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.
Similar content being viewed by others
Abbreviations
- aOR:
-
Adjusted odds ratio
- ATS:
-
American Thoracic Society
- BTS:
-
British Thoracic Society
- CI:
-
Confidence interval
- IDSA:
-
Infectious Diseases Society of America
- NTM-LD:
-
Non- tuberculous mycobacterial lung disease
- TB:
-
Mycobacterium tuberculosis
References
Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F et al (2007) An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 175:367–416
Martin-Casabona N, Bahrmand A, Bennedsen J, Østergaard Thomsen V, Curcio M, Fauville-Dufaux M et al (2004) Non-tuberculous mycobacteria: patterns of isolation. A multi-country retrospective survey. Int J Tuberc Lung Dis 8:1186–1193
Park Y, Lee C, Lee S, Yang S, Yoo C, Kim Y et al (2010) Rapid increase of non-tuberculous mycobacterial lung diseases at a tertiary referral hospital in South Korea [Short communication]. Int J Tuberc Lung Dis 14:1069–1071
Campbell I, Drobniewski F, Novelli V, Ormerod P, Pozniak A (2000) Management of opportunist mycobacterial infections: joint tuberculosis committee guidelines 1999. Thorax 55:210–218
van Ingen J, Bendien SA, de Lange WC, Hoefsloot W, Dekhuijzen PR, Boeree MJ et al (2009) Clinical relevance of non-tuberculous mycobacteria isolated in the Nijmegen-Arnhem region, The Netherlands. Thorax 64:502–506
Lee A-R, Lee J, Choi S-M, Seong M-W, Kim SA, Kim M et al (2013) Phenotypic, immunologic, and clinical characteristics of patients with nontuberculous mycobacterial lung disease in Korea. BMC Infect Dis 13:558
Hartman T, Swensen S, Williams D (1993) Mycobacterium avium-intracellulare complex: evaluation with CT. Radiology 187:23–26
Erasmus JJ, McAdams HP, Farrell MA, Patz EF Jr (1999) Pulmonary nontuberculous mycobacterial infection: radiologic manifestations 1. Radiographics 19:1487–1503
Barker AF (2002) Bronchiectasis. N Engl J Med 346:1383–1393
Chung MJ, Lee KS, Koh W-J, Lee JH, Kim TS, Kwon OJ et al (2005) Thin-section CT findings of nontuberculous mycobacterial pulmonary diseases: comparison between Mycobacterium avium-intracellulare complex and Mycobacterium abscessus infection. J Korean Med Sci 20:777–783
Jeong YJ, Lee KS, Koh W-J, Han J, Kim TS, Kwon OJ (2004) Nontuberculous mycobacterial pulmonary infection in immunocompetent patients: comparison of thin-section CT and histopathologic findings 1. Radiology 231:880–886
Kim JS, Tanaka N, Newell JD, DeGroote MA, Fulton K, Huitt G et al (2005) Nontuberculous mycobacterial infection: CT scan findings, genotype, and treatment responsiveness. CHEST J 128:3863–3869
Bhalla M, Turcios N, Aponte V, Jenkins M, Leitman B, McCauley D et al (1991) Cystic fibrosis: scoring system with thin-section CT. Radiology 179:783–788
Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J (2008) Fleischner society: glossary of terms for thoracic imaging 1. Radiology 246:697–722
Kundel HL, Polansky M (2003) Measurement of observer agreement 1. Radiology 228:303–308
WHO (2014) Tuberculosis country profiles. World Health Organization
Lee SK, Lee EJ, Kim SK, Chang J, Jeong SH, Kang YA (2012) Changing epidemiology of nontuberculous mycobacterial lung disease in South Korea. Scand J Infect Dis 44:733–738
Koh W-J, Lee KS, Kwon OJ, Jeong YJ, Kwak S-H, Kim TS (2005) Bilateral bronchiectasis and bronchiolitis at thin-section CT: diagnostic implications in nontuberculous mycobacterial pulmonary infection 1. Radiology 235:282–288
Fowler S, French J, Screaton N, Foweraker J, Condliffe A, Haworth C et al (2006) Nontuberculous mycobacteria in bronchiectasis: prevalence and patient characteristics. Eur Respir J 28:1204–1210
Koh W, Yu C, Suh G, Chung M, Kim H, Kwon O et al (2006) Pulmonary TB and NTM lung disease: comparison of characteristics in patients with AFB smear-positive sputum. Int J Tuberc Lung Dis 10:1001–1007
Kendall BA, Varley CD, Choi D, Cassidy PM, Hedberg K, Ware MA et al (2011) Distinguishing tuberculosis from nontuberculous mycobacteria lung disease, Oregon, USA. Emerg Infect Dis 17:506
Kim Y, Hahn S, Uh Y, Im D, Lim Y, Choi H et al (2014) Comparable characteristics of tuberculous and non-tuberculous mycobacterial cavitary lung diseases. Int J Tuberc Lung Dis 18:725–729
Yuan M-K, Chang C-Y, Tsai P-H, Lee Y-M, Huang J-W, Chang S-C (2014) Comparative chest computed tomography findings of non-tuberculous mycobacterial lung diseases and pulmonary tuberculosis in patients with afb smear-positive sputum. BMC Pulm Med 14:65
Deeks JJ (2001) Systematic reviews in health care: systematic reviews of evaluations of diagnostic and screening tests. BMJ: Br Med J 323:157
Acknowledgments
The scientific guarantor of this publication is Jae-Joon Yim, M.D. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding from the Seoul National University College of Medicine Research Fund (Grant number: 04-2014-290). The Medical Research Collaborating Center (MRCC) of Seoul National University College of Medicine kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. The study protocol was approved by the Institutional Review Board of Seoul National University Hospital. Written informed consent was waived by the Institutional Review Board. Some study subjects or cohorts have been previously reported in Lee A-R, Lee J, Choi S-M, et al. Phenotypic, immunologic, and clinical characteristics of patients with nontuberculous mycobacterial lung disease in Korea. BMC infectious diseases. 2013;13(1):558. Methodology: retrospective, diagnostic or prognostic study, performed at one institution. Clinical Trial Registration: ClinicalTrials.gov (NCT02340897).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kwak, N., Lee, C.H., Lee, HJ. et al. Non-tuberculous mycobacterial lung disease: diagnosis based on computed tomography of the chest. Eur Radiol 26, 4449–4456 (2016). https://doi.org/10.1007/s00330-016-4286-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-016-4286-6