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



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.


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.


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.


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


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



Cystic fibrosis


Nontuberculous mycobacterium


High-resolution computed tomography


Mycobacterium avium complex


American Thoracic Society


Computed tomography


Pulmonary function testing


Body mass index


Forced expiratory volume in one second






Bronchopulmonary segments


  1. 1.
    Jackson AD, Daly L, Kelleher C et al (2011) The application of current lifetable methods to compare cystic fibrosis median survival internationally is limited. J Cyst Fibros 10:62–65PubMedCrossRefGoogle Scholar
  2. 2.
    Olivier KN, Weber DJ, Wallace RJ et al (2003) Nontuberculous mycobacteria. I: Multicenter prevalence study in cystic fibrosis. Am J Respir Crit Care Med 167:828–834PubMedCrossRefGoogle Scholar
  3. 3.
    Roux AL, Catherinot E, Ripoll F et al (2009) Multicenter study of prevalence of nontuberculous mycobacteria in patients with cystic fibrosis in France. J Clin Microbiol 47:4124–4128PubMedCrossRefGoogle Scholar
  4. 4.
    Ebert DL, Olivier KN (2002) Nontuberculous mycobacteria in the setting of cystic fibrosis. Clin Chest Med 23:655–663PubMedCrossRefGoogle Scholar
  5. 5.
    Esther CR Jr, Henry MM, Molina PL, Leigh MW (2005) Nontuberculous mycobacterial infection in young children with cystic fibrosis. Pediatr Pulmonol 40:39–44PubMedCrossRefGoogle Scholar
  6. 6.
    Esther CR Jr, Esserman DA, Gilligan P, Kerr A, Noone PG (2010) Chronic Mycobacterium abscessus infection and lung function decline in cystic fibrosis. J Cyst Fibros 9:117–123PubMedCrossRefGoogle Scholar
  7. 7.
    Griffith DE, Aksamit T, Brown-Elliott BA et al on behalf of the ATSMDS (2007) An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 175:367–416Google Scholar
  8. 8.
    de Jong PA, Lindblad A, Rubin L et al (2006) Progression of lung disease on computed tomography and pulmonary function tests in children and adults with cystic fibrosis. Thorax 61:80–85PubMedCrossRefGoogle Scholar
  9. 9.
    de Jong PA, Nakano Y, Hop WC et al (2005) Changes in airway dimensions on computed tomography scans of children with cystic fibrosis. Am J Respir Crit Care Med 172:218–224PubMedCrossRefGoogle Scholar
  10. 10.
    de Jong PA, Nakano Y, Lequin MH et al (2004) Progressive damage on high resolution computed tomography despite stable lung function in cystic fibrosis. Eur Respir J 23:93–97PubMedCrossRefGoogle Scholar
  11. 11.
    Helbich T, Heinz-Peer G, Fleischmann D et al (1999) Evolution of CT findings in patients with cystic fibrosis. Am J Roentgenol 173:81–88Google Scholar
  12. 12.
    Judge EP, Dodd JD, Masterson JB, Gallagher CG (2006) Pulmonary abnormalities on high-resolution CT demonstrate more rapid decline than FEV1 in adults with cystic fibrosis. Chest 130:1424–1432PubMedCrossRefGoogle Scholar
  13. 13.
    de Jong PA, Ottink MD, Robben SG et al (2004) Pulmonary disease assessment in cystic fibrosis: comparison of CT scoring systems and value of bronchial and arterial dimension measurements. Radiology 231:434–439PubMedCrossRefGoogle Scholar
  14. 14.
    Helbich TH, Heinz-Peer G, Eichler I et al (1999) Cystic fibrosis: CT assessment of lung involvement in children and adults. Radiology 213:537–544PubMedGoogle Scholar
  15. 15.
    Olivier KN, Weber DJ, Lee JH et al (2003) Nontuberculous mycobacteria. II: Nested-cohort study of impact on cystic fibrosis lung disease. Am J Respir Crit Care Med 167:835–840PubMedCrossRefGoogle Scholar
  16. 16.
    Bhalla M, Turcios N, Aponte V et al (1991) Cystic fibrosis: scoring system with thin-section CT. Radiology 179:783–788PubMedGoogle Scholar
  17. 17.
    Kim TS, Koh WJ, Han J et al (2005) Hypothesis on the evolution of cavitary lesions in nontuberculous mycobacterial pulmonary infection: thin-section CT and histopathologic correlation. AJR Am J Roentgenol 184:1247–1252PubMedGoogle Scholar
  18. 18.
    Koh WJ, Lee KS, Kwon OJ, Jeong YJ, Kwak SH, Kim TS (2005) Bilateral bronchiectasis and bronchiolitis at thin-section CT: diagnostic implications in nontuberculous mycobacterial pulmonary infection. Radiology 235:282–288PubMedCrossRefGoogle Scholar
  19. 19.
    Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J (2008) Fleischner Society: glossary of terms for thoracic imaging. Radiology 246:697–722PubMedCrossRefGoogle Scholar
  20. 20.
    Miller MR, Hankinson J, Brusasco V et al (2005) Standardisation of spirometry. Eur Respir J 26:319–338PubMedCrossRefGoogle Scholar
  21. 21.
    Primack SL, Logan PM, Hartman TE, Lee KS, Muller NL (1995) Pulmonary tuberculosis and Mycobacterium avium-intracellulare: a comparison of CT findings. Radiology 194:413–417PubMedGoogle Scholar
  22. 22.
    Chung MJ, Lee KS, Koh WJ et al (2005) Thin-section CT findings of nontuberculous mycobacterial pulmonary diseases: comparison between Mycobacterium avium-intracellulare complex and Mycobacterium abscessus infection. J Korean Med Sci 20:777–783PubMedCrossRefGoogle Scholar
  23. 23.
    Tanaka E, Amitani R, Niimi A, Suzuki K, Murayama T, Kuze F (1997) Yield of computed tomography and bronchoscopy for the diagnosis of Mycobacterium avium complex pulmonary disease. Am J Respir Crit Care Med 155:2041–2046PubMedGoogle Scholar
  24. 24.
    Moore EH (1993) Atypical mycobacterial infection in the lung: CT appearance. Radiology 187:777–782PubMedGoogle Scholar

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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