Role of contrast-enhanced dynamic CT in the diagnosis of active tuberculoma.
OBJECTIVE
To assess the role of contrast-enhanced dynamic CT in the diagnosis of active tuberculoma.


METHODS
Hospitals with an isolated ward for tuberculosis.


METHODS
Fifty-five subjects with newly diagnosed active tuberculoma and 24 subjects with inactive tuberculoma were examined and evaluated retrospectively. Six subjects with active tuberculomas and seven subjects with inactive tuberculomas were confirmed by histologic and microbiologic evaluation of resected specimens, whereas the remainder of the subjects with tuberculoma were confirmed clinically. The subjects were receiving iopamidol, 370 mg/mL IV, at a rate of 3.0 mL/s on contrast-enhanced dynamic CT. The time-attenuation curve was obtained and adapted to a gamma function. The peak height (PH), maximum attenuation subtracted by the background attenuation, relative flow (RF), and mean regional flow were used for comparison.


RESULTS
In the surgically confirmed group, the PH and RF values of six subjects with active tuberculomas were significantly higher than those of the seven subjects with inactive tuberculoma (p < 0.05). Similarly, in the subjects with noninvasive diagnoses, the PH and RF values of 49 subjects with active tuberculoma were significantly higher than those of the subjects with inactive tuberculoma (mean +/- SD PH, 43.4 +/- 4.1 Hounsfield units [HU] vs 11.6 +/- 2.7 HU, p < 0.0001; RF, 0.012 +/- 0.001/s vs 0.006 +/- 0.001/s, p < 0.05). When the cutoff value was defined as mean +/- 2 SD, the sensitivity and specificity of the diagnosis for active tuberculoma were 77.1% and 96.4% in PH, and 68.5% and 88.8% in RF, respectively.


CONCLUSIONS
Contrast-enhanced dynamic CT is a potentially valuable tool for the diagnosis of active tuberculoma.
Tateishi
Ukihide
U
Division of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, 104 Tokyo, Japan. utateish@ncc.go.jp
Kusumoto
Masahiko
M
Akiyama
Yasushi
Y
Kishi
Fumiya
F
Nishimura
Masaharu
M
Moriyama
Noriyuki
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D003287:Contrast Media; D005260:Female; D006801:Humans; D007479:Iopamidol; D008297:Male; D008875:Middle Aged; D011336:Probability; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013183:Sputum / Q000382:microbiology; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014375:Tuberculoma / Q000175:diagnosis / Q000000981:diagnostic imaging*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000000981:diagnostic imaging*
D003287:Contrast Media; D007479:Iopamidol