Alsowey Ahmed Mohamed, Amin Mohamed Ibrahim, Said Ahmed Mohamed
Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Department of Chest, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Pol J Radiol. 2017 Dec 15;82:808-816. doi: 10.12659/PJR.903743. eCollection 2017.
The aim of this work is to study the usage of multi-detector HRCT chest in diagnosing pulmonary TB cases whose sputum smears are negative and making a correlation between their CT features and their sputum culture results. This study was carried out from December 2014 to December 2016 at Zagazig university hospitals, Radiodiagnosis department. It included 150 patients. Their ages ranged between 10 to 70 years with a mean age 40 years. They were referred from the outpatient respiratory medicine clinic of the hospital. All patients had been presented clinically with suspicion of PTB. Their clinical features and HRCT findings were investigated to predict the risk for PTB. We then designed provisional HRCT diagnostic criteria based on the results to rank the risk of PTB. A positive tuberculin skin test alone among clinical laboratory findings was significantly associated with an increase of risk of PTB. Centrilobular nodules, large nodules, tree-in-bud appearance and the main lesion being located in S1, S2, and S6 lung segments were significantly associated with an increased risk of PTB. At HRCT 40 out of 44 patients with class III ranking showed active pulmonary TB. 12 out of 51 patients presented with class II ranking and 8 out of 40 were ranked as class I. The sensitivity, specificity and positive likelihood ratio of class I ranking HRCT criteria to diagnose active pulmonary TB were 95%, 40% and 1.4, respectively. Class II ranking results were 85%, 72%, 3, respectively. Finally class III ranking results were 45%, 90%, 11.5, respectively. Cases suspected of having active pulmonary TB whose smears are negative can benefit from MD HRCT chest findings to predict those patients of high risk with good reproducibility.
这项工作的目的是研究多排螺旋CT胸部扫描在诊断痰涂片阴性的肺结核病例中的应用，并将其CT特征与痰培养结果进行相关性分析。本研究于2014年12月至2016年12月在扎加齐格大学医院放射诊断科进行。研究纳入了150例患者。他们的年龄在10至70岁之间，平均年龄为40岁。这些患者均来自医院门诊呼吸内科。所有患者临床上均疑似肺结核。对他们的临床特征和HRCT表现进行了调查，以预测患肺结核的风险。然后根据结果设计了临时的HRCT诊断标准，对肺结核风险进行分级。在临床实验室检查结果中，仅结核菌素皮肤试验阳性与患肺结核风险增加显著相关。小叶中心结节、大结节、树芽征以及主要病变位于肺段S1、S2和S6与患肺结核风险增加显著相关。在HRCT检查中，44例III级患者中有40例显示活动性肺结核。51例II级患者中有12例，40例I级患者中有8例。I级HRCT标准诊断活动性肺结核的敏感性、特异性和阳性似然比分别为95%、40%和1.4。II级结果分别为85%、72%、3。最后III级结果分别为45%、90%、11.5。痰涂片阴性但疑似患有活动性肺结核的病例可受益于MD HRCT胸部检查结果，以预测那些具有良好可重复性的高风险患者。
