title: Role of digital tomosynthesis and dual energy subtraction digital radiography in detection of parenchymal lesions in active pulmonary tuberculosis.
abstract: OBJECTIVE
  To assess the role of digital tomosynthesis (DTS) and dual energy subtraction digital radiography (DES-DR) in detection of parenchymal lesions in active pulmonary tuberculosis (TB) and to compare them with digital radiography (DR).
  
  
  METHODS
  This prospective study was approved by our institutional review committee. DTS and DES-DR were performed in 62 patients with active pulmonary TB within one week of multidetector computed tomography (MDCT) study. Findings of active pulmonary TB, that is consolidation, cavitation and nodules were noted on digital radiography (DR), DTS and DES-DR in all patients. Sensitivity, specificity, positive and negative predictive values of all 3 modalities was calculated with MDCT as reference standard. In addition presence of centrilobular nodules was also noted on DTS.
  
  
  RESULTS
  Our study comprised of 62 patients (33 males, 29 females with age range 18-82 years). Sensitivity and specificity of DTS for detection of nodules and cavitation was better than DR and DES-DR. Sensitivity and specificity of DTS for detection of consolidation was comparable to DR and DES-DR. DES-DR performed better than DR in detection of nodules and cavitation. DTS was also able to detect centrilobular nodules with sensitivity and specificity of 57.4% and 86.5% respectively.
  
  
  CONCLUSIONS
  DTS and DES-DR perform better than DR in detection of nodules, consolidation and cavitation in pulmonary TB. DTS gives better results than DES-DR, particularly in detection of cavitation and has moderate sensitivity for detection of centrilobular nodules. Thus DTS can be used for evaluation of patients of suspected pulmonary TB, thereby giving a more confident diagnosis of active disease and also in follow up.
authors.affiliation: Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh 160012, India. Electronic address: madhurimashrm88@gmail.com.
authors.forename: Madhurima
authors.initials: M
authors.lastname: Sharma
authors.affiliation: Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh 160012, India. Electronic address: manavjitsandhu@yahoo.com.
authors.forename: Manavjit Singh
authors.initials: MS
authors.lastname: Sandhu
authors.affiliation: Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh 160012, India. Electronic address: ujjwalgorsi@gmail.com.
authors.forename: Ujjwal
authors.initials: U
authors.lastname: Gorsi
authors.affiliation: Department of Pulmonary Medicine, PGIMER, Chandigarh 160012, India. Electronic address: dheeraj1910@gmail.com.
authors.forename: Dheeraj
authors.initials: D
authors.lastname: Gupta
authors.affiliation: Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh 160012, India. Electronic address: khandelwaln@hotmail.com.
authors.forename: Niranjan
authors.initials: N
authors.lastname: Khandelwal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015588:Observer Variation; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods; D015900:Radiography, Dual-Energy Scanned Projection / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: CT; Digital tomosynthesis; Dual-energy subtraction digital radiography; Tuberculosis