Division of Pulmonology, Department of Medicine.
Division of Ophthalmology, Department of Surgical Sciences.
Int J Tuberc Lung Dis. 2018 Nov 1;22(11):1374-1377. doi: 10.5588/ijtld.18.0013.
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.
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.
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.
CXR had high specificity and NPV for IOS, and poor overall diagnostic accuracy for IOTB, including in the HIV-positive population.
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。
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。
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%。
CXR 对 IOS 具有高特异性和 NPV，对 IOTB 的总体诊断准确性较差，包括在 HIV 阳性人群中。
