常规胸部 X 线摄影在眼结核和结节病中的应用。

Utility of routine chest radiography in ocular tuberculosis and sarcoidosis.

机构信息

Division of Pulmonology, Department of Medicine.

Division of Ophthalmology, Department of Surgical Sciences.

出版信息

Int J Tuberc Lung Dis. 2018 Nov 1;22(11):1374-1377. doi: 10.5588/ijtld.18.0013.

DOI:10.5588/ijtld.18.0013

PMID:30355419

Abstract

BACKGROUND

Tuberculosis (TB) and sarcoidosis commonly present with pulmonary and ocular involvement. Routine chest radiography (CXR) is recommended in the workup for suspected intraocular TB (IOTB) or intraocular sarcoidosis (IOS); however, data on the utility of CXR in this setting are lacking.

METHODS

A post-hoc analysis was performed of a prospectively collected data set comprising 104 patients with uveitis of unknown cause. A pulmonologist and thoracic radiologist, blinded to the final diagnosis, independently reported these CXRs as being in keeping with TB or sarcoidosis.

RESULTS

CXRs were reported as normal/indeterminate ( 88), probable/previous TB ( 9) or possible/probable sarcoidosis ( 8), with a 96% inter-observer concordance. CXRs were more often abnormal in IOS than in IOTB (5/8 vs. 5/34, 0.01). CXR had a sensitivity of 14.7%, specificity of 94.3%, positive predictive value (PPV) of 55.6% and negative predictive value (NPV) of 69.5% for IOTB, compared with a sensitivity of 62.5%, specificity of 96.9%, PPV of 62.5% and NPV of 96.9% for IOS. Overall diagnostic accuracy was 54.5% (58.1% in human immunodeficiency virus [HIV] positive participants) in the case of IOTB and 79.9% for IOS.

CONCLUSION

CXR had high specificity and NPV for IOS, and poor overall diagnostic accuracy for IOTB, including in the HIV-positive population.

摘要

背景

肺结核（TB）和结节病常表现为肺部和眼部受累。常规胸部 X 线摄影（CXR）被推荐用于疑似眼内结核（IOTB）或眼内结节病（IOS）的检查；然而，在这种情况下 CXR 的实用性数据尚缺乏。

方法

对一项前瞻性收集的包含 104 例原因不明的葡萄膜炎患者的数据进行了事后分析。一位肺病专家和胸部放射科医生，对最终诊断不知情，独立地将这些 CXR 报告为符合结核病或结节病。

结果

CXR 报告为正常/不确定（88%）、可能/既往结核病（9%）或可能/可能结节病（8%），观察者间一致性为 96%。在 IOS 中 CXR 更常异常（5/8 与 5/34，0.01）。CXR 对 IOTB 的敏感性为 14.7%，特异性为 94.3%，阳性预测值（PPV）为 55.6%，阴性预测值（NPV）为 69.5%，而对 IOS 的敏感性为 62.5%，特异性为 96.9%，PPV 为 62.5%，NPV 为 96.9%。在 IOTB 的情况下，总体诊断准确性为 54.5%（HIV 阳性参与者为 58.1%），而 IOS 为 79.9%。