Differentiating between active and latent tuberculosis with chest computed tomography

Autor: Nicolas Nagot, Sébastien Bommart, Clément Boissin, Hélène Vernhet-Kovacsik, Edouard Tuaillon, Marie P. Revel, Arnaud Bourdin, Jérémy Charriot
Přispěvatelé: Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Pathogénèse et contrôle des infections chroniques (PCCI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Universitaire de Montpellier (CHU Montpellier )-Université de Montpellier (UM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre Hospitalier Universitaire de Montpellier (CHU Montpellier )
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Adult
Male
medicine.medical_specialty
Microbiological culture
Tuberculosis
[SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging
Computed tomography
Logistic regression
[SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract
030218 nuclear medicine & medical imaging
Multidetector computed tomography
03 medical and health sciences
0302 clinical medicine
[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases
Internal medicine
Medicine
Humans
Radiology
Nuclear Medicine and imaging
Aged
Retrospective Studies
Lung
Interferon-gamma release tests
Radiological and Ultrasound Technology
medicine.diagnostic_test
Latent tuberculosis
business.industry
Tuberculin Test
Incidence (epidemiology)
General Medicine
Odds ratio
Middle Aged
medicine.disease
3. Good health
medicine.anatomical_structure
030228 respiratory system
Female
business
Tomography
X-Ray Computed
Zdroj: Diagnostic and Interventional Imaging
Diagnostic and Interventional Imaging, Elsevier, In press, ⟨10.1016/j.diii.2021.05.011⟩
ISSN: 2211-5684
DOI: 10.1016/j.diii.2021.05.011⟩
Popis: International audience; Purpose: The purpose of this study was to evaluate the capabilities of chest computed tomography (CT) in distinguishing between active and latent tuberculosis in patients positive for interferon-gamma release assay (IGRA) testing, and to compare the performance of CT with that of quantitative IGRA testing in a low incidence setting.Materials and methods: Patients with latent or active tuberculosis define by an IGRA positive test were retrospectively recruited. Sensitivity, specificity and accuracy were determined for CT variables and quantitative IGRA results. Final diagnosis of active tuberculosis was based on clinical data and microbiological culture. Univariable and multivariable analyses were performed using logistic regression model to identify CT variables associated with the diagnosis of active tuberculosis.Results: A total of 92 patients with positive IGRA results who underwent CT examination were included. There were 54 men and 38 women with a mean age of 53.5 ± 18 (SD) years (range: 40–68 years). Of them, 22 patients (24%) had positive Mycobacterium tuberculosis culture and 70 (76%) had latent tuberculosis. Among CT variables, consolidation had the greatest sensitivity (77%; 95%CI: 60–95%) and “tree-in-bud” the greatest specificity (97%; 95% CI: 93–100%) for the diagnosis of active tuberculosis. At univariable analysis “tree-in-bud”, splenic calcification and non-calcified lung nodules were the significant variables independently associated with active tuberculosis. At multivariable analysis, the adjusted odds ratio of “tree-in-bud” was 42.91 (95% CI: 5.62–327.42). Using an optimal threshold of 51 spots, quantitative IGRA yielded 64% sensitivity (95% CI: 44–84%) and 61% specificity (95% CI: 50–73%) for the diagnosis of active tuberculosis.Conclusions: In a low incidence setting, chest CT, especially when “tree-in-bud” pattern is present, is superior to quantitative IGRA testing to identify patients with active tuberculosis among those with positive IGRA testing.
Databáze: OpenAIRE
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