title: Evaluation of a radiological severity score to predict treatment outcome in adults with pulmonary tuberculosis.
abstract: OBJECTIVE
  To refine and evaluate a recently published radiological disease severity score for the prediction of month 2 and end of treatment outcomes in pulmonary tuberculosis (TB). Radiological extent of disease has been linked to early and late outcomes of anti-tuberculosis treatment, but no validated tools are available to quantify this parameter.
  
  
  METHODS
  We enrolled 449 adult, human immunodeficiency virus negative participants with smear- or culture-proven TB from three TB biomarker studies in Cape Town, South Africa. Full-size posteroanterior baseline chest X-rays (CXRs) were evaluated by two clinicians after standardising the published scoring method and the predictive ability assessed for month 2 and final treatment outcomes.
  
  
  RESULTS
  Baseline CXR scores were significantly different in the favourable and unfavourable outcome groups; however, the predictive ability for outcomes at all time points was poor (ROC area under curve ⩿0.68). Inter-reader reliability was high (r = 0.86, P < 0.001), but agreement in cavity identification was modest.
  
  
  CONCLUSIONS
  Standardised application of a CXR score derived from the presence of cavities and overall extent of parenchymal disease in active TB showed good inter- and intrareader reliability. Scores differed significantly in treatment outcome groups, but did not allow accurate outcome prediction.
authors.affiliation: Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research/Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: M
authors.initials: M
authors.lastname: Kriel
authors.affiliation: Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Tygerberg Academic HospitalStellenbosch University, Cape Town, South Africa.
authors.forename: J W
authors.initials: JW
authors.lastname: Lotz
authors.affiliation: Centre for Statistical Consultation, Stellenbosch University, Cape Town, South Africa.
authors.forename: M
authors.initials: M
authors.lastname: Kidd
authors.affiliation: Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research/Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: G
authors.initials: G
authors.lastname: Walzl
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000032:analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis; D011379:Prognosis; D013902:Radiography, Thoracic / Q000379:methods*; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013019:South Africa; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging*; D055815:Young Adult
chemical_list: D015415:Biomarkers