A Comparative Study of Chest Computed Tomography Findings: 1030 Cases of Drug-Sensitive Tuberculosis versus 516 Cases of Drug-Resistant Tuberculosis

Abstract

Purpose

To investigate the CT features of drug-resistant pulmonary tuberculosis (DR-PTB) and the diagnostic value of CT in DR-PTB diagnosis to provide imaging evidence for the timely detection of drug-resistant Mycobacterium tuberculosis.

Materials and Methods

A total of 1546 cases of pulmonary tuberculosis (PTB) with complete clinical data, chest CT images and defined drug sensitivity testing results were consecutively enrolled; 516 cases of DR-PTB were included in the drug-resistant group, and 1030 cases of drug-sensitive pulmonary tuberculosis (DS-PTB) were included in the drug-sensitivity group. Comparative analyses of clinical symptoms and imaging findings were conducted. Univariate and logistic regression analyses were performed, a regression equation model was developed, and the receiver operating characteristic (ROC) curve was constructed.

Results

In the univariate analysis, some features, including whole-lung involvement, multiple cavities, thick-walled cavities, collapsed lung, disseminated lesions along the bronchi, bronchiectasis, emphysema, atelectasis, calcification, proliferative lesions, encapsulated effusion, etc., were observed more frequently in the DR-PTB group than in the DS-PTB group, and the differences were statistically significant (p<0.05). Exudative lesions and pneumoconiosis were observed more frequently in the drug-sensitivity group than in the drug-resistant group (p<0.05). Logistic regression analysis indicated that whole-lung involvement, multiple cavities, thick-walled cavities, disseminated lesions along the bronchi, bronchiectasis, and emphysema were independent risk factors for DR-PTB, and exudative diseases were protective factors. The total prediction accuracy of the regression model was 80.6%, and the area under the ROC curve (AUC) was 82.6%.

Conclusion

Chest CT manifestations of DR-PTB had certain characteristics that significantly indicated the possibility of drug resistance in tuberculosis patients, specifically when multifarious imaging findings, including multiple cavities, thick-walled cavities, disseminated lesions along the bronchi, whole-lung involvement, etc., coexisted simultaneously. These results may provide imaging evidence for timely drug resistance detection in suspected drug-resistant cases and contribute to the early diagnosis of DR-PTB.

Keywords:

• pulmonary tuberculosis
• drug resistance
• tomography
• X-ray computed
• imaging findings
• diagnosis
• Mycobacterium tuberculosis

Acknowledgments

We would like to thank professor Chen Ling (Respiratory Medicine Laboratory of Zunyi Medical University) for cases providing of drug-resistant tuberculosis and professor Li Hong (Public Health School of Zunyi Medical University) for her assistance in statistical analysis.

Abbreviations

AUC, area under the curve; CXR, chest X-ray; DR-PTB, drug-resistant pulmonary tuberculosis; DR-TB, drug-resistant tuberculosis; DS-PTB, drug-sensitive pulmonary tuberculosis; DST, drug sensitivity testing; MDR-TB, multidrug-resistant tuberculosis; MMP, matrix metalloproteinase; MTB, Mycobacterium tuberculosis; PTB, pulmonary tuberculosis; ROC, receiver operating characteristic; SDGs, Sustainable development goals; XDR-TB, extensively drug-resistant tuberculosis.

Disclosure

All authors declared no conflicts of interest in this work.