Computed tomography features of extensively drug-resistant pulmonary tuberculosis in non-HIV-infected patients.
OBJECTIVE
To describe the computed tomography (CT) findings of pulmonary extensively drug-resistant tuberculosis (XDR-TB) in non-HIV-infected patients and to compare them with those of non-XDR multidrug-resistant tuberculosis (MDR-TB).


METHODS
Retrospective review of microbiological results and drug-susceptibility tests of 260 non-HIV-infected patients who had been diagnosed with pulmonary MDR-TB from 1994 to 2005 revealed that 47 patients had XDR-TB, whereas the other 213 patients had non-XDR MDR-TB. Twenty of the 47 XDR-TB patients and 85 of the 213 non-XDR MDR-TB patients with available CT examinations were included in this study. Two radiologists reviewed the CT studies in consensus for the presence and extent of micronodules, tree-in-bud appearance, lobular consolidation (<2 cm), consolidation, cavity, bronchiectasis, emphysema, pleural effusion, lymphadenopathy, bronchopleural fistula, and empyema. We then compared the CT features of XDR-TB with those of non-XDR MDR-TB.


RESULTS
Micronodules and tree-in-bud appearance were the most frequent CT abnormalities and were seen in all XDR-TB patients (100%). Consolidations, cavities, bronchiectasis, and lobular consolidations were found in 85%, 85%, 80%, and 70% of XDR-TB patients, respectively. The extents of micronodules, tree-in-bud appearance, lobular consolidation, consolidation, cavity, bronchiectasis, and emphysema were 3.60, 3.55, 1.35, 1.85, 1.65, 1.45, and 0.25 lobes, respectively. Compared with non-XDR MDR-TB, XDR-TB showed a significantly larger extent of tree-in-bud appearance and consolidation (P < 0.05). With respect to other CT features, there were no significant differences between XDR-TB and non-XDR MDR-TB.


CONCLUSIONS
Computed tomography findings of pulmonary XDR-TB are similar to those of non-XDR MDR-TB; however, XDR-TB tends to have more extensive consolidation and tree-in-bud appearance.
Lee
Eun Sun
ES
Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Korea.
Park
Chang Min
CM
Goo
Jin Mo
JM
Yim
Jae-Joon
JJ
Kim
Hye-Ryoun
HR
Lee
Hyun Ju
HJ
Lee
In Sun
IS
Im
Jung-Gi
JG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001982:Bronchial Diseases / Q000150:complications / Q000000981:diagnostic imaging; D003287:Contrast Media; D024881:Drug Resistance, Bacterial; D024901:Drug Resistance, Multiple, Bacterial; D004654:Empyema, Tuberculous / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008168:Lung / Q000000981:diagnostic imaging / Q000382:microbiology; D008206:Lymphatic Diseases / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010996:Pleural Effusion / Q000150:complications / Q000000981:diagnostic imaging; D011656:Pulmonary Emphysema / Q000150:complications / Q000000981:diagnostic imaging; D011856:Radiographic Image Enhancement / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D055815:Young Adult
D003287:Contrast Media; D007472:Iohexol; C038192:iopromide