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

Nakwon Kwak, Chang Hyun Lee, Hyun Ju Lee, Young Ae Kang, Jae Ho Lee, Sung Koo Han, Jae Joon Yim

Research output: Contribution to journalArticle

7 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)4449-4456
Number of pages8
JournalEuropean Radiology
Volume26
Issue number12
DOIs
Publication statusPublished - 2016 Dec 1

Fingerprint

Lung Diseases
Thorax
Tomography
Odds Ratio
Pulmonary Atelectasis
Bronchiectasis
Pleural Effusion
Pulmonary Tuberculosis
Fibrosis
Logistic Models
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

Kwak, Nakwon ; Lee, Chang Hyun ; Lee, Hyun Ju ; Kang, Young Ae ; Lee, Jae Ho ; Han, Sung Koo ; Yim, Jae Joon. / Non-tuberculous mycobacterial lung disease : diagnosis based on computed tomography of the chest. In: European Radiology. 2016 ; Vol. 26, No. 12. pp. 4449-4456.
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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.",
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Non-tuberculous mycobacterial lung disease : diagnosis based on computed tomography of the chest. / Kwak, Nakwon; Lee, Chang Hyun; Lee, Hyun Ju; Kang, Young Ae; Lee, Jae Ho; Han, Sung Koo; Yim, Jae Joon.

In: European Radiology, Vol. 26, No. 12, 01.12.2016, p. 4449-4456.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Non-tuberculous mycobacterial lung disease

T2 - diagnosis based on computed tomography of the chest

AU - Kwak, Nakwon

AU - Lee, Chang Hyun

AU - Lee, Hyun Ju

AU - Kang, Young Ae

AU - Lee, Jae Ho

AU - Han, Sung Koo

AU - Yim, Jae Joon

PY - 2016/12/1

Y1 - 2016/12/1

N2 - 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.

AB - 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.

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