title: A Systematic Review of the Prevalence and Pattern of Imaging Defined Post-TB Lung Disease.
abstract: BACKGROUND
  Tuberculosis is an important risk factor for chronic respiratory disease in resource poor settings. The persistence of abnormal spirometry and symptoms after treatment are well described, but the structural abnormalities underlying these changes remain poorly defined, limiting our ability to phenotype post-TB lung disease in to meaningful categories for clinical management, prognostication, and ongoing research. The relationship between post-TB lung damage and patient-centred outcomes including functional impairment, respiratory symptoms, and health related quality of life also remains unclear.
  
  
  METHODS
  We performed a systematic literature review to determine the prevalence and pattern of imaging-defined lung pathology in adults after medical treatment for pleural, miliary, or pulmonary TB disease. Data were collected on study characteristics, and the modality, timing, and findings of thoracic imaging. The proportion of studies relating imaging findings to spirometry results and patient morbidity was recorded. Study quality was assessed using a modified Newcastle-Ottowa score. (Prospero Registration number CRD42015027958).
  
  
  RESULTS
  We identified 37 eligible studies. The principle features seen on CXR were cavitation (8.3-83.7%), bronchiectasis (4.3-11.2%), and fibrosis (25.0-70.4%), but prevalence was highly variable. CT imaging identified a wider range of residual abnormalities than CXR, including nodules (25.0-55.8%), consolidation (3.7-19.2%), and emphysema (15.0-45.0%). The prevalence of cavitation was generally lower (7.4-34.6%) and bronchiectasis higher (35.0-86.0%) on CT vs. CXR imaging. A paucity of prospective data, and data from HIV-infected adults and sub-Saharan Africa (sSA) was noted. Few studies related structural damage to physiological impairment, respiratory symptoms, or patient morbidity.
  
  
  CONCLUSIONS
  Post-TB structural lung pathology is common. Prospective data are required to determine the evolution of this lung damage and its associated morbidity over time. Further data are required from HIV-infected groups and those living in sSA.
authors: Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi.|Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors: Jamilah
authors: J
authors: Meghji
authors: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors: Hope
authors: H
authors: Simpson
authors: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors: S Bertel
authors: SB
authors: Squire
authors: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors: Kevin
authors: K
authors: Mortimer
mesh_terms: D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D010363:Pattern Recognition, Automated / Q000379:methods*; D015995:Prevalence; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000473:pathology; D006113:United Kingdom / Q000453:epidemiology