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. 2019 Jul 1;6(7):ofz313.
doi: 10.1093/ofid/ofz313.

Radiological Signs of Latent Tuberculosis on Chest Radiography: A Systematic Review and Meta-Analysis

Jonathan W Uzorka  1 , Jacco Wallinga  2 , Lucia J M Kroft  3 , Tom H M Ottenhoff  1 , Sandra M Arend  1
Affiliations

Radiological Signs of Latent Tuberculosis on Chest Radiography: A Systematic Review and Meta-Analysis

Jonathan W Uzorka et al. Open Forum Infect Dis. .

Abstract

Objective: Current guidelines recommend screening for latent tuberculosis infection (LTBI) with a tuberculin skin test (TST) or interferon gamma release assay (IGRA), or both. Many also recommend chest radiography (CXR), although its added value is uncertain. This systematic review assessed the prevalence of abnormalities suggestive of LTBI on CXR (LTBI-CXR lesions) and evaluated the strength of the association.

Method: We searched 4 databases up to September 2017 and systematically reviewed cross-sectional and cohort studies reporting LTBI-CXR lesions in individuals with a positive TST or IGRA, or both, result. Prevalence estimates were pooled using random effects models and odds ratios (ORs) were used to calculate risk estimates.

Results: In the 26 included studies, the pooled proportion of individuals with LTBI having LTBI-CXR lesions was 0.15 (95% confidence interval [CI], 0.12-0.18]. In 16 studies that reported on individuals with LTBI and uninfected controls, LTBI-CXR lesions were associated with a positive TST result ≥ 5 mm or ≥ 10 mm (OR, 2.45; 95% CI, 1.00-5.99; and OR, 2.06; 95% CI, 1.38-3.09, respectively) and with a positive QuantiFERON result (OR, 1.99; 95% CI, 1.17-3.39) compared to CXR in uninfected controls. Although few studies reported specified lesions, calcified nodules were most frequently reported in individuals with LTBI (proportion, 0.07; 95% CI, 0.02-0.11).

Conclusions: Lesions on CXR suggestive of previous infection with Mycobacterium tuberculosis were significantly associated with positive tests for LTBI, although the sensitivity was only 15%. This finding may have added value when detection of past LTBI is important but immunodiagnostic tests may be unreliable.

Keywords: diagnostic imaging; latent tuberculosis; radiography; systematic review.

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Figures

Figure 1.
Figure 1.
Selection of Articles Included in This Review
Figure 2.
Figure 2.
Proportion of Individuals With Positive Test for Latent Tuberculosis (TB) Infection in Whom Lesions Suggestive of Previous TB Infection Were Found on Chest Radiography.
Figure 3.
Figure 3.
Meta-Analysis of Studies Showing the Crude Effect of a Positive TST Result on the Risk of Lesions Suggestive of Past TB Infection on Chest Radiography
Figure 4.
Figure 4.
Meta-Analysis of Studies Showing the Crude Effect of a Positive Interferon-Gamma Release Assay Result on the Risk of Lesions Suggestive of Past Tuberculosis Infection on Chest Radiography
Figure 5.
Figure 5.
Funnel Plot by Diagnostic Category
See this image and copyright information in PMC

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