De Villiers Richard V P, Andronikou Savvas, Van de Westhuizen Stephan
Department of Radiology, Tygerberg Hospital, University of Stellenbosch, South Africa.
Australas Radiol. 2004 Jun;48(2):148-53. doi: 10.1111/j.1440-1673.2004.01276.x.
Tuberculosis (TB) remains the most common notifiable infectious disease in South Africa. The diagnosis of pulmonary TB in children is often very difficult because of the non-specific radiological signs and inter-observer variation in the interpretation of radiographs. The frontal high-kilovolt (kV) radiograph has been used to assess the effect of TB adenopathy on the tracheobronchial tree and to detect endobronchial lesions. The aims of the present study were to assess the specificity and sensitivity of chest radiographs in the diagnosis of pulmonary TB and to assess whether the addition of the high-kV radiograph affects these parameters. The study group consisted of paediatric patients suspected of having pulmonary TB over a 6-year period. These patients had clinical, bacteriological and radiographic examinations. Radiographs were examined by one experienced radiologist in two sittings separated by a 6-week interval. On the first sitting, only standard radiographs were examined and, on the second sitting, these were supplemented with high-kV radiographs. Differences in the detection of each recognized radiological feature of pulmonary TB before and after the addition of the high-kV film were analysed for statistical significance. The frequency of radiographic findings in our study compared favourably with other reports. No statistically significant differences for the detection of radiographic features consistent with pulmonary TB, or for the diagnosis of pulmonary TB, were demonstrated between the two sittings. Specificity increased from 74.4% to 86.6% with the addition of the high-kV view and sensitivity remained constant at 38.8%. The present study does not support the routine use of the frontal high-kV radiograph for the diagnosis of pulmonary TB. This paper also confirms the findings of others, that standard chest radiographs are a poor indicator of pulmonary TB in children.
结核病（TB）仍是南非最常见的须上报的传染病。儿童肺结核的诊断往往非常困难，因为其放射学征象不具特异性，且不同观察者对X光片的解读存在差异。额部高千伏（kV）X光片已被用于评估结核性淋巴结肿大对气管支气管树的影响以及检测支气管内病变。本研究的目的是评估胸部X光片在肺结核诊断中的特异性和敏感性，并评估添加高千伏X光片是否会影响这些参数。研究组由6年间疑似患有肺结核的儿科患者组成。这些患者接受了临床、细菌学和放射学检查。X光片由一位经验丰富的放射科医生分两次进行检查，两次检查间隔6周。第一次检查时，仅检查标准X光片，第二次检查时，在标准X光片基础上增加高千伏X光片。分析添加高千伏片前后肺结核各公认放射学特征检测结果的差异，以确定其统计学意义。我们研究中放射学检查结果的频率与其他报告相比情况良好。两次检查之间，在检测与肺结核相符的放射学特征或肺结核诊断方面，未显示出统计学上的显著差异。添加高千伏视图后，特异性从74.4%提高到86.6%，而敏感性保持在38.8%不变。本研究不支持将额部高千伏X光片常规用于肺结核的诊断。本文还证实了其他人的研究结果，即标准胸部X光片对儿童肺结核的指示性较差。
