Mehrian Payam, Farnia Poopak, Jalalvand Dina, Chamani Mostafa Rezaei, Bakhtiyari Mahmood
Telemedicine Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Mycobacteriology Research Centre (MRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Pol J Radiol. 2020 Jan 23;85:e39-e44. doi: 10.5114/pjr.2020.93123. eCollection 2020.
Multi-drug-resistant tuberculosis (MDR-TB) is simultaneously resistant to isoniazid and rifampin. Of course, this germ may also be resistant to other anti-tuberculosis drugs. Patients with extensively drug-resistant tuberculosis (XDR-TB) are also resistant to all types of fluoroquinolone and at least one of the three injectable medications: amikacin, clarithromycin, or kanamycin, in addition to isoniazid and rifampin. Therefore, the main objective of the current study was to evaluate and compare the computed tomography (CT) scan findings of MDR-TB and XDR-TB patients.
In this comparative descriptive cross-sectional study 45 consecutive TB patients who referred to Masih Daneshvari Hospital, Tehran, Iran from 2013 to 2019 were enrolled. TB was diagnosed based on sputum smear and sensitive molecular and microbial tests. Patients were divided into two groups (MDR-TB and XDR-TB) based on two types of drug resistance. CT scan findings were compared for cavitary, parenchymal, and non-parenchymal disorders. The early diagnostic values of these factors were also calculated.
Findings related to cavitary lesions including the pattern, number, size of the largest cavity, maximum thickness of the cavity, lung involvement, number of lobes involved, and the air-fluid levels in the two patient groups were similar ( > 0.05). Parenchymal findings of the lung also included fewer and more nodules of 10 mm in the MDR-TB and XDR-TB groups, respectively. Tree-in-bud, ground-glass-opacity, bronchiectasis, cicatricial emphysema, and lobar atelectasis were similar in the two patient groups ( > 0.05). Findings outside the parenchymal lung, including mediastinal lymphadenopathy and pericardial effusion, showed no statistically significant difference between the MDR-TB and XDR-TB groups ( > 0.05). Parenchymal calcification was more common in the XDR group than in the MDR group (64.7% and 28.6%, respectively) with a significant difference ( = 0.01).
CT scan findings in patients with XDR-TB are similar to those of patients with MDR-TB for cavitary, parenchymal, and non-parenchymal lung characteristics. However, patients with XDR-TB tend to have more parenchymal calcification and left-sided plural effusion. CT characteristics overlap between XDR-TB and those with MDR-TB. It can be concluded that CT scan features are not sensitive to the diagnosis.
耐多药结核病（MDR-TB）对异烟肼和利福平同时耐药。当然，这种病菌也可能对其他抗结核药物耐药。广泛耐药结核病（XDR-TB）患者除对异烟肼和利福平耐药外，还对所有类型的氟喹诺酮类药物以及三种注射用药物（阿米卡星、克拉霉素或卡那霉素）中的至少一种耐药。因此，本研究的主要目的是评估和比较MDR-TB和XDR-TB患者的计算机断层扫描（CT）扫描结果。
在这项比较性描述性横断面研究中，纳入了2013年至2019年转诊至伊朗德黑兰马西·达内什瓦里医院的45例连续性结核病患者。结核病根据痰涂片以及敏感的分子和微生物检测进行诊断。根据两种耐药类型将患者分为两组（MDR-TB和XDR-TB）。比较两组患者空洞性、实质性和非实质性病变的CT扫描结果。还计算了这些因素的早期诊断价值。
与空洞性病变相关的结果，包括空洞的形态、数量、最大空洞大小、空洞最大厚度、肺受累情况、受累肺叶数量以及两组患者的气液平面均相似（P>0.05）。肺实质的表现还包括，MDR-TB组和XDR-TB组分别有较少和较多的10mm结节。两组患者的树芽征、磨玻璃影、支气管扩张、瘢痕性肺气肿和肺叶肺不张相似（P>0.05）。肺实质外的表现，包括纵隔淋巴结肿大和心包积液，在MDR-TB组和XDR-TB组之间无统计学显著差异（P>0.05）。XDR组的实质钙化比MDR组更常见（分别为64.7%和28.6%），差异有统计学意义（P=0.01）。
XDR-TB患者在空洞性、实质性和非实质性肺部特征方面的CT扫描结果与MDR-TB患者相似。然而，XDR-TB患者往往有更多的实质钙化和左侧胸腔积液。XDR-TB与MDR-TB的CT特征存在重叠。可以得出结论，CT扫描特征对诊断不敏感。
