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A high-resolution computed tomography-based scoring system to differentiate the most infectious active pulmonary tuberculosis from community-acquired pneumonia in elderly and non-elderly patients

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Abstract

Objective

The objective of this study was to use high-resolution computed tomography (HRCT) imaging to predict the presence of smear-positive active pulmonary tuberculosis (PTB) in elderly (at least 65 years of age) and non-elderly patients (18–65 years of age).

Methods

Patients with active pulmonary infections seen from November 2010 through December 2011 received HRCT chest imaging, sputum smears for acid-fast bacilli and sputum cultures for Mycobacterium tuberculosis. Smear-positive PTB was defined as at least one positive sputum smear and a positive culture for M. tuberculosis. Multivariate logistic regression analyses were performed to determine the HRCT predictors of smear-positive active PTB, and a prediction score was developed on the basis of receiver operating characteristic curve analysis.

Results

Of 1,255 patients included, 139 were diagnosed with smear-positive active PTB. According to ROC curve analysis, the sensitivity, specificity, positive predictive value, negative predictive value, false positive rates and false negative rates were 98.6 %, 95.8 %, 78.5 %, 99.8 %, 4.2 % and 1.4 %, respectively, for diagnosing smear-positive active PTB in elderly patients, and 100.0 %, 96.9 %, 76.5 %, 100.0 %, 3.1 % and 0.0 %, respectively, for non-elderly patients.

Conclusions

HRCT can assist in the early diagnosis of the most infectious active PTB, thereby preventing transmission and minimizing unnecessary immediate respiratory isolation.

Key Points

• HRCT can assist in the early diagnosis of the infectious active PTB

• HRCT imaging is useful to predict the presence of smear-positive active PTB

• Predictions from the HRCT imaging are valid even before sputum smear or culture results

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Abbreviations

AFB:

Acid-fast bacilli

AUC:

Area under the curve

CAP:

Community-acquired pneumonia

CI:

Confidence interval

CXR:

Chest x-ray

ED:

Emergency department

FNR:

False negative rate

EPR:

False positive rate

HRCT:

High-resolution computed tomography

HU:

Hounsfield unit

MDCT:

Multi-detector CT

MDR:

Multi-drug resistance

NAA:

Nucleic acid amplification

NPV:

Negative predictive value

OPD:

Outpatient department

OR:

Odds ratio

PACS:

Picture archiving and communication system

PPV:

Positive predictive value

ROC:

Receiver-operating characteristic

SD:

Standard deviation

SE:

Standard error

TB:

Tuberculosis

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Acknowledgements

The scientific guarantor of this publication is Jun-Jun Yeh. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Jun-Jun Yeh, Solomon Chih-Cheng Chen, Cheng-Ren Chen, Ming-Ting Wu kindly provided statistical advice for this manuscript. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: retrospective, observational, multicentre study

Author information

Authors and Affiliations

  1. Section of Thoracic Imaging, Department of Chest Medicine and Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd, Chiayi City, Taiwan, 600, Republic of China

    Jun-Jun Yeh

  2. Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd, Chiayi City, Taiwan, 600, Republic of China

    Solomon Chih-Cheng Chen & Cheng-Ren Chen

  3. Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd, Chiayi City, Taiwan, 600, Republic of China

    Ting-Chun Yeh, Hsin-Kai Lin, Jia-Bin Hong & Bing-Tsang Wu

  4. Chia Nan University of Pharmacy and Science, Tainan, Taiwan, Republic of China

    Jun-Jun Yeh

  5. Meiho University, Pingtung, Taiwan, Republic of China

    Jun-Jun Yeh

  6. Pingtung Christian Hospital, Pingtung, Taiwan, Republic of China

    Jun-Jun Yeh

  7. Section of Thoracic and Circulation Imaging, Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, 813-62, Republic of China

    Ming-Ting Wu

  8. Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Republic of China

    Ming-Ting Wu

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  1. Jun-Jun Yeh
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  2. Solomon Chih-Cheng Chen
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  3. Cheng-Ren Chen
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  4. Ting-Chun Yeh
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  7. Bing-Tsang Wu
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Corresponding authors

Correspondence to Jun-Jun Yeh or Ming-Ting Wu.

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Yeh, JJ., Chen, S.CC., Chen, CR. et al. A high-resolution computed tomography-based scoring system to differentiate the most infectious active pulmonary tuberculosis from community-acquired pneumonia in elderly and non-elderly patients. Eur Radiol 24, 2372–2384 (2014). https://doi.org/10.1007/s00330-014-3279-6

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  • DOI: https://doi.org/10.1007/s00330-014-3279-6

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