Main Article Content
Abstract
BACKGROUND
Mycobacterium tuberculosis complex causes pulmonary tuberculosis (PT) which is a major public health problem worldwide and endemic in India. PT diagnosis is done by high-resolution computed tomography (HRCT) which has high sensitivity and specificity.
METHODS
At a tertiary hospital, this cross-sectional study was conducted for 3 years. Patients presenting with productive cough with or without haemoptysis, shortness of breath, fever with night sweats or weight loss were suspected of having tuberculosis and underwent HRCT. PT was defined as the presence of consolidation, centrilobular nodules, and branching nodules with a tree in bud appearance with or without lymphadenopathy and pleural effusion on HRCT.
RESULTS
In this study, a total of 118 patients with a mean age of 51.85 ± 16.86 years were included. 64 (54.2%) were males and 54 (45.76%) were females out of 118 patients. Sputum smear was negative in a total of 66 (55.9%) patients and positive in 52(44.06%) patients. 84.26% was the diagnostic accuracy of HRCT in diagnosing PT with sensitivity, specificity, PPV and NPV of 84.28%, 83.33%, 78.98%, and 99.02%, respectively. HRCT had diagnostic accuracy, sensitivity, specificity, PPV and NPV of 86.40%, 89.46%, 83.42%, 94.14% and 72.43%, respectively in sputum smear positive patients. Whereas it was 83.87%, 91.54%, 75.40%, 64.57%, and 92.14%, respectively in sputum smear negative patients.
CONCLUSIONS
In diagnosing sputum smear-positive and sputum smear-negative PT, HRCT has high sensitivity. The specificity of HRCT was high in diagnosing sputum smear-positive PT, whereas in case of sputum smear-negative PT it was slightly low.
Keywords
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References
- Lönnroth K, Raviglione M. Global epidemiology of tuberculosis: prospects for control. Semin Respir Crit Care Med 2008;29(5):481-91.
- Cain KP, Benoit SR, Winston CA, et al. Tuberculosis among foreign-born persons in the United States. JAMA 2008;300(4):405-12.
- Nachiappan AC, Rahbar K, Shi X, et al. Pulmonary tuberculosis: role of radiology in diagnosis and management. RadioGraphics 2017;37(1):52-72.
- Wei Z, Zhang X, Wei C, et al. Diagnostic accuracy of in-house real-time PCR assay for Mycobacterium tuberculosis: a systematic review and meta-analysis. BMC Infect Dis 2019;19:701.
- Yoon C, Chaisson LH, Patel SM, et al. Diagnostic accuracy of C-reactive protein for active pulmonary tuberculosis: a meta-analysis. Int J Tuberc Lung Dis 2017;21(9):1013-9.
- Rakotoarivelo R, Ambrosioni J, Rasolofo V, et al. Evaluation of the Xpert MTB/RIF assay for the diagnosis of smear-negative pulmonary and extrapulmonary tuberculosis in Madagascar. Int J Infect Dis 2018;69:20-5.
- Detjen AK, DiNardo AR, Leyden J, et al. Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis in children: a systematic review and meta-analysis. Lancet Respir Med 2015;3(6):451-61.
- Dorman SE, Schumacher SG, Alland D, et al. Xpert MTB/RIF Ultra for detection of Mycobacterium tuberculosis and rifampicin resistance: a prospective multicentre diagnostic accuracy study. Lancet Infect Dis 2018;18(1):76-84.
- Burrill J, Williams CJ, Bain G, et al. Tuberculosis: a radiologic review. RadioGraphics. 2007;27(5):1255-73.
- Verver S, Warren RM, Beyers N, et al. Rate of reinfection tuberculosis after successful treatment is higher than rate of new tuberculosis. Am J Respir Crit Care Med 2005;171(12):1430-5.
- Yeh JJ, Yu JK, Teng WB, et al. High-resolution CT for identify patients with smear-positive, active pulmonary tuberculosis. Eur J Radiol 2012;81(1):195-201.
- Wekesa C, Kirenga BJ, Joloba ML, et al Chest X-ray vs Xpert® MTB/RIF assay for the diagnosis of sputum smear-negative tuberculosis in Uganda. Int J Tuberc Lung Dis 2014;18(2):216-9.
- Bhalla AS, Goyal A, Guleria R, et al. Chest tuberculosis: radiological review and imaging recommendations. Indian J Radiol Imaging 2015;25(3):213-25.
- Van Dyck P, Vanhoenacker FM, Van den Brande P, et al. Imaging of pulmonary tuberculosis. Eur Radiol 2003;13(8):1771-85.
- Raghuvanshi V, Sood RG, Jhobta A, et al. Use of high-resolution computed tomography (HRCT) in diagnosis of sputum negative pulmonary tuberculosis. Turk Thorac J 2016;17(2):59-64.
- Alsowey AM, Amin MI, Said AM. The predictive value of multidetector high resolution computed tomography in evaluation of suspected sputum smear negative active pulmonary tuberculosis in Egyptian Zagazig University Hospital patients. Pol J Radiol 2017;82:808-16.
- Rizzi EB, Schinina' V, Cristofaro M, et al. Detection of pulmonary tuberculosis: comparing MR imaging with HRCT. BMC Infect Dis 2011;11:243.
- Lee HM, Shin JW, Kim JY, et al. HRCT and whole-blood interferon-gamma assay for the rapid diagnosis of smear-negative pulmonary tuberculosis. Respiration 2010;79(6):454-60.
References
Lönnroth K, Raviglione M. Global epidemiology of tuberculosis: prospects for control. Semin Respir Crit Care Med 2008;29(5):481-91.
Cain KP, Benoit SR, Winston CA, et al. Tuberculosis among foreign-born persons in the United States. JAMA 2008;300(4):405-12.
Nachiappan AC, Rahbar K, Shi X, et al. Pulmonary tuberculosis: role of radiology in diagnosis and management. RadioGraphics 2017;37(1):52-72.
Wei Z, Zhang X, Wei C, et al. Diagnostic accuracy of in-house real-time PCR assay for Mycobacterium tuberculosis: a systematic review and meta-analysis. BMC Infect Dis 2019;19:701.
Yoon C, Chaisson LH, Patel SM, et al. Diagnostic accuracy of C-reactive protein for active pulmonary tuberculosis: a meta-analysis. Int J Tuberc Lung Dis 2017;21(9):1013-9.
Rakotoarivelo R, Ambrosioni J, Rasolofo V, et al. Evaluation of the Xpert MTB/RIF assay for the diagnosis of smear-negative pulmonary and extrapulmonary tuberculosis in Madagascar. Int J Infect Dis 2018;69:20-5.
Detjen AK, DiNardo AR, Leyden J, et al. Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis in children: a systematic review and meta-analysis. Lancet Respir Med 2015;3(6):451-61.
Dorman SE, Schumacher SG, Alland D, et al. Xpert MTB/RIF Ultra for detection of Mycobacterium tuberculosis and rifampicin resistance: a prospective multicentre diagnostic accuracy study. Lancet Infect Dis 2018;18(1):76-84.
Burrill J, Williams CJ, Bain G, et al. Tuberculosis: a radiologic review. RadioGraphics. 2007;27(5):1255-73.
Verver S, Warren RM, Beyers N, et al. Rate of reinfection tuberculosis after successful treatment is higher than rate of new tuberculosis. Am J Respir Crit Care Med 2005;171(12):1430-5.
Yeh JJ, Yu JK, Teng WB, et al. High-resolution CT for identify patients with smear-positive, active pulmonary tuberculosis. Eur J Radiol 2012;81(1):195-201.
Wekesa C, Kirenga BJ, Joloba ML, et al Chest X-ray vs Xpert® MTB/RIF assay for the diagnosis of sputum smear-negative tuberculosis in Uganda. Int J Tuberc Lung Dis 2014;18(2):216-9.
Bhalla AS, Goyal A, Guleria R, et al. Chest tuberculosis: radiological review and imaging recommendations. Indian J Radiol Imaging 2015;25(3):213-25.
Van Dyck P, Vanhoenacker FM, Van den Brande P, et al. Imaging of pulmonary tuberculosis. Eur Radiol 2003;13(8):1771-85.
Raghuvanshi V, Sood RG, Jhobta A, et al. Use of high-resolution computed tomography (HRCT) in diagnosis of sputum negative pulmonary tuberculosis. Turk Thorac J 2016;17(2):59-64.
Alsowey AM, Amin MI, Said AM. The predictive value of multidetector high resolution computed tomography in evaluation of suspected sputum smear negative active pulmonary tuberculosis in Egyptian Zagazig University Hospital patients. Pol J Radiol 2017;82:808-16.
Rizzi EB, Schinina' V, Cristofaro M, et al. Detection of pulmonary tuberculosis: comparing MR imaging with HRCT. BMC Infect Dis 2011;11:243.
Lee HM, Shin JW, Kim JY, et al. HRCT and whole-blood interferon-gamma assay for the rapid diagnosis of smear-negative pulmonary tuberculosis. Respiration 2010;79(6):454-60.