title: A high-resolution computed tomography-based scoring system to differentiate the most infectious active pulmonary tuberculosis from community-acquired pneumonia in elderly and non-elderly patients.
abstract: OBJECTIVE
  The objective of this study was to use high-resolution computed tomography (HRCT) imaging to predict the presence of smear-positive active pulmonary tuberculosis (PTB) in elderly (at least 65 years of age) and non-elderly patients (18-65 years of age).
  
  
  METHODS
  Patients with active pulmonary infections seen from November 2010 through December 2011 received HRCT chest imaging, sputum smears for acid-fast bacilli and sputum cultures for Mycobacterium tuberculosis. Smear-positive PTB was defined as at least one positive sputum smear and a positive culture for M. tuberculosis. Multivariate logistic regression analyses were performed to determine the HRCT predictors of smear-positive active PTB, and a prediction score was developed on the basis of receiver operating characteristic curve analysis.
  
  
  RESULTS
  Of 1,255 patients included, 139 were diagnosed with smear-positive active PTB. According to ROC curve analysis, the sensitivity, specificity, positive predictive value, negative predictive value, false positive rates and false negative rates were 98.6 %, 95.8 %, 78.5 %, 99.8 %, 4.2 % and 1.4 %, respectively, for diagnosing smear-positive active PTB in elderly patients, and 100.0 %, 96.9 %, 76.5 %, 100.0 %, 3.1 % and 0.0 %, respectively, for non-elderly patients.
  
  
  CONCLUSIONS
  HRCT can assist in the early diagnosis of the most infectious active PTB, thereby preventing transmission and minimizing unnecessary immediate respiratory isolation.
  
  
  CONCLUSIONS
  • HRCT can assist in the early diagnosis of the infectious active PTB • HRCT imaging is useful to predict the presence of smear-positive active PTB • Predictions from the HRCT imaging are valid even before sputum smear or culture results.
authors: Section of Thoracic Imaging, Department of Chest Medicine and Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd, Chiayi City, Taiwan, 600, Republic of China, cych07239@gmail.com.tw.
authors: Jun-Jun
authors: JJ
authors: Yeh
authors: Solomon Chih-Cheng
authors: SC
authors: Chen
authors: Cheng-Ren
authors: CR
authors: Chen
authors: Ting-Chun
authors: TC
authors: Yeh
authors: Hsin-Kai
authors: HK
authors: Lin
authors: Jia-Bin
authors: JB
authors: Hong
authors: Bing-Tsang
authors: BT
authors: Wu
authors: Ming-Ting
authors: MT
authors: Wu
mesh_terms: D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011014:Pneumonia / Q000000981:diagnostic imaging*; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013183:Sputum / Q000382:microbiology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging* / Q000382:microbiology