How to Differentiate Inactive from Active Disease in Patients of Primary Multidrug-resistant Tuberculosis with Persistent Cavity after Anti-tuberculous Therapy
SH Kim, JH Min, JY Lee
Hong Kong J Radiol 2014;17:240-6
DOI: 10.12809/hkjr1413228
Objective: To determine how to differentiate inactive from active disease in patients with primary multidrug-resistant tuberculosis who have a persistent cavity after completing treatment.
Methods: We evaluated computed tomography findings to determine activity of chronic cavitary disease in patients with primary multidrug-resistant tuberculosis after completing treatment. This study evaluated cavity, centrilobular nodules, consolidation, large nodules, calcified nodules, parenchymal calcification, emphysema, bronchovascular distortion, irregular lines, and parenchymal band. The presence of pleural thickening, pleural effusion, and lymphadenopathy was recorded.
Results: In univariate analysis, centrilobular nodules and consolidation were significantly less common in the chronic inactive cavitary group. The cavity wall was thinner in the chronic inactive cavitary group than that in the chronic active cavitary group. A multivariate analysis revealed that centrilobular nodules and thickness of the cavity wall were significant computed tomography findings associated with active disease.
Conclusions: Centrilobular nodules and thickness of the cavity wall were the most characteristic computed tomography findings to predict active disease in patients with chronic cavitary pulmonary multidrug-resistant tuberculosis at the time of treatment completion. In the proper clinical setting, these computed tomography findings could help decision-making for completing treatment in cases of chronic cavitary multidrug-resistant tuberculosis after anti-tuberculous therapy.
中文摘要
原發性多重耐藥性結核病患者抗結核治療後持續性肺部空洞中活動性與非活動性病變如何鑑別？
金尚泫、JH Min、JY Lee
目的：確定原發性多重耐藥性結核病患者抗結核治療後持續性肺部空洞中活動性與非活動性病變的鑑別診斷方法。
方法：評估抗結核治療後的原發性多重耐藥性結核病患者的電腦斷層掃描（CT）特徵，以確定其慢性肺部空洞性病變的活動性。評估項目包括空洞、小葉中心結節、小葉實變、大結節、鈣化結節、實質鈣化、肺氣腫、支氣管血管扭曲變形、不規則線狀影和肺實質帶。並記錄病人胸膜增厚、胸腔積液和淋巴結腫大的出現。
結果：單元分析顯示在慢性非活動性空洞組別中，明顯較少見小葉中心結節和小葉實變；其空洞壁也比活動性空洞組別更薄。多元分析顯示小葉中心結節和空洞壁厚度是與活動性病變顯著相關的CT特徵。
結論：原發性多重耐藥性結核病患者抗結核治療後，其小葉中心結節和空洞壁厚度為最具特徵性CT表現，能預測慢性空洞的活動性。在適當的臨床環境中，這些CT特徵有助於抗結核療程終止的決策制定，以防治療後慢性空洞性多重耐藥結核的發生。