Specificity and sensitivity of chest radiographs in the diagnosis of paediatric pulmonary tuberculosis and the value of additional high‐kilovolt radiographs

Abstract

Tuberculosis (TB) remains the most common notifiable infectious disease in South Africa. The diagnosis of pulmonary TB in children is often very difficult because of the non-specific radiological signs and inter-observer variation in the interpretation of radiographs. The frontal high-kilovolt (kV) radiograph has been used to assess the effect of TB adenopathy on the tracheobronchial tree and to detect endobronchial lesions. The aims of the present study were to assess the specificity and sensitivity of chest radiographs in the diagnosis of pulmonary TB and to assess whether the addition of the high-kV radiograph affects these parameters. The study group consisted of paediatric patients suspected of having pulmonary TB over a 6-year period. These patients had clinical, bacteriological and radiographic examinations. Radiographs were examined by one experienced radiologist in two sittings separated by a 6-week interval. On the first sitting, only standard radiographs were examined and, on the second sitting, these were supplemented with high-kV radiographs. Differences in the detection of each recognized radiological feature of pulmonary TB before and after the addition of the high-kV film were analysed for statistical significance. The frequency of radiographic findings in our study compared favourably with other reports. No statistically significant differences for the detection of radiographic features consistent with pulmonary TB, or for the diagnosis of pulmonary TB, were demonstrated between the two sittings. Specificity increased from 74.4% to 86.6% with the addition of the high-kV view and sensitivity remained constant at 38.8%. The present study does not support the routine use of the frontal high-kV radiograph for the diagnosis of pulmonary TB. This paper also confirms the findings of others, that standard chest radiographs are a poor indicator of pulmonary TB in children.

Risk factors, clinico-epidemiological profile of tuberculosis among children attending a tertiary care hospital: a two year study

“…21 59.18% of childhood cases on chest X-ray showed evidence of radiological findings strongly suggestive of pulmonary tuberculosis which was similar to the reports of De villers RV et al in his study. 22 Primary pulmonary complex was the common radiological finding in the study followed by consolidation, which are on par with the findings of Nantongo et al in their study. 23 Mantoux test positivity was seen in 46.94% of cases in Present study in both pulmonary and extra pulmonary cases of TB.…”

Management of children exposed toMycobacterium tuberculosis: a public health evaluation in West Java, Indonesia

“…28 In another study from the country, the proportion of children's chest radiographs judged positive for tuberculosis by three reviewers ranged from 11 to 51%. 29 While it is reasonable that the use of chest radiographs for diagnosis in child contact management programmes should be reviewed, 25,30 there is, perhaps, as great a need for standardizing the training of readers.…”

“…[25][26][27] However, their sensitivity and specificity in the diagnosis of tuberculosis are reportedly low. 25,27 Furthermore, poor agreement between readers is common: in South Africa, the reported agreement on hilar lymphadenopathy between different observer pairs ranged from 5 to 55% 27 and a similar study reported a kappa of 33%. 28 In another study from the country, the proportion of children's chest radiographs judged positive for tuberculosis by three reviewers ranged from 11 to 51%.…”

Advances in Imaging Chest Tuberculosis: Blurring of Differences Between Children and Adults

“…33A). 55 In more advanced departments, reconstruction of multidetector CT (MDCT) is possible in many ways including minimum intensity projections (Fig. 33B, C), volume rendered three-dimensional (Fig.…”

“…29B). 10,14,55 Offending lymphadenopathy can be enucleated to relieve the obstruction and allow re-expansion of the lung (Fig. 29C-E).…”