector computed tomography
AU - Yeh, Jun Jun
AU - Chen, Solomon Chih Cheng
AU - Teng, Wen Bao
AU - Chou, Chun Hsiung
AU - Hsieh, Shih Peng
AU - Lee, Tsung Lung
AU - Wu, Ming Ting
PY - 2010/9
Y1 - 2010/9
N2 - Objective: This study aimed to determine whether characteristics detected by multi-detector computed tomography (MDCT) were predictive of highly infectious, smear-positive, active pulmonary tuberculosis (PTB). Methods: Among 124 patients with active PTB, 84 had positive (group 1) and 40 had negative (group 2) smear results for acid-fast bacilli. Multiplanar MDCT, axial conventional CT and chest X-ray images were analysed retrospectively for morphology, number, and segmental (lobe) distribution of lesions. Results: By multivariate analysis, consolidation over any segment of the upper, middle, or lingual lobes, cavitations, and clusters of nodules were associated with group 1, while centrilobular nodules were predictive of group 2. Using five independent variables associated with risk in group 1, a prediction model was created to distinguish between group 1 and group 2. ROC curve analysis showed an area under the curve of 0.951±0.021 for this prediction model. With the ideal cutoff point score of 1, the sensitivity, specificity, and positive predictive values were 84.5%, 97.5%, and 98.0%, respectively. Conclusions: A model to predict smear-positive active PTB on the basis of findings from MDCT may be a useful tool for clinical decisions about isolating patients pending sputum smear results.
AB - Objective: This study aimed to determine whether characteristics detected by multi-detector computed tomography (MDCT) were predictive of highly infectious, smear-positive, active pulmonary tuberculosis (PTB). Methods: Among 124 patients with active PTB, 84 had positive (group 1) and 40 had negative (group 2) smear results for acid-fast bacilli. Multiplanar MDCT, axial conventional CT and chest X-ray images were analysed retrospectively for morphology, number, and segmental (lobe) distribution of lesions. Results: By multivariate analysis, consolidation over any segment of the upper, middle, or lingual lobes, cavitations, and clusters of nodules were associated with group 1, while centrilobular nodules were predictive of group 2. Using five independent variables associated with risk in group 1, a prediction model was created to distinguish between group 1 and group 2. ROC curve analysis showed an area under the curve of 0.951±0.021 for this prediction model. With the ideal cutoff point score of 1, the sensitivity, specificity, and positive predictive values were 84.5%, 97.5%, and 98.0%, respectively. Conclusions: A model to predict smear-positive active PTB on the basis of findings from MDCT may be a useful tool for clinical decisions about isolating patients pending sputum smear results.
KW - Decision making
KW - Patient isolation
KW - Receiver-operating characteristic (ROC) curve
KW - Sputum
KW - Tuberculosis
UR - http://www.scopus.com/inward/record.url?scp=77957941550&partnerID=8YFLogxK
U2 - 10.1007/s00330-010-1796-5
DO - 10.1007/s00330-010-1796-5
M3 - Article
C2 - 20432040
AN - SCOPUS:77957941550
SN - 0938-7994
VL - 20
SP - 2135
EP - 2145
JO - European Radiology
JF - European Radiology
IS - 9
ER -