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Non-tuberculous mycobacterial lung disease: diagnosis based on computed tomography of the chest.

Authors
 Nakwon Kwak  ;  Chang Hyun Lee  ;  Hyun-Ju Lee  ;  Young Ae Kang  ;  Jae Ho Lee  ;  Sung Koo Han  ;  Jae-Joon Yim 
Citation
 Eur Radiol, Vol.26(12) : 4449-4456, 2016 
Journal Title
 Eur Radiol 
Issue Date
2016
MeSH
Aged ; Bronchiectasis/diagnostic imaging* ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Mycobacterium Infections, Nontuberculous/diagnostic imaging* ; Observer Variation ; Odds Ratio ; Pulmonary Atelectasis/diagnostic imaging ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed/methods ; Tuberculosis, Pulmonary/diagnostic imaging*
Abstract
OBJECTIVES: To elucidate the accuracy and inter-observer agreement of non-tuberculous mycobacterial lung disease (NTM-LD) diagnosis based on chest CT findings. METHODS: Two chest radiologists and two pulmonologists interpreted chest CTs of 66 patients with NTM-LD, 33 with pulmonary tuberculosis and 33 with non-cystic fibrosis bronchiectasis. These observers selected one of these diagnoses for each case without knowing any clinical information except age and sex. Sensitivity and specificity were calculated according to degree of observer confidence. Inter-observer agreement was assessed using Fleiss' κ values. Multiple logistic regression was performed to elucidate which radiological features led to the correct diagnosis. RESULTS: The sensitivity of NTM-LD diagnosis was 56.4 % (95 % CI 47.9-64.7) and specificity 80.3 % (73.1-86.0). The specificity of NTM-LD diagnosis increased with confidence: 44.4 % (20.5-71.3) for possible, 77.4 % (67.4-85.0) for probable, 95.2 % (87.2-98.2) for definite (P < 0.001) diagnoses. Inter-observer agreement for NTM-LD diagnosis was moderate (κ = 0.453). Tree-in-bud pattern (adjusted odds ratio [aOR] 6.24, P < 0.001), consolidation (aOR 1.92, P = 0.036) and atelectasis (aOR 3.73, P < 0.001) were associated with correct NTM-LD diagnoses, whereas presence of pleural effusion (aOR 0.05, P < 0.001) led to false diagnoses. CONCLUSIONS: NTM-LD diagnosis based on chest CT findings is specific but not sensitive. KEY POINTS: Diagnosis of NTM-LD based on radiological findings showed high specificity. Sensitivity of NTM-LD diagnosis was around 50 %. Inter- observer agreement was moderate. Identification of tree-in-bud pattern, consolidation and atelectasis led to correct diagnoses.
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/166521
Full Text
https://link.springer.com/article/10.1007%2Fs00330-016-4286-6
DOI
10.1007/s00330-016-4286-6
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
강영애(Kang, Young Ae) ORCID logo https://orcid.org/0000-0002-7783-5271
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