scholarly journals Chest Computed Tomography Characteristics and Time to Culture Conversion Among Patients with Pulmonary Tuberculosis

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S720-S720
Author(s):  
Alfonso Hernandez
Keyword(s):  
Computed Tomography ◽  
Pulmonary Tuberculosis ◽  
Chest Computed Tomography ◽  
Culture Conversion

scholarly journals 792. Number and Volume of Cavitary Lesions on Chest Computed Tomography Associated With Prolonged Time to Culture Conversion in Drug-Susceptible Pulmonary Tuberculosis

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S284-S284
Author(s):  
Alfonso Hernandez
Keyword(s):  
Computed Tomography ◽  
Pulmonary Tuberculosis ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Chest Roentgenogram ◽  
Sputum Smear ◽  
Chest Computed Tomography ◽  
Median Difference ◽  
Cox Proportional Hazards Models ◽  
Culture Conversion

Abstract Background Cavitary lesions (CLs) may be a marker of poor treatment response in pulmonary tuberculosis (PTB). Identification of CLs by chest roentgenogram (CXR) has important limitations. Chest computed tomography (CT) is more sensitive than CXR to detect CLs but the clinical relevance of CLs identified by CT remains understudied. We compared detection of CLs between CT and CXR and assessed their association with time to sputum culture conversion (tSCC). We hypothesized that increasing number and volume of CLs on CT would be associated with prolonged tSCC. Methods Retrospective cohort study of 141 culture confirmed PTB patients who underwent chest CT. We used multivariate Cox proportional hazards models to evaluate the association between chest radiological features and tSCC. Results Seventy-five (53%) patients had one or more CLs on CT. CT identified cavities in 31% of patients without a CL on CXR. Detection of cavity on CT was associated with an increased median [IQR] time to culture conversion (15 [7–35] days among noncavitary CT vs. 39 [25–55] days among cavitary CT; P < 0.0001). Among patients without CL on CXR, detection of CL on CT was associated with prolonged tSCC (median difference (CI): 16 (7–25) days, P = 0.0008). Similar results were observed among patients with 3–4+ sputum smear (median difference: 19.5 (8–31) days, P = 0.001). Adjusted Kaplan–Meier curves of number and volume of CLs and tSCC are shown in Figure 1. After confounder adjustment patients with single and multiple CL had a prolonged tSCC relative to patients without CLs on CT (adjusted Hazard Ratio [aHR] 0.56 (0.32–0.97) and 0.31 (0.16–0.60), respectively). Similarly, patients with CL volume 25 mL or more had a prolonged tSCC (aHR 0.39 (0.21–0.72)). CXR CL was not associated with prolonged tSCC. Conclusion We observed a dose–response relationship between increasing number and volume of CLs on CT and delayed tSCC independent of sputum bacillary load. Our findings highlight a role for CT in a clinical research setting to predict shorter time to culture conversion. Disclosures All authors: No reported disclosures.

scholarly journals Increasing Number and Volume of Cavitary Lesions on Chest Computed Tomography Are Associated With Prolonged Time to Culture Conversion in Pulmonary Tuberculosis

2019 ◽  
Vol 6 (6) ◽  
Author(s):  
Alfonso C Hernandez-Romieu ◽  
Brent P Little ◽  
Adam Bernheim ◽  
Marcos C Schechter ◽  
Susan M Ray ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Tuberculosis ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Chest Computed Tomography ◽  
Sputum Microscopy ◽  
Cox Proportional Hazards Models ◽  
Increased Sensitivity ◽  
Multivariable Adjustment ◽  
Culture Conversion

Abstract Background Cavitary lesions (CLs) primarily identified by chest x-ray (CXR) have been associated with worse clinical outcomes among patients with pulmonary tuberculosis (PTB). Chest computed tomography (CT), which has better resolution and increased sensitivity to detect lung abnormalities, has been understudied in PTB patients. We compared detection of CLs by CT and CXR and assessed their association with time to sputum culture conversion (tSCC). Methods This was a retrospective cohort study of 141 PTB patients who underwent CT. We used multivariate Cox proportional hazards models to evaluate the association between CLs on CXR and the number and single largest volume of CLs on CT with tSCC. Results Thirty (21%) and 75 (53%) patients had CLs on CXR and CT, respectively. CT detected cavities in an additional 44 patients (31%) compared with CXR. After multivariable adjustment, we observed a negative association between CLs and tSCC, with an adjusted hazard ratio (aHR) of 0.56 (95% confidence interval [CI], 0.32 to 0.97) for single CLs and 0.31 (95% CI, 0.16 to 0.60) for multiple CLs present on CT. Patients with a CL volume ≥25 mL had a prolonged tSCC (aHR, 0.39; 95% CI, 0.21 to 0.72). CLs on CXR were not associated with increased tSCC after multivariable adjustment. Conclusions CT detected a larger number of cavities in patients with PTB relative to CXR. We observed an association between increasing number and volume of CLs on CT and delayed tSCC independent of sputum microscopy result. Our findings highlight a potential role for CT in the clinical and research setting as a tool to risk-stratify patients with PTB.

scholarly journals Correlation of microbiological yield with radiographic activity on chest computed tomography in cases of suspected pulmonary tuberculosis

PLoS ONE ◽  
2018 ◽  
Vol 13 (8) ◽  
pp. e0201748
Author(s):  
Yousang Ko ◽  
Ho Young Lee ◽  
Yong Bum Park ◽  
Su Jin Hong ◽  
Jeong Hwan Shin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Tuberculosis ◽  
Chest Computed Tomography

scholarly journals Tomographic Aspects of Advanced Active Pulmonary Tuberculosis and Evaluation of Sequelae following Treatment

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Rafael Barcelos Capone ◽  
Domenico Capone ◽  
Thiago Mafort ◽  
Roberto Mogami ◽  
Rosana de Souza Rodrigues ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Drug Therapy ◽  
Pulmonary Tuberculosis ◽  
Descriptive Study ◽  
Architectural Distortion ◽  
Cross Sectional ◽  
Chest Computed Tomography ◽  
Active Pulmonary Tuberculosis ◽  
Laboratory Results ◽  
Pleural Involvement

Objectives.To evaluate tomographic changes in pulmonary tuberculosis (TB), degree of agreement among three radiologists regarding tomographic diagnoses, and sequelae following treatment.Methods.Cross-sectional and descriptive study of 74 TB patients confirmed by sputum culture and chest computed tomography before (CT1) and 6 months after (CT2) drug therapy. Results were performed by three radiologists blinded to clinical and laboratory results.Results.Main findings in CT1 included nodules indicating the presence of a tree-in-bud pattern in 93% of cases, ill-defined nodules in 84% of cases, consolidation in 77% of cases, architectural distortion in 71% of cases, cavitary lesions in 62% of cases, and ground glass opacities in 37% of cases. Airway involvement, characterized by increased thickness and dilatation of the bronchial walls, occurred in 93% of cases. Pleural involvement occurred in 54%. There was an agreement on active TB among the three radiologists in 85% of cases. The results in CT2 indicated the presence of architectural distortion in 91% of cases and cylindrical bronchiectasis in 86%.Conclusions.The study established a tomographic pattern for diagnosis of active TB characterized by the presence of airway nodules, consolidation, architectural distortion, and cavitary lesions, and an almost complete degree of agreement (Kappa) was observed among the radiologists (0.85). CT after treatment assists in defining the cure.

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