Pulmonary tuberculosis: CT findings--early active disease and sequential change with antituberculous therapy.

TLDR

The study prospectively evaluated CT findings of active pulmonary tuberculosis and their changes before and after antituberculous therapy in 29 newly diagnosed and 12 reactivation patients. Diagnosis relied on sputum acid‑fast bacilli and serial radiographs, with 26 patients undergoing serial CT scans over 1–20 months and cadaver lung pathology examined to confirm findings. Centrilobular lesions were the most common CT feature, largely resolving within five months of treatment, and CT could distinguish new active lesions from old fibrosis, indicating that small‑airway–adjacent lesions reliably mark disease activity.

Abstract

To evaluate findings of active pulmonary tuberculosis on computed tomographic (CT) scans and their sequential changes before and after antituberculous chemotherapy, 29 patients with newly diagnosed pulmonary tuberculosis and 12 patients with recent reactivation were studied prospectively. The diagnosis of active pulmonary tuberculosis was based on positive acid-fast bacilli in sputum (n = 29) and changes on serial radiographs obtained during treatment (n = 12). Twenty-six patients were followed up with CT during treatment for 1-20 months. Lungs from the cadavers of nine other patients, who died of pulmonary tuberculosis, were studied to provide a pathologic basis for diagnosis. At examination with CT, centrilobular lesions (nodules or branching linear structures 2-4 mm in diameter) were most commonly seen (n = 39 [95%]); in the 26 patients with follow-up, most of these lesions disappeared within 5 months after the start of treatment. In 11 of 12 patients with recent reactivation, CT clearly differentiated old fibrotic lesions from new active lesions. Lesions in and around the small airways appear to be the most characteristic CT feature of early active tuberculosis and may be a reliable criterion for disease activity.