European Radiology

, Volume 20, Issue 9, pp 2135–2145 | Cite as

Identifying the most infectious lesions in pulmonary tuberculosis by high-resolution multi-detector computed tomography

  • Jun Jun Yeh
  • Solomon Chih-Cheng Chen
  • Wen-Bao Teng
  • Chun-Hsiung Chou
  • Shih-Peng Hsieh
  • Tsung-Lung Lee
  • Ming-Ting WuEmail author
Computed Tomography



This study aimed to determine whether characteristics detected by multi-detector computed tomography (MDCT) were predictive of highly infectious, smear-positive, active pulmonary tuberculosis (PTB).


Among 124 patients with active PTB, 84 had positive (group 1) and 40 had negative (group 2) smear results for acid-fast bacilli. Multiplanar MDCT, axial conventional CT and chest X-ray images were analysed retrospectively for morphology, number, and segmental (lobe) distribution of lesions.


By multivariate analysis, consolidation over any segment of the upper, middle, or lingual lobes, cavitations, and clusters of nodules were associated with group 1, while centrilobular nodules were predictive of group 2. Using five independent variables associated with risk in group 1, a prediction model was created to distinguish between group 1 and group 2. ROC curve analysis showed an area under the curve of 0.951 ± 0.021 for this prediction model. With the ideal cutoff point score of 1, the sensitivity, specificity, and positive predictive values were 84.5%, 97.5%, and 98.0%, respectively.


A model to predict smear-positive active PTB on the basis of findings from MDCT may be a useful tool for clinical decisions about isolating patients pending sputum smear results.


Patient isolation Tuberculosis Receiver-operating characteristic (ROC) curve Sputum Decision making 



The authors wish to thank Associate Professor Yi-Hsin Yang, Ph.D., of the Department of Medical Research in Kaohsiung Medical University for her assistance with statistical analysis.


  1. 1.
    American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Controlling Tuberculosis in the United States (2005) Am J Respir Crit Care Med 172:1169–1227Google Scholar
  2. 2.
    Behr MA, Warren SA, Salamon H et al (1999) Transmission of mycobacterium tuberculosis from patients smear-negative for acid-fast bacilli. Lancet 353:444–449CrossRefPubMedGoogle Scholar
  3. 3.
    Blumberg HM, Watkins DL, Berschling JD et al (1995) Preventing the nosocomial transmission of tuberculosis. Ann Intern Med 122:658–663PubMedGoogle Scholar
  4. 4.
    Greenaway C, Menzies D, Fanning A, Grewal R, Yuan L, FitzGerald JM (2002) Delay in diagnosis among hospitalized patients with active tuberculosis–predictors and outcomes. Am J Respir Crit Care Med 165:927–933PubMedGoogle Scholar
  5. 5.
    WHO (1994) WHO tuberculosis programme-framework for effective tuberculosis control. WHO, Geneva, SwitzerlandGoogle Scholar
  6. 6.
    Foulds J, O’Brien R (1998) New tools for the diagnosis of tuberculosis: the perspective of developing countries. Int J Tuberc Lung Dis 2:778–783PubMedGoogle Scholar
  7. 7.
    Okur E, Yilmaz A, Saygi A et al (2006) Patterns of delays in diagnosis amongst patients with smear-positive pulmonary tuberculosis at a teaching hospital in Turkey. Clin Microbiol Infect 12:90–92CrossRefPubMedGoogle Scholar
  8. 8.
    Phoa LL, Teleman MD, Wang YT, Chee CB (2005) Characteristics of patients with delayed diagnosis of infectious pulmonary tuberculosis. Respirology 10:196–200PubMedGoogle Scholar
  9. 9.
    Mostaza JL, Garcia N, Fernandez S, Bahamonde A, Fuentes MI, Palomo MJ (2007) Analysis and predictor of delays in the suspicion and treatment among hospitalized patients with pulmonary tuberculosis. An Med Interna 24:478–483PubMedGoogle Scholar
  10. 10.
    Hsieh MJ, Liang HW, Chiang PC et al (2009) Delayed suspicion, treatment and isolation of tuberculosis patients in pulmonology/infectious diseases and non-pulmonology/infectious diseases wards. J Formos Med Assoc 108:202–209CrossRefPubMedGoogle Scholar
  11. 11.
    Steen TW, Mazonde GN (1998) Pulmonary tuberculosis in Kweneng District, Botswana: delays in diagnosis in 212 smear-positive patients. Int J Tuberc Lung Dis 2:627–634PubMedGoogle Scholar
  12. 12.
    Im JG, Itoh H, Shim YS et al (1993) Pulmonary tuberculosis: CT findings–early active disease and sequential change with antituberculous therapy. Radiology 186:653–660PubMedGoogle Scholar
  13. 13.
    Jeong YJ, Lee KS (2008) Pulmonary tuberculosis: up-to-date imaging and management. Am J Roentgenol 191:834–844CrossRefGoogle Scholar
  14. 14.
    Hatipoglu ON, Osma E, Manisali M et al (1996) High resolution computed tomographic findings in pulmonary tuberculosis. Thorax 51:397–402CrossRefPubMedGoogle Scholar
  15. 15.
    Matsuoka S, Uchiyama K, Shima H et al (2004) Relationship between CT findings of pulmonary tuberculosis and the number of acid-fast bacilli on sputum smears. Clin Imaging 28:119–123CrossRefPubMedGoogle Scholar
  16. 16.
    Kosaka N, Sakai T, Uematsu H et al (2005) Specific high-resolution computed tomography findings associated with sputum smear-positive pulmonary tuberculosis. J Comput Assist Tomogr 29:801–804CrossRefPubMedGoogle Scholar
  17. 17.
    Byrd RP Jr, Mehta JB, Roy TM (2003) Delay in diagnosis among hospitalized patients with active tuberculosis—predictors and outcomes. Am J Respir Crit Care Med 167:278, author reply 278PubMedGoogle Scholar
  18. 18.
    Webb WR, Nestor LM, Naidich DP (2009) Sarcoidosis. In: Webb WR, Nestor LM, Naidich DP (eds) High resolution CT of the lung. LWW, Philadelphia, pp 273–300Google Scholar
  19. 19.
    Webb WR (2005) Solitary and multiple nodules, masses, cavities, and cysts. In: Webb WR, Higgins CB (eds) Thoracic imaging. LWW, Philadelphia, pp 271–305Google Scholar
  20. 20.
    Webb WR (2005) Sarcoidosis. In: Webb WR, Higgins CB (eds) Thoracic imaging. LWW, Philadelphia, pp 439–449Google Scholar
  21. 21.
    Bock NN, McGowan JE Jr, Ahn J, Tapia J, Blumberg HM (1996) Clinical predictors of tuberculosis as a guide for a respiratory isolation policy. Am J Respir Crit Care Med 154:1468–1472PubMedGoogle Scholar
  22. 22.
    Tattevin P, Casalino E, Fleury L, Egmann G, Ruel M, Bouvet E (1999) The validity of medical history, classic symptoms, and chest radiographs in predicting pulmonary tuberculosis: derivation of a pulmonary tuberculosis prediction model. Chest 115:1248–1253CrossRefPubMedGoogle Scholar
  23. 23.
    El-Solh AA, Hsiao CB, Goodnough S, Serghani J, Grant BJ (1999) Predicting active pulmonary tuberculosis using an artificial neural network. Chest 116:968–973CrossRefPubMedGoogle Scholar
  24. 24.
    Schoch OD, Rieder P, Tueller C et al (2007) Diagnostic yield of sputum, induced sputum, and bronchoscopy after radiologic tuberculosis screening. Am J Respir Crit Care Med 175:80–86CrossRefPubMedGoogle Scholar
  25. 25.
    Raniga S, Parikh N, Arora A (2006) Is HRCT reliable in determining disease activity in pulmonary tuberculosis. Ind J Radiol Imag 16:221–228CrossRefGoogle Scholar
  26. 26.
    CY HJN, Jeon SC et al (2005) Pulmonary tuberculosis: another disease showing clusters of small nodules. Am J Roentgenol 184:639–642Google Scholar
  27. 27.
    Rathman G, Sillah J, Hill PC et al (2003) Clinical and radiological presentation of 340 adults with smear-positive tuberculosis in The Gambia. Int J Tuberc Lung Dis 7:942–947PubMedGoogle Scholar
  28. 28.
    Poey C, Verhaegen F, Giron J, Lavayssiere J, Fajadet P, Duparc B (1997) High resolution chest CT in tuberculosis: evolutive patterns and signs of activity. J Comput Assist Tomogr 21:601–607CrossRefPubMedGoogle Scholar
  29. 29.
    Wisnivesky JP, Henschke C, Balentine J, Willner C, Deloire AM, McGinn TG (2005) Prospective validation of a prediction model for isolating inpatients with suspected pulmonary tuberculosis. Arch Intern Med 165:453–457CrossRefPubMedGoogle Scholar
  30. 30.
    Liam CK, Tang BG (1997) Delay in the diagnosis and treatment of pulmonary tuberculosis in patients attending a university teaching hospital. Int J Tuberc Lung Dis 1:326–332PubMedGoogle Scholar
  31. 31.
    Lee KS, Hwang JW, Chung MP, Kim H, Kwon OJ (1996) Utility of CT in the evaluation of pulmonary tuberculosis in patients without AIDS. Chest 110:977–984CrossRefPubMedGoogle Scholar
  32. 32.
    Campos M, Quartin A, Mendes E et al (2008) Feasibility of shortening respiratory isolation with a single sputum nucleic acid amplification test. Am J Respir Crit Care Med 178:300–305CrossRefPubMedGoogle Scholar
  33. 33.
    Mathur P, Sacks L, Auten G, Sall R, Levy C, Gordin F (1994) Delayed diagnosis of pulmonary tuberculosis in city hospitals. Arch Intern Med 154:306–310CrossRefPubMedGoogle Scholar
  34. 34.
    Ikezoe J, Takeuchi N, Johkoh T et al (1992) CT appearance of pulmonary tuberculosis in diabetic and immunocompromised patients: comparison with patients who had no underlying disease. Am J Roentgenol 159:1175–1179Google Scholar
  35. 35.
    Kobashi Y, Mouri K, Yagi S et al (2007) Clinical features of immunocompromised and nonimmunocompromised patients with pulmonary tuberculosis. J Infect Chemother 13:405–410CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2010

Authors and Affiliations

  • Jun Jun Yeh
    • 1
    • 2
    • 3
  • Solomon Chih-Cheng Chen
    • 1
    • 4
  • Wen-Bao Teng
    • 1
  • Chun-Hsiung Chou
    • 1
  • Shih-Peng Hsieh
    • 1
  • Tsung-Lung Lee
    • 1
  • Ming-Ting Wu
    • 5
    • 6
    Email author
  1. 1.Pingtung Christian HospitalPingtungTaiwan
  2. 2.Mei-Ho Institute of TechnologyPingtungTaiwan
  3. 3.China Medical UniversityTaichungTaiwan
  4. 4.Institute of Occupational Medicine and Industrial Hygiene, College of Public HealthNational Taiwan UniversityTaipeiTaiwan
  5. 5.Faculty of Medicine, School of MedicineNational Yang Ming UniversityTaipeiTaiwan
  6. 6.Section of Thoracic and Circulation Imaging, Department of RadiologyKaohsiung Veterans General HospitalKaohsiungRepublic of China

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