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European Radiology

, Volume 22, Issue 12, pp 2736–2742 | Cite as

High-resolution CT of nontuberculous mycobacterium infection in adult CF patients: diagnostic accuracy

  • Sinead McEvoy
  • Lisa Lavelle
  • Aoife Kilcoyne
  • Colin McCarthy
  • Pim A. deJong
  • Martine Loeve
  • Harm A. W. M. Tiddens
  • Edward McKone
  • Charles G. Gallagher
  • Jonathan D. Dodd
Chest

Abstract

Objectives

To determine the diagnostic accuracy of high-resolution computed tomography (HRCT) for the detection of nontuberculous mycobacterium infection (NTM) in adult cystic fibrosis (CF) patients.

Methods

Twenty-seven CF patients with sputum-culture-proven NTM (NTM+) underwent HRCT. An age, gender and spirometrically matched group of 27 CF patients without NTM (NTM-) was included as controls. Images were randomly and blindly analysed by two readers in consensus and scored using a modified Bhalla scoring system.

Results

Significant differences were seen between NTM (+) and NTM (-) patients in the severity of the bronchiectasis subscore [45 % (1.8/4) vs. 35 % (1.4/4), P = 0.029], collapse/consolidation subscore [33 % (1.3/3 vs. 15 % (0.6/3)], tree-in-bud/centrilobular nodules subscore [43 % (1.7/3) vs. 25 % (1.0/3), P = 0.002] and the total CT score [56 % (18.4/33) vs. 46 % (15.2/33), P = 0.002]. Binary logistic regression revealed BMI, peribronchial thickening, collapse/consolidation and tree-in-bud/centrilobular nodules to be predictors of NTM status (R2 = 0.43). Receiver-operator curve analysis of the regression model showed an area under the curve of 0.89, P < 0.0001.

Conclusion

In adults with CF, seven or more bronchopulmonary segments showing tree-in-bud/centrilobular nodules on HRCT is highly suggestive of NTM colonisation.

Key Points

Lung function declines rapidly in cystic fibrosis patients with nontuberculous mycobacterium infection

High-resolution computed tomography can help identify nontuberculous mycobacterium in CF patients

Extensive collapse/consolidation and tree-in-bud/centrilobular nodules are predictive of NTM infection

Multiple bronchopulmonary segments showing tree-in-bud/centrilobular nodules strongly suggest nontuberculous mycobacterium infection

Keywords

Tomography X-ray computed Cystic fibrosis Mycobacterium infections Nontuberculous Bronchiolitis Function test Pulmonary 

Abbreviations

CF

Cystic fibrosis

NTM

Nontuberculous mycobacterium

HRCT

High-resolution computed tomography

MAC

Mycobacterium avium complex

ATS

American Thoracic Society

CT

Computed tomography

PFT

Pulmonary function testing

BMI

Body mass index

FEV1

Forced expiratory volume in one second

Hmz

Homozygous

Hetz

Heterozygous

BPS

Bronchopulmonary segments

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Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Sinead McEvoy
    • 1
  • Lisa Lavelle
    • 1
  • Aoife Kilcoyne
    • 1
  • Colin McCarthy
    • 1
  • Pim A. deJong
    • 2
  • Martine Loeve
    • 3
  • Harm A. W. M. Tiddens
    • 3
  • Edward McKone
    • 4
  • Charles G. Gallagher
    • 4
  • Jonathan D. Dodd
    • 1
  1. 1.Department of RadiologySt. Vincent’s University HospitalDublinIreland
  2. 2.Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
  3. 3.Department of Radiology, Department of Pediatric Pulmonology and AllergologyErasmus MC-Sophia Children’s HospitalRotterdamThe Netherlands
  4. 4.Department of Respiratory Medicine and National Referral Centre for Adult Cystic FibrosisSt. Vincent’s University HospitalDublinIreland

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