title: Comparative chest computed tomography findings of non-tuberculous mycobacterial lung diseases and pulmonary tuberculosis in patients with acid fast bacilli smear-positive sputum.
abstract: BACKGROUND
  Early diagnosis and treatment of nontuberculous mycobacterial lung diseases (NTM-LD) and pulmonary tuberculosis (PTB) are important clinical issues. The present study aimed to compare and identify the chest CT characteristics that help to distinguish NTM lung disease from PTB in patients with acid-fast bacilli (AFB) smear-positive sputum.
  
  
  METHODS
  From January 2009 to April 2012, we received 467 AFB smear-positive sputum specimens. A total of 95 CT scans obtained from the 159 patients were analyzed, 75 scans were from patients with PTB and 20 scans from NTM-LD. The typical chest CT findings of mycobacterial diseases were analyzed.
  
  
  RESULTS
  In patients with PTB, the prevalence of pleural effusion (38.7% vs. 15.0%; P = 0.047), nodules < 10 mm in size (76.0% vs. 25.0%; P < 0.001), tree-in-bud pattern (81.3% vs. 55.0%; P = 0.021), and cavities (31.1% vs. 5.0%; P = 0.018) were significantly higher than patients with NTM. Of the 20 patients with NTM lung diseases, bronchiectasis and cystic changes were significantly higher than patients with PTB (20.0% vs. 4.0%; P = 0.034). In multivariate analysis, CT scan findings of nodules was independently associated with patients with diagnoses of PTB (odds ratio [OR], 0.07; 95% confidence interval [CI], 0.02-0.30). Presence of bronchiectasis and cystic changes in CT scans was strongly associated with patients with NTM-LD (OR, 33.04; 95% CI, 3.01-362.55).
  
  
  CONCLUSIONS
  The CT distinction between NTM-LD and PTB may help radiologists and physicians to know the most likely diagnoses in AFB-smear positive patients and avoid unnecessary adverse effects and the related costs of anti-TB drugs in endemic areas.
authors.forename: Mei-Kang
authors.initials: MK
authors.lastname: Yuan
authors.forename: Cheng-Yu
authors.initials: CY
authors.lastname: Chang
authors.forename: Ping-Huang
authors.initials: PH
authors.lastname: Tsai
authors.forename: Yuan-Ming
authors.initials: YM
authors.lastname: Lee
authors.forename: Jen-Wu
authors.initials: JW
authors.lastname: Huang
authors.affiliation: Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. 11319@ymuh.ym.edu.tw.
authors.forename: Shih-Chieh
authors.initials: SC
authors.lastname: Chang
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D016001:Confidence Intervals; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D013183:Sputum / Q000382:microbiology*; D013624:Taiwan / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology
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