Imaging findings of primary multidrug-resistant tuberculosis: a comparison with findings of drug-sensitive tuberculosis.

OBJECTIVE: This study was designed to identify and describe thin-section computed tomographic (CT) findings of primary multidrug-resistant tuberculosis (MDR TB) as compared with the findings for drug-sensitive TB.

METHODS: Between October 2002 and December 2007, thin-section chest CT findings of 39 patients with primary MDR TB and 39 patients with drug-sensitive TB were retrospectively reviewed. The frequency and patterns of lung lesions (including centrilobular nodules, large nodules, consolidation, cavity, fibrotic bands, bronchiectasis, calcification, pleural effusion, lymphadenopathy, number of lobes affected by parenchymal lesions, and laterality) were compared. Statistical comparisons were performed with the use of the chi2 and the Mann-Whitney U tests for univariate analysis, and a stepwise logistic regression method was used for multivariate analysis.

RESULTS: Based on univariate analysis, bilateral involvement (P < 0.001), segmental or lobar consolidation (P < 0.001), and cavities (P < 0.001) were more frequently seen in primary MDR TB patients. A stepwise logistic regression analysis demonstrated that bilateral involvement of parenchymal lesions (odds ratio, 4.7; 95% confidence interval, 1.4-15.6; P = 0.012) and multiple cavities (odds ratio, 1.7; 95% confidence interval, 1.2-2.5; P = 0.004) were significant CT findings associated with primary MDR TB.

CONCLUSIONS: The presence of primary MDR TB as detected on a CT scan may help the use of appropriate therapy for infected patients before obtaining a definite diagnosis based on bacteriology.