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High-resolution CT of nontuberculous mycobacterium infection in adult CF patients: diagnostic accuracy

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Abstract

Objectives

To determine the diagnostic accuracy of high-resolution computed tomography (HRCT) for the detection of nontuberculous mycobacterium infection (NTM) in adult cystic fibrosis (CF) patients.

Methods

Twenty-seven CF patients with sputum-culture-proven NTM (NTM+) underwent HRCT. An age, gender and spirometrically matched group of 27 CF patients without NTM (NTM-) was included as controls. Images were randomly and blindly analysed by two readers in consensus and scored using a modified Bhalla scoring system.

Results

Significant differences were seen between NTM (+) and NTM (-) patients in the severity of the bronchiectasis subscore [45 % (1.8/4) vs. 35 % (1.4/4), P = 0.029], collapse/consolidation subscore [33 % (1.3/3 vs. 15 % (0.6/3)], tree-in-bud/centrilobular nodules subscore [43 % (1.7/3) vs. 25 % (1.0/3), P = 0.002] and the total CT score [56 % (18.4/33) vs. 46 % (15.2/33), P = 0.002]. Binary logistic regression revealed BMI, peribronchial thickening, collapse/consolidation and tree-in-bud/centrilobular nodules to be predictors of NTM status (R2 = 0.43). Receiver-operator curve analysis of the regression model showed an area under the curve of 0.89, P < 0.0001.

Conclusion

In adults with CF, seven or more bronchopulmonary segments showing tree-in-bud/centrilobular nodules on HRCT is highly suggestive of NTM colonisation.

Key Points

• Lung function declines rapidly in cystic fibrosis patients with nontuberculous mycobacterium infection

• High-resolution computed tomography can help identify nontuberculous mycobacterium in CF patients

• Extensive collapse/consolidation and tree-in-bud/centrilobular nodules are predictive of NTM infection

• Multiple bronchopulmonary segments showing tree-in-bud/centrilobular nodules strongly suggest nontuberculous mycobacterium infection

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Abbreviations

CF:

Cystic fibrosis

NTM:

Nontuberculous mycobacterium

HRCT:

High-resolution computed tomography

MAC:

Mycobacterium avium complex

ATS:

American Thoracic Society

CT:

Computed tomography

PFT:

Pulmonary function testing

BMI:

Body mass index

FEV1 :

Forced expiratory volume in one second

Hmz:

Homozygous

Hetz:

Heterozygous

BPS:

Bronchopulmonary segments

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Authors and Affiliations

  1. Department of Radiology, St. Vincent’s University Hospital, Dublin, Ireland

    Sinead McEvoy, Lisa Lavelle, Aoife Kilcoyne, Colin McCarthy & Jonathan D. Dodd

  2. Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands

    Pim A. deJong

  3. Department of Radiology, Department of Pediatric Pulmonology and Allergology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands

    Martine Loeve & Harm A. W. M. Tiddens

  4. Department of Respiratory Medicine and National Referral Centre for Adult Cystic Fibrosis, St. Vincent’s University Hospital, Dublin, Ireland

    Edward McKone & Charles G. Gallagher

Authors
  1. Sinead McEvoy
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  2. Lisa Lavelle
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  3. Aoife Kilcoyne
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  4. Colin McCarthy
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  5. Pim A. deJong
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  6. Martine Loeve
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  7. Harm A. W. M. Tiddens
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  8. Edward McKone
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  9. Charles G. Gallagher
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  10. Jonathan D. Dodd
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Corresponding author

Correspondence to Jonathan D. Dodd.

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McEvoy, S., Lavelle, L., Kilcoyne, A. et al. High-resolution CT of nontuberculous mycobacterium infection in adult CF patients: diagnostic accuracy. Eur Radiol 22, 2736–2742 (2012). https://doi.org/10.1007/s00330-012-2558-3

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  • DOI: https://doi.org/10.1007/s00330-012-2558-3

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