M Kriel1, J W Lotz2, M Kidd3, G Walzl1. 1. Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research/Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. 2. Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Tygerberg Academic HospitalStellenbosch University, Cape Town, South Africa. 3. Centre for Statistical Consultation, Stellenbosch University, Cape Town, South Africa.
Abstract
OBJECTIVE: To refine and evaluate a recently published radiological disease severity score for the prediction of month 2 and end of treatment outcomes in pulmonary tuberculosis (TB). Radiological extent of disease has been linked to early and late outcomes of anti-tuberculosis treatment, but no validated tools are available to quantify this parameter. DESIGN: We enrolled 449 adult, human immunodeficiency virus negative participants with smear- or culture-proven TB from three TB biomarker studies in Cape Town, South Africa. Full-size posteroanterior baseline chest X-rays (CXRs) were evaluated by two clinicians after standardising the published scoring method and the predictive ability assessed for month 2 and final treatment outcomes. RESULTS: Baseline CXR scores were significantly different in the favourable and unfavourable outcome groups; however, the predictive ability for outcomes at all time points was poor (ROC area under curve ⩿0.68). Inter-reader reliability was high (r = 0.86, P < 0.001), but agreement in cavity identification was modest. CONCLUSION: Standardised application of a CXR score derived from the presence of cavities and overall extent of parenchymal disease in active TB showed good inter- and intrareader reliability. Scores differed significantly in treatment outcome groups, but did not allow accurate outcome prediction.
OBJECTIVE: To refine and evaluate a recently published radiological disease severity score for the prediction of month 2 and end of treatment outcomes in pulmonary tuberculosis (TB). Radiological extent of disease has been linked to early and late outcomes of anti-tuberculosis treatment, but no validated tools are available to quantify this parameter. DESIGN: We enrolled 449 adult, human immunodeficiency virus negative participants with smear- or culture-proven TB from three TB biomarker studies in Cape Town, South Africa. Full-size posteroanterior baseline chest X-rays (CXRs) were evaluated by two clinicians after standardising the published scoring method and the predictive ability assessed for month 2 and final treatment outcomes. RESULTS: Baseline CXR scores were significantly different in the favourable and unfavourable outcome groups; however, the predictive ability for outcomes at all time points was poor (ROC area under curve ⩿0.68). Inter-reader reliability was high (r = 0.86, P < 0.001), but agreement in cavity identification was modest. CONCLUSION: Standardised application of a CXR score derived from the presence of cavities and overall extent of parenchymal disease in active TB showed good inter- and intrareader reliability. Scores differed significantly in treatment outcome groups, but did not allow accurate outcome prediction.
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