Identifying the most infectious lesions in pulmonary tuberculosis by high-resolution multi-detector computed tomography

Yeh, Jun-Jun; Chen, Solomon Chih–Cheng; Teng, Wen Bao; Chou, Chun Hsiung; Hsieh, Shih-Peng; Lee, Tsung Lung; Wu, Ming Ting

doi:10.1007/s00330-010-1796-5

Cited by 36 publications

(33 citation statements)

References 27 publications

(43 reference statements)

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“…These findings largely agree with recent HRCT studies showing that not only cavitation of s1, s2, and s1+s2 [8] but also consolidation in s1, s2, s1+s2, and s6 [25] and clusters of nodules/mass in s1, s2, and s1+s2 [8] are predictive of culture-positive PTB. This observation is also in accordance with other previous studies [35], [36].…”

Section: Discussionsupporting

confidence: 92%

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A High Resolution Computer Tomography Scoring System to Predict Culture-Positive Pulmonary Tuberculosis in the Emergency Department

et al. 2014

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This study evaluated the use of high-resolution computed tomography (HRCT) to predict the presence of culture-positive pulmonary tuberculosis (PTB) in adult patients with pulmonary lesions in the emergency department (ED). The study included a derivation phase and validation phase with a total of 8,245 patients with pulmonary disease. There were 132 patients with culture-positive PTB in the derivation phase and 147 patients with culture-positive PTB in the validation phase. Imaging evaluation of pulmonary lesions included morphology and segmental distribution. The post-test probability ratios between both phases in three prevalence areas were analyzed. In the derivation phase, a multivariate analysis model identified cavitation, consolidation, and clusters/nodules in right or left upper lobe (except anterior segment) and consolidation of the superior segment of the right or left lower lobe as independent positive factors for culture-positive PTB, while consolidation of the right or left lower lobe (except superior segment) were independent negative factors. An ideal cutoff point based on the receiver operating characteristic (ROC) curve analysis was obtained at a score of 1. The sensitivity, specificity, positivity predictive value, and negative predictive value from derivation phase were 98.5% (130/132), 99.7% (3997/4008), 92.2% (130/141), and 99.9% (3997/3999). Based on the predicted positive likelihood ratio value of 328.33 in derivation phase, the post-test probability was observed to be 91.5% in the derivation phase, 92.5% in the validation phase, 94.5% in a high TB prevalence area, 91.0% in a moderate prevalence area, and 76.8% in moderate-to-low prevalence area. Our model using HRCT, which is feasible to perform in the ED, can promptly diagnose culture-positive PTB in moderate and moderate-to-low prevalence areas.

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Section: Discussionsupporting

confidence: 92%

“…It has been shown that HRCT can detect culture-positive PTB and predict the risk of sputum smear-negative and sputum-positive PTB [8]–[10]. A recent study has reported the cost-effectiveness of using HRCT for detecting culture-positive PTB [10].…”

Section: Introductionmentioning

confidence: 99%

A High Resolution Computer Tomography Scoring System to Predict Culture-Positive Pulmonary Tuberculosis in the Emergency Department

et al. 2014

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“…Yadav et al 2 reported slightly different findings where the major abnormalities were centrilobular nodules (91%), consolidation (38%), cavity (48%), tree in bud pattern (88%). 2 Yeh et al 7 performed thoracic CT in forty cases of smear-negative TB and reported findings such as centrilobular nodules (51.2%), consolidation (35%), cavity (17.5%), and tree in bud (87.5%). Tree in bud is a sign of endobronchial TB, and a sign of active PTB if it is found in areas of PTB predilection.…”

Section: Discussionmentioning

confidence: 99%

“…Tree in bud is a sign of endobronchial TB, and a sign of active PTB if it is found in areas of PTB predilection. 2,7,9,12 Besides finding abnormalities associated with PTB, thoracic CT scans also find other abnormalities. This study found emphysema in 23 patients (17.7%), bronchiectasis in 16 patients (12.3%), fungal infections in three patients (2.3%) and mass in three patients (2.3%).…”

Section: Discussionmentioning

confidence: 99%

“…5,6 The high resolution computed tomography (HRCT) is more sensitive (98%) compared to chest X-ray (19-58%) in showing minimal lesions, differentiating between active and non-active lesions, detecting endobronchial dissemination, and diagnosing active smear-negative PTB. 2,[7][8][9][10][11][12][13][14][15] It is important to create a standardized system using a scoring system to guide radiologists in reporting computed tomography (CT) findings when diagnosing smear-negative adult PTB. A scoring system could produce a valid and reliable evaluation of chest CT regardless of radiologists' varying experiences and skills, and in turn, help clinicians to make an empirical judgment in treating PTB.…”

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confidence: 99%

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The accuracy of Aziza’s scoring system in limited slice non-enhanced thoracic CT for the diagnosis of adult pulmonary tuberculosis

2017

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ABSTRAK ABSTRACTBackground: Tuberculosis (TB) is still a major cause of morbidity and mortality in Indonesia. Thus, a fast and accurate method in diagnosing pulmonary TB (PTB) is needed, especially in adult smear-negative-TB cases. The purpose of this study was to determine the accuracy of a novel scoring system (Aziza's score) using clinical data and characteristic abnormalities that are found in the limited slice non-enhanced thoracic CT.

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Mycobacterium tuberculosis dysregulates MMP/TIMP balance to drive rapid cavitation and unrestrained bacterial proliferation

Kübler

Luna

Larsson

et al. 2014

The Journal of Pathology

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Active tuberculosis (TB) often presents with advanced pulmonary disease, including irreversible lung damage and cavities. Cavitary pathology contributes to antibiotic failure, transmission, morbidity and mortality. Matrix metalloproteinases (MMPs), in particular MMP-1 are implicated in TB pathogenesis. We explored the mechanisms relating MMP/TIMP imbalance to cavity formation in a modified rabbit model of cavitary TB. Our model results in consistent progression of consolidation to human-like cavities (100% by day 28) with resultant bacillary burdens (>107 CFU/g) far greater than those found in matched granulomatous tissue (105 CFU/g). Using a novel, breath-hold computerized tomography scanning and image analysis protocol. We show that cavities develop rapidly from areas of densely consolidated tissue. Radiological change correlated with a decrease in functional lung tissue as estimated by changes in lung density during controlled pulmonary expansion (R2=0.6356, p<0.0001). We demonstrated that the expression of interstitial collagenase (MMP-1) is specifically greater in cavitary compared to granulomatous lesions (p<0.01), and that TIMP-3 significantly decreases at the cavity surface. Our findings demonstrate that an MMP-1/TIMP imbalance, is associated with the progression of consolidated regions to cavities containing very high bacterial burdens. Our model provided mechanistic insight, correlating with human disease at the pathological, microbiological and molecular levels,. It also provides a strategy to investigate therapeutics in the context of complex TB pathology. We used these findings to predict a MMP/TIMP balance in active TB; and confirmed this in human plasma, revealing the potential of MMP/TIMP levels as key components of a diagnostic matrix aimed at distinguishing active from latent TB (PPV=92.9%; 95%CI 66.1–99.8%, NPV=85.6%; 95%CI 77.0–91.9%).

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Identifying the most infectious lesions in pulmonary tuberculosis by high-resolution multi-detector computed tomography

Abstract: 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.

Cited by 36 publications

References 27 publications

A High Resolution Computer Tomography Scoring System to Predict Culture-Positive Pulmonary Tuberculosis in the Emergency Department

A High Resolution Computer Tomography Scoring System to Predict Culture-Positive Pulmonary Tuberculosis in the Emergency Department

The accuracy of Aziza’s scoring system in limited slice non-enhanced thoracic CT for the diagnosis of adult pulmonary tuberculosis

Mycobacterium tuberculosis dysregulates MMP/TIMP balance to drive rapid cavitation and unrestrained bacterial proliferation

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