Chest Imaging for Pulmonary TB-An Update.

Michael Nel,Heather J Zar,Tanyia Pillay,Savvas Andronikou,Zoe Franckling-Smith

doi:10.3390/pathogens11020161

Abstract

The diagnosis of pulmonary tuberculosis (PTB) in children is challenging. Difficulties in acquiring suitable specimens, pauci-bacillary load, and limitations of current diagnostic methods often make microbiological confirmation difficult. Chest imaging provides an additional diagnostic modality that is frequently used in clinical practice. Chest imaging can also provide insight into treatment response and identify development of disease complications. Despite widespread use, chest radiographs are usually non-specific and have high inter- and intra-observer variability. Other diagnostic imaging modalities such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) can provide additional information to substantiate diagnosis. In this review, we discuss the radiological features of PTB in each modality, highlighting the advantages and limitations of each. We also address newer imaging technologies and potential use.

Highlights

The diagnosis of pulmonary tuberculosis (PTB) remains a challenge, especially in young children in whom non-specific clinical presentation, difficulty in collecting adequate samples for microbiologic testing, and pauci-bacillary load can result in diagnostic uncertainty
This paper aims to review the different radiographic modalities and features for diagnosis of paediatric PTB, their use and limitations, as well as newer imaging techniques
Following an incubation period, during which the chest radiograph is typically normal, hilar or mediastinal lymphadenopathy occur as part of primary disease (Table 2) [2]

Summary

Introduction

The diagnosis of pulmonary tuberculosis (PTB) remains a challenge, especially in young children in whom non-specific clinical presentation, difficulty in collecting adequate samples for microbiologic testing, and pauci-bacillary load can result in diagnostic uncertainty. Chest imaging as a diagnostic tool for paediatric PTB has specific challenges depending on the modality used, including poor inter-observer reliability, non-specific radiological signs, and lack of standardized scoring or classification systems [1]. Despite the reliance on radiographs in the diagnosis of paediatric PTB, poor sensitivity, specificity, and wide inter observer agreement have been demonstrated [2,6]. A moderate correlation between findings of lymphadenopathy on lateral chest radiograph and CT scan was shown, with precarinal lymph nodes associated with the highest sensitivity and specificity [7]. The detection of lymphadenopathy on chest radiographs has significant inter-observer variability (average weighted kappa of 0.33–0.36) and poor intra-observer agreement (average weighted kappa of 0.55) [2,8,9]

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Conclusion