Table of Content

10 July 2018, Volume 40 Issue 7

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Original Articles

Analysis of CT signs and dynamic changes of tuberculous pleurisy at the early stage of onset

Dong-po WANG,Xin-ting YANG,Yan LYU,Jue WANG,Kun FANG,Xin-hua ZHOU,Bu-dong CHEN

Chinese Journal of Antituberculosis. 2018, 40(7):  677-681.  doi:10.3969/j.issn.1000-6621.2018.07.003

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Objective To analyze the characteristics of CT signs and dynamic changes of early-stage tuberculous pleurisy, and to improve the accuracy of diagnosis.Methods The imaging data of 38 patients diagnosed as tuberculous pleurisy in Beijing Chest Hospital affiliated to Capital Medical University from March 2015 to February 2017 were collected. The subjects included 16 men and 22 women. The age was ranged 21-61 years, and the average age was (35.74±11.92) years. All the patients were treated within 7-10 days of the first onset. The CT image data of the early stage of the disease were analyzed, and the imaging features and signs were extracted.Results Among the 38 subjects, there were 34 cases with unilateral pleural lesions (including 18 in the left pleura and 16 in the right pleural) and 4 with bilateral lesions; there were 14 patients involving the mediastinal pleura (including 6 in the left mediastinal pleural and 8 in the right mediastinal pleura), and 34 involving the interlobular pleura. There were 38 cases showing encapsulated pleural effusion, 24 cases showing pleural septal thickening, and 24 cases showing pleural stripe. During the dynamic follow-up period, the thickening of the pleura was reduced in 37 patients. In 1 case, the thickening degree was aggravated at 6 months, and the thickest was about 1.1 cm. The thickening of pleura was rechecked at 12 months, and it was found to become thinned. During follow-up, the pleural effusion of all patients showed decreased absorption, the pleural septal thickening showed decreased absorption, and the pleural stripe was gradually reduced and thinned. Another 22 patients had pleural tuberculoma during follow-up.Conclusion In the early stage of the disease, unilateral pleural thickening and unsmoothness, interlobular fissure involvement, multiple miliary and micronodules, encapsulated pleural effusion, pleural septal thickening and stripe were found in CT images. We may consider tuberculous pleurisy.

Correlation analysis of HRCT image features and CD4 ⁺ T lymphocyte level in AIDS patients complicated with thoracic tuberculosis

Ming XUE,Jing-jing LI,Shuo YAN,Zhi-bin LYU,Tao CUI,Qi-yi CHEN,Zi-xin ZHANG,Yan-ni DU,Ru-ming XIE

Chinese Journal of Antituberculosis. 2018, 40(7):  682-688.  doi:10.3969/j.issn.1000-6621.2018.07.004

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Objective To analyze the high-resolution computed tomography (HRCT) image features in patients with acquired immunodeficiency syndrome (AIDS) complicated with thoracic tuberculosis (TB), and to investigate the correlation of the HRCT signs with CD4 ⁺ T lymphocyte level. Methods From January 2013 to December 2017, 235 patients who were pathological and laboratory confirmed or clinically diagnosed with AIDS complicated with thoracic TB in Beijing Ditan Hospital affiliated to Capital Medical University were selected as subjects. Data on HRCT signs and CD4 ⁺ T lymphocyte counts of each subject were collected. The CD4 ⁺ T lymphocyte levels of patients were graded to Ⅰ (<100×10 ⁶/L) and Ⅱ (≥100×10 ⁶/L). The correlation between the HRCT signs and different immunity levels was analyzed. Results The overall incidence of secondary pulmonary TB, hematogenous disseminated TB, and mediastinal lymph node TB were 66.8% (157/235), 31.9% (75/235), and 63.8% (150/235), respectively. For patients with grade Ⅰ and Ⅱ CD4 ⁺ T lymphocyte level, the incidence of mediastinal lymph node TB was 51.9% (122/235) and 11.9% (28/235), respectively. The difference was statistically significant (χ ²=3.59, P=0.048). In AIDS patients complicated with secondary pulmonary TB who had grade Ⅰ CD4 ⁺ T lymphocyte level, the occurrence rates of consolidation, consolidation and cavitation, and multiple cavitation in the HRCT scan were 55.4% (87/157), 17.2% (27/157), and 10.2% (16/157), which were higher than those of the patients having grade Ⅱ CD4 ⁺ T lymphocyte level (13.4% (21/157), 3.8% (6/157), and 1.9% (3/157)), respectively. The discrepancies were statistically significant (χ ²=6.47, 8.22, and 7.47; P=0.014, 0.004, and 0.045, respectively). The incidence of secondary pulmonary TB occurring in the anterior segment of the superior lobe, the right middle lobe, and the left segment of the tongue were higher in cases with grade Ⅰ CD4 ⁺ T lymphocyte level (26.1% (41/157), 24.2% (38/157), and 27.4% (43/157)) compared with cases with grade Ⅱ (5.7% (9/157), 3.2% (5/157), and 3.8% (6/157)). The differences were statistically significant (χ ²=0.78, 5.40, and 6.79; P=0.037, 0.045, and 0.039, respectively). Conclusion The thoracic TB complicated in AIDS patients are mainly secondary pulmonary TB and mediastinal lymph node TB. The HRCT signs are related to the degree of damage on the immune function of CD4 ⁺ T lymphocytes. The lower the CD4 ⁺ T lymphocyte count is, the more complex and untypical the chest HRCT signs are.

MR imaging features of acquired immunodeficiency syndrome patients complicated with intracranial tuberculosis and its relationship with CD4 ⁺ T cell count

Jing-jing LI,Shuo YAN,Ming XUE,Lian-gui WEI,Zhi-bin LYU,Ru-ming XIE

Chinese Journal of Antituberculosis. 2018, 40(7):  689-695.  doi:10.3969/j.issn.1000-6621.2018.07.005

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Objective To investigate the features of magnetic resonance imaging (MRI) of the acquired immunodeficiency syndrome (AIDS) patients complicated with cerebral tuberculosis (TB) and its relationship with CD4 ⁺ T-cell count. Methods A retrospective analysis was conducted. The related clinical information and data were collected from 46 AIDS patients complicated with cerebral TB, who were hospitalized at Beijing Ditan Hospital from January 2014 to December 2017. Those information and data were analyzed and the patients’ MRI features were summarizes; the difference of CD4 ⁺ T-cell count between the patient groups of brain parenchymal TB and meningeal TB was compared by using Mann-Whitney test; the difference of MRI features in two groups of the patients with CD4 ⁺ T cells ≥100/μl and <100/μl were compared by using χ ² test, such as the lesion location, scope, size, shape, the way of enhancement, as well as the situation combined with other organ TB, etc.; the relationship between the CD4 ⁺ T-cell count and the lesion size, the way of enhancement was also analyzed. Results Among 46 enrolled AIDS patients with cerebral TB, the CD4 ⁺ T-cell count was significantly lower in the patients with brain parenchymal TB (47 (20.5,131.5)/μl) than that in the patients with meningeal TB (153 (130.5,228.5)/μl) (Z=-2.37, P=0.018). In the patients with CD4 ⁺ T cells ≥100/μl, the proportion of meningeal TB was 19.6% (9/46) and the proportions that the lesions located in cerebral basal cistern, cerebral lateral fissure cistern and cerebral sulcus were 17.4% (8/46), 13.0% (6/46) and 13.6% (6/46) respectively, which were much higher than those (4.3% (2/46), 2.2% (1/46), 2.2% (1/46), 2.2% (1/46) respectively) in the patients with CD4 ⁺ T cells <100/μl (χ ²=7.62, P=0.006; Fisher’s exat test: P=0.001, 0.008 and 0.008, respectively); the proportion that the lesions located in cerebral cortex was 19.6% (9/46) which was much lower than that (47.8%, 22/46) in the patients with CD4 ⁺ T cells <100/μl (Fisher’s exat test, P=0.037). When the lesion diameter was 3-5 mm, the point enhancement was found on MRI (136 lesions, 47.1%), while the ring enhancement was found on the MRI when the lesion diameter was more than 5 mm (89 lesions, 30.8%); the difference was statistically significant (χ ²=105.36, P<0.001). In the patient group with brain parenchymal TB, most of their lesions located in cerebral cortex and the point or ring enhancements were found (88.6%, 31/35); in the patient group with meningeal TB, the meningeal thickening enhancement was found on MRI (81.8%, 9/11); the lesions were all in cluster distributions in both brain parenchyma TB (17.4%, 8/46) and meningeal TB (21.7%, 10/46), the difference was statistically significant (χ ²=4.13,P=0.042). Conclusion The features of MRI in AIDS patients complicated with cerebral TB are closely related to their CD4 ⁺ T-cell counts. When the number of CD4 ⁺ T-cell is <100/μl, the brain parenchymal TB is the major type and the lesions are more likely to locate in cerebral cortex; when the number of CD4 T-cell is ≥100个/μl, the meningeal TB is the major type and the lesions are more likely to locate in cerebral basal cistern, cerebral lateral fissure cistern and cerebral sulcus; the point enhancement is observed when the lesion diameter is <5 mm, while the ring enhancement is found when the lesion diameter is >5 mm.

Application of CT guided percutaneous pulmonary biopsy in the diagnosis of smear and culture negative pulmonary tuberculosis

Zhen ZHOU,Yan LYU,Ping-xin LYU,Xin-hua ZHOU,Cheng-hai LI,Dong-po. WANG

Chinese Journal of Antituberculosis. 2018, 40(7):  696-701.  doi:10.3969/j.issn.1000-6621.2018.07.006

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Objective To analyze the relationship of morphology, density and diagnostic positive rate of lesion at the sampling site using CT guided percutaneous pulmonary biopsy, in order to improve its diagnostic accuracy.Methods The data of the relationship between various features of CT imaging and diagnostic positive rates using CT guided percutaneous pulmonary biopsy were analyzed retrospectively in 103 patients with smear and culture negative diagnosis confirmed by pathology or diagnostic antituberculosis treatment admitted in Beijing Chest Hospital, Capital Medical University from January to December 2017. The statistics were processed by IBM SPSS 24.0 software, and the enumeration data were analyzed by χ ² test and the differences were considered significantly when P<0.05. Results According to lesion morphology of CT, the positive rate of lesion biopsy was 33.33% (1/3) in ground glass opacity lesions and were 91.67% (33/36), 94.74% (18/19), 100.00% (21/21) and 75.00% (18/24) in nodule, consolidation, cavity, mass lesion with significant difference statistically in these four lesions (χ ²=8.918,P=0.030). A comparison was made between nodular group and solid group (χ ²=0.174, P=0.677), cavity group (χ ²=1.847,P=0.174), and mass group (χ ²=3.137,P=0.077), when the comparison was made between consolidation group and cavity group (χ ²=1.134,P=0.287), mass group (χ ²=3.031,P=0.082), and the comparison between the cavity group and the mass group (χ ²=8.058,P=0.014), the differences were no significant statistically due to the modified P' more than 0.008. According to lesion density of CT, the positive rate of lesion biopsy was 33.33% (1/3) in mediastinal window unmeasurable group and were 96.88% (31/32), 94.34% (50/53) and 60.00% (9/15) in non-enhancement group with 0-20 HU, non-enhancement or enhancement not obvious group with more than 20 HU, and obvious enhancement group with more than 20 HU with significant differences statistically (χ ²=17.790,P=0.000). A comparison was made between non-enhancement group with 0-20 HU and obvious enhancement group with more than 20 HU with significant difference statistically (χ ²=10.956,P=0.001), and between non-enhancement group or enhancement not obvious group with more than 20 HU and obvious group with more than 20 HU with also significant difference statistically (χ ²=12.005,P=0.001). However, a comparison was made between non-enhancement group with 0-20 HU and non-enhancement or enhancement not obvious group with more than 20 HU without significant difference statistically (χ ²=0.286,P=0.593).According to pathological detection, the diagnosis were confirmed in 33 cases (32.04%, 33/103) using HE staining,in 87 cases (84.47%, 87/103) using acid-fast stain and in 91 cases (88.35%, 91/103) using TB-DNA. The diagnostic accuracy rates were compared between different two groups with significant differences statistically (χ ²=94.084,P=0.001). Conclusion CT-guided percutaneous pulmonary biopsy is of great value in the diagnosis of smear and culture negative pulmonary tuberculosis. The correct sampling according to morphology, density of lesions using this technique can improve the positive rate of puncture biopsy.

The value analysis in qualitative diagnosis of ultrahigh resolution CT scan and CT target reconstruction in lung glass nodules

Mei-hong LAN,Ming-ming GAO,Dai-lun HOU

Chinese Journal of Antituberculosis. 2018, 40(7):  702-706.  doi:10.3969/j.issn.1000-6621.2018.07.007

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Objective The aim of this study was to assess the differences in microscopic signs of the pulmonary glass nodules between the ultra-high resolution CT (UHRCT) target scan and conventional CT target reconstruction,and analyzed the difference of the two methods in qualitative diagnosis of pulmonary ground glass nodules.Methods From August 2016 through December 2017, 120 cases of suspected pulmonary tuberculosis were screened in Shandong Provincial Chest Hospital, who with a single glass nodule in lung. The patients underwent routine CT scanning, followed by target reconstruction and UHRCT target scanning, a total of 120 nodules.Two experienced radiologists with subtropical high or above physicians,were asked to analyze the two kinds of lung CT image ground glass nodules signs (Margin of nodles, pulmonary markings thickening, solid component, burr fin,bubble sign, air bronchogram, pleural pull) respectively, the diagnosis of precancerous lesions (AAH, AIS), microinvasive adenocarcinoma (MIA) and infiltrating adenocarcinoma (IAC) were determined, and the accuracy of the diagnosis of lung adenocarcinoma by two methods was compared according to the pathological results. In this study, Chi square test was used in SPSS 17.0 statistical software, and P<0.05 difference was statistically significant.Results Margin of nodule, UHRCT target scanning was 71 (78.0%), and CT target reconstruction was 56 (61.5%) (χ ²=5.863, P=0.015). Thickening pulmonary markings, the UHRCT target scanning was 60 (65.9%), and the CT target reconstruction was 45 (49.5%)(χ ²=5.065, P=0.024). Solid component,the UHRCT target scanning was 66 (72.5%), and the CT target reconstruction was 50 (54.9%) (χ ²=6.086, P=0.014). Burr fin, the UHRCT target scanning was 34 (37.4%), and the target reconstruction of CT was 29 (31.9%) (χ ²=0.319, P=0.572). Bubble sign, UHRCT target scanning was 22 (24.2%), CT target reconstruction was 18 (19.8%) (χ ²=0.513, P=0.474).Air bronchogram, UHRCT target scanning was 28 (30.8%) and CT target reconstruction was 26 (28.6%) (χ ²=0.105, P=0.746). Pleural indentation, UHRCT target scanning is 30 (32.9%),and CT target reconstruction was 21 (23.1%) (χ ²=2.207, P=0.137).The number of the pathologic coincidence CT target reconstruction was 75 (82.4%) and discrepancy was 16 (17.6%). The number of the pathologic coincidence UHRCT was 86 (94.5%) and discrepancy is 5 (5.5%). Chi-square test, χ ²=6.513, P=0.011. Conclusion The target scan of UHRCT is more clear than that of conventional target reconstructed images, and it is helpful for pathological stages of pulmonary glass nodules.

Contrast analysis of CT findings of different types of drug-resistant tuberculosis and drug-sensitive tuberculosis

Cheng-hai LI,Xin-hua ZHOU,Yan LYU,Xia YU,Fang LI,Wei HE,Bu-dong CHEN,Dong-po WANG,Zhen ZHOU,Feng-gang. NING

Chinese Journal of Antituberculosis. 2018, 40(7):  707-712.  doi:10.3969/j.issn.1000-6621.2018.07.008

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Objective To compare the CT signs of different types of drug-resistant pulmonary tuberculosis (PTB) and drug-sensitive PTB (DS-PTB), and to improve the CT diagnosis and differential diagnosis of drug-resis-tant PTB.Methods The clinical and CT scan data of 116 drug-resistant PTB patients admitted to Beijing Chest Hospital from January 1, 2016 to October 31, 2017 were collected for retrospective analysis. There were 26 untreated patients and 90 retreated patients. Also, by the stratified sampling method at a ratio of 1∶4, 31 patients with DS-PTB admitted to this hospital at the same period were selected using random number table method. The 147 cases with drug-resistant TB were divided into 4 groups according to the results of drug sensitivity test (DST), that were multidrug-resistant PTB (MDR-PTB) group (39 cases), extensively drug-resistant PTB (XDR-PTB) group (31 cases), other drug-resistant PTB (DR-PTB) group (46 cases including 41 with mono-resistant PTB (MR-PTB) and 5 with poly-resistant tuberculosis (PDR-PTB)), and DS-PTB group (31 cases). All patients underwent chest CT non-contrast enhanced scan and thin layer reconstruction with a layer thickness of 1.25 mm. The distribution of lung lesions, CT signs and incidence of cavity in patients of different groups were statistically analyzed.Results Contrast analysis of CT findings of the 147 patients showed that the lesions in drug-resistant PTB patients was extensively distributed. The rates of patients with lesions involving three or more lobes were 84.6% (33/39) in the MDR-PTB group, 83.9% (26/31) in the XDR-PTB group, and 91.3% (42/46) in the DR-PTB group, which were higher than that in the DS-PTB group (51.6%, 16/31); the differences were statistically significant (χ ²=8.96, P=0.003; χ ²=7.38, P=0.007; χ ²=15.70, P<0.001). In addition, the lesions were more likely to involve the uncommon sites of TB infection (such as anterior superior lobe and lower lobe basal segment) (94.9% (37/39) in the MDR-PTB group, 87.1% (27/31) in the XDR-PTB group, 95.7% (44/46) in the DR-PTB group, and 51.6% (16/31) in the DS-PTB group; compared with the DS-PTB group, the rates in the MDR-PTB, XDR-PTB, and DR-PTB were statistically higher (χ ²=17.58, P<0.001; χ ²=9.18, P=0.002; χ ²=20.88, P<0.001). However, there was no significant difference in the number and location of lesions among the three drug-resistant PTB groups (MDR-PTB vs XDR-PTB group, MDR-PTB vs DR-PTB group, XDR-PTB vs DR-PTB group: χ ² values were 0.00, 0.38, 0.40 and 0.53, 0.00, 0.88, respectively; P values were 1.000, 0.538, 0.526 and 0.248, 1.000, 0.347, respectively). Contrast analysis of CT signs showed that the incidences of nodules in the lungs and bronchial wall thickening in patients with different types of drug-resistant PTB were 100.0% (39/39) and 87.2% (34/39) in the MDR-PTB group, 100.0% (31/31) and 87.1% (27/31) in the XDR-PTB group, and 100.0% (46/46) and 84.8% (39/46) in the DR-PTB group, respectively, which were significantly higher than that in the DS-PTB group (80.6% (25/31) and 48.4% (15/31)); the differences were statistically significant (χ ²=5.97, P=0.015; χ ²=4.61, P=0.032; χ ²=7.15, P=0.007 and χ ²=12.38, P<0.001; χ ²=10.63, P=0.001; χ ²=11.71, P=0.001). However, there was no significant difference in the incidence of bronchial wall thickness among different drug-resistant PTB groups (MDR-PTB vs XDR-PTB group, XDR-PTB vs DR-PTB group, MDR-PTB vs DR-PTB group: χ ² values were 0.00, 0.00, and 0.10; P values were 1.000, 1.000, and 0.752, respectively). As for the comparison on cavity formation in nodules and consolidations, the incidences in the XDR-PTB and DR-PTB groups were 87.1% (27/31) and 87.0% (40/46), significantly higher than that in the DS-PTB group (58.1%, 18/31); the differences were statistically significant (χ ²=6.57, P=0.010, χ ²=8.32, P=0.004). However, there was no significant difference among different drug-resistant PTB groups (MDR-PTB vs XDR-PTB group, XDR-PTB vs DR-PTB group, MDR-PTB vs DR-PTB group:χ ² values were 1.18, 0.00, and 1.46; P values were 0.277, 1.000, and 0.227, respectively. Conclusion CT signs have diagnostic and differential diagnostic value for drug-resistant and drug-sensitive PTB, but it has no obvious value in identifying different drug-resistant types.

Analysis of CT imaging signs of 66 cases with cervical lymph node tuberculosis

Rong REN,Gong-ling YUAN,Min LI,Rong-rong. LIU

Chinese Journal of Antituberculosis. 2018, 40(7):  713-718.  doi:10.3969/j.issn.1000-6621.2018.07.009

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Objective To explore the CT imaging features of cervical lymph node tuberculosis.Methods A retrospective analysis was conducted to analyze the CT imaging data of 66 patients with surgical excision and pathological confirmed cervical lymph tuberculosis in the Fifth People’s Hospital of Suzhou from August 2015 to August 2017. Among them, there were 28 (42.4%) males and 38 (57.6%) females. Patients were aged 15-75 years, with an average age of (31.7±12.9) years. The lesion location, CT classification and imaging signs of all patients were analyzed.Results Among the 66 cases with cervical lymph tuberculosis, 65 (98.5%) cases had multiple lesions, 1 (1.5%) case had single lesion, 39 (59.1%) cases had bilateral lesions, and 27 (40.9%) cases showed unilateral lesion. As for the location distribution, lesions in 59 cases (89.4%) were distributed in multiple node levels, but only 7 cases (10.6%) had lesions in single level. The most common levels of cervical lymph node tuberculosis were as follows: 35 (53.0%) cases in Ⅱb level, 30 (45.5%) cases in Ⅰa level, 30 (45.5%) cases in Ⅰb level, 26 (39.4%) cases in Ⅳb level, 23 (34.8%) cases in Ⅱa level, 22 (33.3%) cases in Ⅲ level, and 18 (27.3%) cases in Ⅳa level. Lymph nodes CT classification and imaging findings were as follows.Type Ⅰ: homogeneous enhancement type was observed in 49 (74.2%) cases, showing tuberculous nodules and granuloma; Type Ⅱ: envelop enhancement was detected in 24 (36.4%) cases, manifested as caseous necrosis of lymph nodes, envelop enhancement, and no enhancement in the central low-density area; Type Ⅲ: edge enhancement was detected in 34 (51.5%) cases, manifested as lymph node envelope necrosis, segregation, marginal enhancement, no enhancement in the central low-density area, and disappearance of the surrounding fat gap; Type Ⅳ: non-uniform reinforcement type (or fusion type) was found in 44 (66.7%) cases, of which 8 (12.1%) cases were complicated with sinus tract, manifested as lymph node caseous necrosis, destruction and invasion to the surrounding tissues, inhomogeneous marginal enhancement, disappearance of the normal structure of lymph nodes, disappearance of the surrounding fat space, and visible sinus tract. In most cases (90.9%, 60/66), peripheral tissue invasion from the primary lesions was found in varying degrees.Conclusion Cervical lymph node tuberculosis has the characteristics of lesion distribution in multiple lymph node levels, multiple CT classification types and multiple imaging sings. The method of CT-enhanced examination can display the pathological changes of lesions with high quality, and has a high diagnostic value.

Analysis of chest CT findings of pneumoconiosis complicated with pulmonary tuberculosis

Xue-yan LIU,Chun-hua LI,Sheng-xiu LYU,Wei-qiang SHU,Xin. DAI

Chinese Journal of Antituberculosis. 2018, 40(7):  719-723.  doi:10.3969/j.issn.1000-6621.2018.07.010

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Objective To explore the features of chest CT in patients with pneumoconiosis complicated with pulmonary tuberculosis.Methods We analyzed retrospectively the clinical and CT data from 96 cases of pneumoconiosis complicated with pulmonary tuberculosis admitted in Chongqing Infectious Disease Medical Center from June 2015 to December 2016. The location, scope, morphology, type and other organ tuberculosis were observed.Results Of 96 cases, there were pneumoconiosis stage Ⅰ in one case, stage Ⅱ in 23 cases and stage Ⅲ in 72 cases. Pulmonary lesions involved multiple lobes in cases and located at the apicoposterior segment in 93 (96.9%) cases, at the anterior segment in 48 (50.0%) cases, at the middle lobe or/and lingula lobe in 49 (51.0%) cases, at the apical segment of lower lobe in 68 (70.8%) cases and at the basal segment in 53 (55.2%) cases. Of 96 cases, the pathological morphology were patch shadow in 85 (88.5%) cases, large patch shadow in 48 (50.0%) cases, cavity in 64 (66.7%) cases including multiple cavities in 43 cases (67.2%, 43/64), tree-in-bud in 56 (58.3%) cases, pleural effusion in 36 (37.5%) cases, pleural thickening in 72 (75.0%) cases, mediastinal lymph node enlargement in 85 (88.5%) cases, mediastinal lymph node calcification in 58 (60.4%) cases. The incidence of thin-wall cavity in patients with stage Ⅱ pneumoconiosis (47.8%,11/23) was higher than that in patients with stage Ⅲ pneumoconiosis (15.3%,11/72) (χ ²=10.378,P<0.05). The incidence of large patch (59.7%,43/72), tree-in-bud (69.4%,50/72), thick wall cavity (56.9%,41/72), pleural thickening (83.3%,60/72), mediastinal lymph node enlargement (93.1%,67/72) and calcification (69.4%, 50/72) in patients with stage Ⅲ pneumoconiosis were higher than those ((21.7%,5/23),(26.1%,6/23),(8.7%,2/23),(52.2%,12/23),(78.3%,18/23),(34.8%,8/23)) in patients with stage Ⅱ pneumoconiosis, respectively (χ ²=10.061,13.541,14.489,9.224,4.051 and 8.808,P<0.05 for each). Conclusion CT findings of the patients with pulmonary tuberculosis complicated with different stages pneumoconiosis is certain specificity with multiple cavities, tree-in-bud, pleural effusion and extrapulmonary tuberculosis.

Analysis of CT features of pulmonary sclerosing pneumocytoma

Wei HE,Xin-hua ZHOU,Fang LI,Yan LYU,Zhen ZHOU,Cheng-hai LI,Bu-dong CHEN

Chinese Journal of Antituberculosis. 2018, 40(7):  724-729.  doi:10.3969/j.issn.1000-6621.2018.07.011

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Objective To retrospectively analyze the CT features of pulmonary sclerosing pneumocytoma (PSP), in order to improve the correct rate of CT in diagnosis of PSP.Methods Thirty-three cases confirmed by operation and pathology in our hospital from 2012 to 2017 were selected. All cases were scanned by plain scan and 29 cases underwent simultaneous CT enhanced scan in addition. The CT manifestations were retrospectively analyzed.Results CT images of PSP were often shown as a single (30, 90.9%) soft tissue density nodule (20, 60.6%). Most were round (30, 90.9%), regular in edge (27, 81.8%) and located in peripheral (22,66.7%); 19 (65.5%) lesions were inhomogeneous enhancement in enhanced scan. Significant enhancement and delayed enhancement were seen in most cases (26,89.7%). The lesions often complicated with vascular border sign (21, 72.4%),while rarely lymph node enlargement (3, 9.1%).Calcification (10,30.3%), cystic change (5, 15.2%), tail sign (5, 15.2%), halo sign (8, 24.2%), air crescent sign (5, 15.2%) were found in PSP lesions; and 4 cases (12.1%) showed air crescent sign and halo sign simultaneously.Conclusion PSP is often shown as a single round soft tissue density nodule. Enhanced scan is characterized by obvious enhancement and continuous enhancement of delayed scan, with some characteristic concomitant signs. If age and sex were also considered, the accuracy of CT diagnosis could be improved.

CT findings of pulmonary multiple nodules

Li-fang GUO,Jian-mei ZHANG,Ren-gui WANG,Tong ZHAO,Ting-guo WEN,Chun-yan ZHANG,Xiao-jiao GUAN,Yan FU,Yan-wen WANG,Yong-ge. YANG

Chinese Journal of Antituberculosis. 2018, 40(7):  730-735.  doi:10.3969/j.issn.1000-6621.2018.07.012

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Objective To investigate the morphologic characteristics of pulmonary multiple nodules (PMN) on chest computed tomography (CT).Methods Fifty-three patients from the Beijing Shijitan Hospital with PMN were retrospectively reviewed, including 19 cases with pulmonary tuberculosis, 23 cases with pulmonary metastasis, 5 cases with chronic pulmonary inflammation and 6 cases with diffuse lymphangiomatosis. The CT morphologic characteristics of PMN in the above four diseases were analyzed.Results 68.4% (13/19) of pulmonary tuberculosis patients and 78.3% (18/23) of pulmonary metastasis patients possessed PMN with maximum diameter ranging from 10 mm to 20 mm, while 60% (3/5) of chronic pulmonary inflammation patients and 60.0% (3/6) of diffuse lymphangiomatosis patients were detected PMN with maximum diameter ranging from 3 mm to 8 mm. The CT findings of chronic pulmonary inflammation group showed that there was no calcification and cavity in the nodules, 79.3% (69/87) cases had nodules with smooth edge and no lobule septum, 41.3% (36/87) cases had pleural thickening and adhesion adjacent to the lesions. The rates of no lobule septal nodule with smooth edge, calcification, cavity, and adjacent pleural thickening and adhesion in pulmonary tuberculosis group were 82.1% (128/156), 55.1% (86/156), 27.6% (43/156), and 45.5% (71/156), respectively. For the pulmonary metastasis group, the rates of no lobule septal nodule, calcification, cavity, and adjacent pleural thickening and adhesion were 60.0% (369/615), 3.7% (23/615), 18.0% (111/615), and 18.5% (114/615), respectively. Compared to the pulmonary metastasis group, the rates of no lobule septal nodule in chronic pulmonary inflammation group and pulmonary tuberculosis group were statistically significant (χ ²=47.613, P=0.000; χ ²=88.095, P=0.000). There were statistical differences in calcification and cavity between the pulmonary tuberculosis group and pulmonary metastasis group (χ ²=270.707,P=0.000; χ ²=7.048,P=0.008). Compared to the pulmonary metastasis group, the rates of adjacent pleural thickening and adhesion in chronic pulmonary inflammation group and pulmonary tuberculosis group were statistically significant (χ ²=23.670,P=0.000; χ ²=49.650,P=0.000). The types of cavity in pulmonary metastasis group were as follows: the incidence of vacuolar cavity, 34.2% (38/111) > cystic cavity, 26.2% (29/111) > small annular cavity, 22.5% (25/111) > irregular cavity 17.1% (19/111). In addition, all the vacuolar cavities were only detected in the pulmonary metastasis of adenocarcinoma and 78.9% (30/38) of vacuolar cavity nodules possessed characteristic of lobule septal and rag margin. All the five patients in chronic inflammation group showed nodules with poorly defined margins, surrounded by flaky infiltrating shadows and stripe shadows. The nodules of diffuse lymphangiomatosis showed a diffuse or multifocal growth pattern, involving multiple regions with multiple cystic lesions of unequal size, and the pulmonary nodules were smooth in margin and homogeneous in density. Conclusion When the pulmonary tuberculosis, pulmonary metastasis, chronic pulmonary inflammation, and diffuse lymphangiomatosis showed PMN, the specific visual characteristics on CT, such as lesion size, location, morphology, edge, density and adjacent tissue have important value in the differential diagnosis of the above four diseases.

Development and assessment of the XTT/mPMS combination system for the rapid anti-mycobacteria drug susceptibility testing

Zhan-qiang SUN

Chinese Journal of Antituberculosis. 2018, 40(7):  736-743.  doi:10.3969/j.issn.1000-6621.2018.07.013

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Objective To establish and evaluate a novel colorimetric method (sodium 3,3'-{1-((phenylamino) carbonyl)-3,4-tetrazolium}-bis (4-methoxy-6-nitro) benzene sulfonic acid hydrate (XTT)/1-methoxy-5-methylphenazinium methylsulfate (1-methoxy-PMS) assay, XTT/mPMS assay) for the rapid anti-mycobacteria drug susceptibility testing.Methods The properties of the XTT/mPMS and XTT/2-methyl-1,4-NQ (mNQ) colorimetric assay, including optimal reagent concentrations, linear range, reaction time, stability, cytotoxicity and drug interference, were assessed. The performance of XTT/mPMS for the rapid drug susceptibility testing of clinical isolated Mycobacteria strains was evaluated taking solid culture method as the gold standard, and the minimum inhibitory concentration (MIC) was determined. The results were compared with the resazurin assay.Results The optimal concentrations of XTT and the electron mediators in XTT/mPMS and XTT/mNQ systems were 0.2 mmol/L and 0.04 mmol/L, respectively. The chromogenic reaction time with Mycobacterium smegmatis was shorter than that with Mycobacterium bovis and Mycobacterium tuberculosis in both systems (XTT/mPMS: 60, 420 and 420 min; XTT/mNQ: 60, 420 and 420 min, respectively). Both systems showed low cytotoxicity to the three mycobacteria, and could prolong the time of reaching the state phase for 12 to 48 hours approximately. The XTT/mPMS system was stable when co-cultured with Middlebrook 7H9 liquid medium at 37 ℃ or when long-term stored at 37 ℃ for 8 d, 25 ℃ for 15 d and 4 ℃ for 30 d. Moreover, using the solid culture method as the gold standard, the specificity of the XTT/mPMS colorimetric method for the rapid drug susceptibility testing (rifampicin and isoniazid) of clinical isolated Mycobacteria strains were 100.0% (17/17) and 100.0% (13/13) and the sensitivity were 95.7% (22/23) and 92.6% (25/27), respectively, which were consistent with the resazurin assay (specificity: 100.0% (17/17) and 100.0% (13/13); sensitivity: 100.0% (23/23) and 92.6% (25/27)).Conclusion We found that the XTT/mPMS chromogenic system is stable, low-toxic and inexpensive, and is well suited for the rapid drug susceptibility testing of Mycobacterium.

Analysis of plasma concentrations of first-line anti-tuberculosis drugs in 909 tuberculosis patients

Shao-chen GUO,Hui ZHU,Chao GUO,Bin WANG,Zhong-quan LIU,Jian XU,Lei FU,Xiao-you CHEN,Yu LU

Chinese Journal of Antituberculosis. 2018, 40(7):  744-749.  doi:10.3969/j.issn.1000-6621.2018.07.014

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Objective This study aimed to analyze the plasma concentrations of first-line anti-tuberculosis drugs in tuberculosis patients.Methods A total of 909 patients (909 for isoniazid (INH), 783 for ethambutol (EMB), 587 for pyrazinamide (PZA), and 503 for rifampin (RFP)), who admitted to Beijing Chest Hospital Affilia-ted to Capital Medical University from January 2010 to November 2016 and initiated a daily first-line regimen for treatment of tuberculosis, were selected as the subjects of this study. The doses of medicine were: INH 300 mg/d; RFP 450 mg/d or 600 mg/d; PZA 1500 mg/d; or EMB 750 mg/d. Basic information including gender, age and comorbidity and concentrations of INH, EMB, PZA and RFP were collected and analyzed.Results 57.3% (521/909, INH), 82.2% (644/783, EMB), 29.8% (175/587, PZA), 51.6% (190/368, RFP 450 mg/d) and 36.3% (49/135, RFP 600 mg/d) cases had a C2h lower than the reference ranges. 67.2% (396/589), 85.9% (451/525), 39.9% (153/383) and 60.0% (135/225) of male patients had a C2h lower than the reference ranges of these drugs (INH, EMB, PZA and RFP 450 mg/d), which were significantly higher than the counterparts of female cases (39.1% (125/320), 74.8% (193/258), 10.8% (22/204) and 38.5% (55/143)). The differences were statistically significant (χ ²=67.26, 14.59, 54.10 and 16.24; Ps<0.01). 61.7% (428/694), 83.3% (513/616), 35.3% (159/451) and 55.6% (154/277) of cases with body weight ≥50 kg had a C2h lower than the reference ranges of drugs (INH, EMB, PZA and RFP 450 mg/d), which were significantly higher than the counterparts of those with body weight <50 kg (30.3% (40/132), 72.4% (76/105), 4.7% (4/86) and 37.1% (23/62)). The differences were statistically significant (χ ²=44.44, 7.12, 32.00 and 6.95; Ps<0.05). Low plasma drug concentration of INH and PZA often occurred in cases with diabetes mellitus, with a proportion of 72.6% (143/197) and 53.8% (71/132), compared with those without diabetes mellitus (53.1% (378/712) and 22.9% (104/455)). The differences were statistically significant (χ ²=23.98 and 46.78; Ps<0.01). Conclusion It is common that tuberculosis patients have low blood drug concentrations after taking first-line anti-tuberculosis drugs. The individual’s situation varies with several factors including gender, body weight and comorbidity. The monitoring of blood concentration of first-line anti-tuberculosis drugs should be carried out, and modification of treatment plans based on individual’s conditions is essential for therapeutic goals.

Characteristics of 157 tuberculosis and HIV co-infected patients in Hunan province

Bin-bin LIU,Jue WANG,Zhen-hua CHEN,Yan-yan YU,Feng-ping LIU,Yun-hong TAN

Chinese Journal of Antituberculosis. 2018, 40(7):  750-755.  doi:10.3969/j.issn.1000-6621.2018.07.015

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Objective To understand the epidemiology and clinical features of tuberculosis and HIV co-infected patients in Hunan province and provide a reliable reference for its prevention and treatment.Methods A total of 157 tuberculosis and HIV co-infected patients were enrolled from 2013 to 2017 in Hunan Chest Hospital, and 200 patients were selected from the non-HIV-infected tuberculosis patients as controls by stratified random sampling method. Data on the sociological characteristics, clinical features and results of laboratory tests were collected, and statistical analysis was conducted to identify the risk factors for tuberculosis complicated with HIV infection.Results Univariate analysis showed that male tuberculosis patients (125 cases, 79.6%), patients who aged 20-60 years old (20-39 years old: 55 (35.0%) cases; 40-60 years old: 79 (50.3%) cases, married patients (102 cases, 65.0%), patients who suffered from fever (70 cases, 44.6%), neck mass (31 cases, 19.7%), abdominal distension (9 cases, 5.7%), abdominal pain (10 cases, 6.4%) or lymphatic tuberculosis (50 cases, 31.8%), and patients complicated with syphilis infection (32 cases, 23.0%) were more likely infected with HIV. The differences were statistically significant (χ ² values were 7.55, 21.31, 15.06, 49.98, 15.70, 4.85, 5.95, 22.39, and 25.05; P values were 0.006, 0.000, 0.005, 0.000, 0.000, 0.028, 0.015, 0.000, and 0.000, respectively). The positive detection rates of tuberculosis antibody and tuberculosis infection T-cell spot test (T-SPOT.TB) in the double infection group (16.8% (25/149) and 61.7% (50/81)) were lower than those in the non-HIV-infected tuberculosis group (34.1% (60/176) and 78.2% (86/110)). The differences were statistically significant (χ ² values were 12.52 and 6.45; P values were 0.000 and 0.040, respectively). Multivariate analysis showed that among the TB patients, age of 20-39 and 40-60 were risk factors influencing the double infection of tuberculosis and HIV (the odds ratio (OR) (95%CI): 12.54 (1.53-102.89) and 9.09 (1.20-69.40)). The probability of clinical manifestations with fever, lymph node tuberculosis and syphilis in tuberculosis and HIV co-infected patients were higher, and the OR (95%CI) values were 6.51 (2.35-18.01), 5.80 (1.93-17.41) and 15.06 (2.71-83.84), respectively. The probability of bronchial tuberculosis in tuberculosis and HIV co-infected patients was lower (OR (95%CI): 0.03 (0.00-0.31)). Conclusion Tuberculosis patients aged 20-60 years are prone to be infected by HIV. The clinical manifestations with fever and lymph node tuberculosis are more common among tuberculosis and HIV co-infected patients.

Sampling survey of knowledge of pulmonary tuberculosis prevention and treatment on rural population in Heilongjiang province

Yan-fu WANG,Shu-e ZHANG,Yu SHI,Feng-zhe XIE,Jing-hui WANG,Zhen WANG,Jia-rui ZHANG,Dong YIN,Chun-cheng ZHAI

Chinese Journal of Antituberculosis. 2018, 40(7):  756-760.  doi:10.3969/j.issn.1000-6621.2018.07.016

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Objective To understand the current status of health knowledge, attitude and practice (KAP) about pulmonary tuberculosis (TB) prevention and treatment among rural population in Heilongjiang province and to test the influencing factors of health KAP about TB prevention and treatment.Methods Based on the geographical distribution, stratified sampling and questionnaires were used to collect data from rural population in 30 villages from 5 counties in Heilongjiang province from August 2016 to December 2016. The items of the questionnaire mainly included demographic characteristics, and KAP about TB prevention and treatment. A total of 1100 questionnaires were distributed and 941 participants provided valid data (the rate of response=85.5%). Current status and influencing factors of health KAP about TB prevention and treatment were analyzed by descriptive statistics and logistic regression analysis, respectively.Results The rate of awareness of TB prevention and treatment knowledge among rural population in Heilongjiang province was 66.0% (3105/4705). Univariate logistic regression analysis showed that the population with junior high school and equivalent education, annual income per capita more than 12 thousand yuan, and non-smoking had a higher rate of awareness of TB prevention and treatment knowledge (57.4% (221/385),57.5% (348/605),55.2% (345/625)). The difference was statistically significant (χ ² values were 30.80, 14.24 and 4.08, respectively. All P values were less than 0.05). Multivariate logistic regression analysis further showed that the rural population with junior high school and equivalent education (taking unschooled as reference, OR=2.13, 95%CI: 1.31-3.44; P=0.002) and annual income per capita more than 12 thousand yuan (taking income <12 thousand yuan as reference, OR=0.69, 95%CI: 0.52-0.91; P=0.010) had a higher rate of awareness of TB prevention and treatment knowledge. Descriptive statistics showed that the number of rural population who will intentionally alienate TB patients was 319 (33.9%), the number of rural population who will actively understand TB knowledge was 606 (64.4%), the number of rural population who will take the initiative to explain TB knowledge to others was 580 (61.6%). Conclusion The awareness rate of TB prevention and treatment among rural population in Heilongjiang province is low. Then the department of TB prevention and treatment should pay attention to the poor peasants who have a low cultural level and make some targeted propaganda to them.

Analysis of influencing factors of pulmonary tuberculosis in schools students in Guangzhou

Gui-zhen PAN,Jin-xin ZHANG,Qi ZHANG,Liang CHEN,Wen-ji ZUO,Yun-hui CHEN,Ping-ping LIU,Nai-rong. ZHONG

Chinese Journal of Antituberculosis. 2018, 40(7):  761-767.  doi:10.3969/j.issn.1000-6621.2018.07.017

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Objective To explore the influencing factors of pulmonary tuberculosis in schools students in Guangzhou, in order to provide better scientific basis for schools tuberculosis prevention and control.Methods A 1:4 matched case-control study was conducted. The case group was composed of 116 pulmonary tuberculosis patients in 4 schools in Guangzhou during tuberculosis screening and registered in our center from January 2013 to December 2014, and each case selected 4 controls of healthy students with the same gender, age, faculty and hostel. All the 464 controls had neiher pulmonary suspicious lesions nor symptoms of respiratory tract infection in the past two weeks. Self-designed questionnaire with guidance from tuberculosis professionals was used to investigate the two groups face-to-face. The survey included the basic information and 21 indicators such as BMI, parental educational level, percapita family income, life behavior, dietary status, psychosocial and social factors, history of exposure to tuberculosis, and vaccination history of Bacille Calmette Guerin, et.al. To explore the influencing factors of pulmonary tuberculosis prevalence, Chi-square test was used for univariate analysis, and then a total of 21 indicators were analyzed using the conditional logistic regression model for multivariate analysis.Results Multivariate conditional logistic regression analysis showed that history of exposure to tuberculosis (OR(95%CI): 5.44 (1.30-22.71), P=0.020), smoking (OR (95%CI):14.30 (3.86-51.76, P<0.001), introversion personality (OR (95%CI): 5.99 (2.67-13.44), P<0.001), negative life events (OR(95%CI): 3.73 (1.19-11.73), P=0.024) were risk factors of pulmonary tuberculosis prevalence in schools students, living expense level ≥RMB 800 yuan per month (<RMB 800 yuan per month as reference, OR (95%CI):0.06 (0.02-0.23), P<0.001)and the frequence of vegetables and fruits intake ≥7 times every 3 times every week as reference, OR (95%CI): <0.01 (<0.01-0.06), P<0.001) were protective factors of the pulmonary tuberculosis prevalence in schools students, respectively.Conclusion History of exposure to tuberculosis, smoking, introversion personality and negative life events could increase the risk while high living expenses level and increased intake of vegetables and fruits might reduce the risk of pulmonary tuberculosis prevalence in schools students.

Effect analysis of the health management of tuberculosis incorporated into the public health service project in Miyun District, Beijing

Xiao-li TANG,Yu-feng GUO,Hua-li. CAI

Chinese Journal of Antituberculosis. 2018, 40(7):  768-771.  doi:10.3969/j.issn.1000-6621.2018.07.018

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Objective To analyze and evaluate the effect of tuberculosis (TB) prevention and control work, after taking the health management of TB patients into the basic public health service project in Miyun district (hereinafter referred to as the “public health project”).Methods Through comparatively analyzing the situation the patients’ discovery, referral, and treatment outcome between the years from Jan.2014 to Dec.2015 and the last two years since Jan.2016 initiating public health project, to explore the implementation effects of taking TB health mana-gement into public health project. SPSS 18.0 software was used for statistical analysis and chi-square test was used to compare the rates. P<0.05 was considered the difference had statistical significanceResults The incidence of patients with active TB fell by 6.63/100000, from 41.63/100000 (404/970000) (2014-2015) to 35.00/100000 (336/960000) (2016-2017). The discovery rate of smear-positive patient increased by 4.22%, from 29.70% (120/404) (2014-2015) to 33.93% (114/336) (2016-2017), and the difference had no statistical significance (χ ²=1.515, P=0.218). The proportion of patients did not test sputum decreased by 6.81%, from 19.31% (78/404) (2014-2015) to 12.50% (42/336) (2016-2017), and the difference had statistical significance (χ ²=6.266, P=0.012). The rate of referral arrival increased by 6.69%, from 67.81% (455/6710 (2014-2015) to 74.50% (482/647) (2016-2017), and the difference had statistical significance (χ ²=7.170, P=0.007).The overall arrival rate increased by 3.46%, from 93.29% (626/671) (2014-2015) to 96.75% (626/647) (2016-2017), and the difference had statistical significance (χ ²=8.293, P=0.004). The cure rate of new smear positive cases increased by 7.93%, from 87.78% (79/90) (2014-2015) to 95.71% (134/140) (2016-2017), and the difference had statistical significance (χ ²=5.041, P=0.025).Conclusion The proportion of patients did not test sputum decreases, and the rate of referral arrival and cure rate of new smear positive cases increase. In short, taking TB patients health management into the basic public health project improves the TB prevention and control.

Review Articles

Radiological features of pulmonary tuberculosis in the elderly

Yi ZENG,Dai-lun HOU,Xia ZHANG

Chinese Journal of Antituberculosis. 2018, 40(7):  772-775.  doi:10.3969/j.issn.1000-6621.2018.07.019

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Because of the long course of disease, decreased immune function and increased complications in elderly patients with pulmonary tuberculosis (TB), the lesions in interstitial lung and pulmonary vascular lesions can be caused except for lesions of the pulmonary parenchyma. So the multiple pulmonary lesions, as well as the pleomorphic and atypical manifestations are often showed on the radiological images in elderly patients. With the development of imaging technology, timely and accurate interpretations of radiological images can provide a powerful basis for clinical diagnosis of pulmonary TB in the elderly.

Clinical application and research progress of Xpert MTB/RIF Ultra and Xpert MTB/RIF tests

Shu-qi WANG,Hai-rong HUANG,Gui-rong WANG

Chinese Journal of Antituberculosis. 2018, 40(7):  776-780.  doi:10.3969/j.issn.1000-6621.2018.07.020

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Tuberculosis (TB) is one of the leading infectious diseases worldwide. As a rapid nucleic acid amplification test, Xpert MTB/RIF (Xpert) assay can detect mycobacteria bacilli and rifampicin resistance simulta-neously, and provide reliable information for TB diagnosis and treatment due to its high sensitivity and specificity. However, Xpert also demonstrated some imperfections during the clinical practice. Xpert MTB/RIF Ultra (Xpert Ultra) assay is a next-generation assay of Xpert, WHO recommended it in March, 2007. In contrast to Xpert, Ultra has acquired increased sensitivity with paucibacillary specimens collected from patients with extra-pulmonary TB, TB/HIV co-infection or pediatric TB, which is of great significance for regimen establishment. In this review, the limitation of Xpert, the similarity and difference between Xpert and Xpert Ultra are discussed, which will throw light on the value of Xpert Ultra’s clinical application.