Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
Lung Research Institute of Hallym University College of Medicine, Chuncheon, Republic of Korea.
PLoS One. 2018 Aug 9;13(8):e0201748. doi: 10.1371/journal.pone.0201748. eCollection 2018.
Little is known about the correlation between microbiological yield and radiographic activity, on chest computed tomography (CT), in suspected pulmonary tuberculosis (PTB) cases, despite CT being widely used, clinically.
We used multicenter retrospective data, obtained from medical records, focusing on the diagnostic performance for definite PTB. We categorized patients into four groups, by radiographic activity: definitely active, probably active, indeterminate activity, and probably inactive.
Of the 650 patients included, 316 had culture-confirmed PTB; 190 (29.2%), 323 (49.7%), 70 (10.8%), and 67 (10.3%) were classified into the definitely active, probably active, indeterminate activity, and probably inactive groups, respectively. The corresponding observed culture rates for CT radiographic activity were 61.6%, 60.7%, 4.3% and 0%, respectively. When not only culture rates but TB-PCR and histological results were taken into consideration as definite PTB, it showed 66.6%, 67.2%, 14.3%, and 0% of each CT radiographic activity, respectively. Regarding the diagnostic performance for definite PTB, radiographic activity displayed high sensitivity (97.1%, 95% confidence interval (CI), 94.6-98.5) and negative predictive values (92.7%, 95% CI, 86.6-96.2), considered definitely and probably active PTB. Apart from PTB, other etiologies, according to radiographic activity, were predominantly respiratory infections such as bacterial pneumonia and non-tuberculous mycobacterial infection.
Radiographic activity showed good diagnostic performance, and can be used easily in clinical practice. However, clinicians should consider other possibilities, because radiologic images do not confirm microbiological PTB.
尽管胸部计算机断层扫描（CT）在临床上广泛应用，但对于疑似肺结核（PTB）病例中微生物学检出率与影像学活动性之间的相关性知之甚少。
我们使用多中心回顾性数据，从病历中获取，重点是明确 PTB 的诊断性能。我们将患者分为 4 组，根据影像学活动分为：明确活动、可能活动、不确定活动和可能不活动。
在 650 例患者中，316 例经培养证实为 PTB；190 例（29.2%）、323 例（49.7%）、70 例（10.8%）和 67 例（10.3%）分别归入明确活动、可能活动、不确定活动和可能不活动组。相应的 CT 影像学活动的观察培养率分别为 61.6%、60.7%、4.3%和 0%。当不仅考虑培养率，还考虑 TB-PCR 和组织学结果作为明确的 PTB 时，分别显示 CT 影像学活动的 66.6%、67.2%、14.3%和 0%。对于明确 PTB 的诊断性能，影像学活动显示出高敏感性（97.1%，95%置信区间（CI），94.6-98.5）和阴性预测值（92.7%，95%CI，86.6-96.2），考虑为明确和可能的 PTB。除 PTB 外，根据影像学活动，其他病因主要为细菌性肺炎和非结核分枝杆菌感染等呼吸道感染。
影像学活动具有良好的诊断性能，可在临床实践中方便地使用。然而，临床医生应该考虑其他可能性，因为影像学图像不能确认微生物学 PTB。
