Pulmonary mycobacterial disease: diagnostic performance of low-dose digital tomosynthesis as compared with chest radiography.

PURPOSE To compare the diagnostic performance of a low-radiation-dose digital tomosynthesis (DTS) technique with that of conventional radiography in the detection of lung lesions in patients with pulmonary mycobacterial disease. MATERIALS AND METHODS The institutional review board approved this study, and all patients provided informed consent. In this study, 100 patients (65 study patients, 35 control patients) underwent multidetector computed tomography (CT), chest radiography, and low-dose DTS (effective doses: 3.4, 0.02, and 0.05 mSv, respectively). Two radiologists evaluated radiographs and DTS images for the presence of parenchymal lesions and the number of cavities in each patient; CT served as the reference standard. Wilcoxon signed rank and McNemar tests and κ statistics were used. RESULTS The accuracies of DTS and radiography in depicting mycobacterial disease were 97% and 89%, respectively, for observer 1 (P = .039) and 99% and 93%, respectively, for observer 2 (P = .031). The accuracies of DTS and radiography in depicting each lesion type were, respectively, 95% and 77% for bronchiolitis, 92% and 76% for nodules, 86% and 79% for consolidation, and 93% and 70% for cavities. Interobserver agreement with DTS (κ = 0.62-0.94) was superior to that with radiography (κ = 0.46-0.62). Of a total of 141 cavities found with CT, means of 27 (19%) cavities at chest radiography and 108 (77%) cavities at DTS (P < .01) were detected by the two observers. CONCLUSION DTS performed with a low-dose technique is superior to radiography for the detection of lung lesions in patients with pulmonary mycobacterial disease.

[1]  E. Uçan,et al.  High resolution computed tomographic findings in pulmonary tuberculosis. , 1996, Thorax.

[2]  J. Im,et al.  Pulmonary tuberculosis: CT findings--early active disease and sequential change with antituberculous therapy. , 1993, Radiology.

[3]  J. Eng,et al.  Sample Size Estimation : How Many Individuals Should Be Studied ? , 2022 .

[4]  M Båth,et al.  Effect of clinical experience of chest tomosynthesis on detection of pulmonary nodules , 2009, Acta radiologica.

[5]  Santiago Martinez-Jimenez,et al.  Digital tomosynthesis of the chest for lung nodule detection: interim sensitivity results from an ongoing NIH-sponsored trial. , 2008, Medical physics.

[6]  Pan‐Chyr Yang,et al.  Factors influencing time to smear conversion in patients with smear‐positive pulmonary tuberculosis , 2009, Respirology.

[7]  James T. Dobbins,et al.  Digital tomosynthesis of the chest. , 2008, Journal of thoracic imaging.

[8]  S. Garay,et al.  Factors related to response to intermittent treatment of Mycobacterium avium complex lung disease. , 2006, American journal of respiratory and critical care medicine.

[9]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[10]  R. Chaisson,et al.  Rifapentine and isoniazid once a week versus rifampicin and isoniazid twice a week for treatment of drug-susceptible pulmonary tuberculosis in HIV-negative patients: a randomised clinical trial , 2002, The Lancet.

[11]  A. Bankier,et al.  Tuberculosis: value of lateral chest radiography in pre-employment screening of patients with positive purified protein derivative skin test results. , 2009, Radiology.

[12]  T. Williams,et al.  Update: the radiographic features of pulmonary tuberculosis. , 1986, AJR. American journal of roentgenology.

[13]  James T Dobbins,et al.  Digital x-ray tomosynthesis: current state of the art and clinical potential. , 2003, Physics in medicine and biology.

[14]  A. Flinck,et al.  Comparison of chest tomosynthesis and chest radiography for detection of pulmonary nodules: human observer study of clinical cases. , 2008, Radiology.

[15]  B. Wall,et al.  Revised radiation doses for typical X-ray examinations. Report on a recent review of doses to patients from medical X-ray examinations in the UK by NRPB. National Radiological Protection Board. , 1997, The British journal of radiology.

[16]  R. Leithiser,et al.  The changing epidemiology of tuberculosis and other mycobacterial infections in the United States: implications for the radiologist. , 1991, AJR. American journal of roentgenology.

[17]  N. Müller,et al.  Fleischner Society: glossary of terms for thoracic imaging. , 2008, Radiology.

[18]  K. Chida,et al.  Mycobacterium avium complex disease: prognostic implication of high-resolution computed tomography findings , 2008, European Respiratory Journal.

[19]  Greta Toncheva,et al.  Radiation dose from contemporary cardiothoracic multidetector CT protocols with an anthropomorphic female phantom: implications for cancer induction. , 2007, Radiology.

[20]  Thomas R Frieden,et al.  The global tuberculosis situation. Progress and problems in the 20th century, prospects for the 21st century. , 2002, Infectious disease clinics of North America.

[21]  S. Gupta,et al.  Risk factors for new pulmonary tuberculosis patients failing treatment under the Revised National Tuberculosis Control Programme, India. , 2009, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[22]  J. R. Beck,et al.  Likelihood ratios. Another enhancement of sensitivity and specificity. , 1986, Archives of pathology & laboratory medicine.

[23]  Kyung Soo Lee,et al.  Pulmonary tuberculosis: up-to-date imaging and management. , 2008, AJR. American journal of roentgenology.