Follow-up Studies Of MSCT Appearance Of Active Pulmonary Tuberculosis With Sputum Smear And Sputum Culture-Negative Pre-and Post-Antituberculotic Treatment

Objective1、Describe the MSCT imaging characteristic about active pulmonary tuberculosiswith sputum smear and sputum culture-negative,and compare with the activepulmonary tuberculosis with sputum smear and sputum culture-positive underwentCT examination to improve the accurate diagnosis and differential diagnosis of activepulmonary tuberculosis with sputum smear and sputum culture-negative.2、To observe changes of the CT images of active pulmonary tuberculosis withsputum smear and sputum culture-negative with pretreatment,post antituberculotictreatment6months and12months follow-up.And probe the regularity of activepulmonary tuberculosis with sputum smear and sputum culture-negative active CTimage change in the active and post-treatment phases.Materials and methods1、Active pulmonary tuberculosis with sputum smear and sputum culture-negativegroup: Thirty-eight cases which have complete clinical data were confirmed asactive pulmonary tuberculosis with sputum smear and sputum culture-negativereceived chest CT examination in our hospital from2006to2011.There were24males and14females,ranging in age from1to74years.The possibility of combinewith any other disease in the lung or diabetes or deficiency diseases of the immunesystem in these cases has been excluded.All the patients had regular treatment,whose changes of the CT images of pretreatment,post antituberculotic treatment6months and12months follow-up were observed.2、Active pulmonary tuberculosis with sputum smear and sputum culture-positivegroup: Thirty-eight cases which had complete clinical data were confirmed as active pulmonary tuberculosis with sputum smear and sputum culture-positive receivedchest CT examination in our hospital from2006to2011.There were23males and15females,ranging in age from20to79years.The possibility of combine with anyother disease in the lung or diabetes or deficiency diseases of the immune system inthese cases has been excluded. All the patients received chest CT examination in ourhospital before antituberculotic treatment.3、Spiral CT scanner was Toshiba Aquilion16(matrix640×640,120kV,1mm sectionthickness,1mm pitch). All the patients received the non-enhancing CT scan of thewhole lung. All acquired data was measured and analyzed in Toshibaworkstation.One radiologist was in charge of reconstructing image.There are twodoctors in charge of image analysis and data recording.4、Statistical method:To use the chi-square test in the differences of CT manifestationand its occurrence between the pretreatment and post antituberculotic treatment12months with active pulmonary tuberculosis with sputum smear and sputumculture-negative. There were significantly different(P<0.05).And probe the regularityof active pulmonary tuberculosis with sputum smear and sputum culture-negativeactive CT image change in the active and post-treatment phase.Also to use thechi-square test in the differences of CT manifestation and its occurrence between thepositive and negative smear and culture pulmonary tuberculosis. There weresignificantly different(P<0.05).Some valuable signs were picked up.Results1、Many kinds of active CT imaging can be found before treatment.It showed that thecheck-out rate of active images was100%.And23cases(60.53%)in the unilateral lung.At the start of the treatment the check-out rate of main CT findings of activepulmonary tuberculosis with sputum smear and sputum culture-negative werecentrilobular nodules(86.84%),tree in bud(52.63%),interlobular septalthickening(34.21%),consolidation(34.21%), thickening of bronchialwall(68.42%),ground-glass opacity(78.95%) and thick-wall cavity(28.95%).These CTfindings had a higher check-out rate in active pulmonary tuberculosis with sputumsmear and sputum culture-negative.And it is an important for multislice spiral CT to diagnose active pulmonary tuberculosis with sputum smear and sputumculture-negative accurately. While after the treatment of12months, the check-out rateof the images changed to15.79%,0,0,2.63%,42.11%,0,5.26%.After the treatment,thenumber of lesions are decreased and the range of lesions become narrow.The edge ofthe lesion become sharp gradually.The difference was significant(P<0.001) betweenthe pretreatment and post antituberculotic treatment12months with active pulmonarytuberculosis with sputum smear and sputum culture-negative.Tree in bud、interlobularseptal thickening and ground-glass opacity can be totally absorbed after theantituberculotic treatment of12months,other active CT images would mainly changeto the inactive CT images.Inactive CT imaging:The check-out rate of includebronchial flection、band and calcification are18.42%、18.42%and7.89%before thetreatment,73.68%、73.68%and10.53%after the antituberculotic treatment of6months,and78.95%、78.95%and23.68%after the antituberculotic treatment of12months.There was significant differences in the bronchial flection and band betweenthe pretreatment and post antituberculotic treatment12months with active pulmonarytuberculosis with sputum smear and sputum culture-negative.2、Single lobe was always involved in the sputum smear and sputum culture-negativegroup,while multiple lobes were involved in the sputum smear and sputumculture-positive group,with the statistical significance.In sputum smear and sputumculture-positive group CT manifestations representative of activity were found muchmore than sputum smear and sputum culture-negative group. At the start of thetreatment the check-out rate of main CT findings of active pulmonary tuberculosiswith sputum smear and sputum culture-positive were centrilobularnodules(94.74%),thickening of bronchial wall(81.58%) and ground-glassopacity(89.47%).These CT findings had a higher check-out rate in active pulmonarytuberculosis with sputum smear and sputum culture-positive.Tree in bud(78.95%)and thick-wall cavity(63.16%) in positive group were higher than the negative group.There were significantly different(P<0.05). Conclusions1、 The active pulmonary tuberculosis with sputum smear and sputumculture-negative active images includes:centrilobular nodules,tree in bud,interlobularseptal thickening,consolidation, thickening of bronchial wall,ground-glass opacityand thick-wall cavity.2、Tree in bud and thick-wall cavity in positive group were higher than the negativegroup. And it is important in differentiate diagnosis of active pulmonary tuberculosiswith sputum smear and sputum culture-negative and active pulmonary tuberculosiswith sputum smear and sputum culture-positive.3、After the treatment,the number of lesions are decreased and the range of lesionsbecome narrow.The edge of the lesion become sharp gradually. Tree in bud、interlobular septal thickening and ground-glass opacity can be totally absorbed afterthe antituberculotic treatment of12months,other active CT images would mainlychange to the inactive CT images. After the antituberculotic treatment the inactive CTimaging include bronchial flection、band and calcification which the check-out rate isincrease.4、Multi-slice spiral CT scan has obvious advantage in the high distinguishing abilityabout definition and space,and is superior in finding the active pulmonary tuberculosiswith sputum smear and sputum culture-negative active images. Multi-slice spiral CTscan plays the important role in diagnosis and differentiate diagnosis of activepulmonary tuberculosis with sputum smear and sputum culture-negative. AndMulti-slice spiral CT is helpful in the evaluation of treatment effect of it.