ROLE OF MULTI DETECTOR COMPUTED TOMOGRAPHY IN DIAGNOSIS OF TUBERCULOSIS AND ITS MIMICKERS

www.worldwidejournals. com 595 Volume-6 | Issue-11 | November-2017 | ISSN 2250-1991 | IF : 5.761 | IC Value : 79.96 PARIPEX INDIAN JOURNAL OF RESEARCH Patel Kailash M.B. B.S, M.D, Associate Professor, S.A.M.C & P.G Institute Sabir Ali Asgar M.B. B.S, M.D, Fellow Intervention Radiology, Shri Ganga Ram hospital New Delhi Mehla Ruchika M.B. B.S, M.D Senior Resident, Max Hospital Vaishali Bilagoji Sanchita Laxman st M.B. B.S, 1 Year Resident, S.A.M.C & P.G Institute subjected to MDCT imaging on SIEMENS SOMATOM DEFINITION AS TRUE 64 SLICE SCANNER. The scans (120 kV; 10 mA; window width, 1,200 Hounsfield units [HU]; and window level,-600 HU) was obtained with a scan time of 7 s with the patient in the supine position at full end-inspiration from lung apex to base with 0.6 mm contiguous slices using the high-spatial frequency algorithm. The scans will be analyzed at the lobar level as well as the segmental level. HRCT PARAMETERS: Tube voltage 120kV Effective tube current 10mA Pitch 1 Scan type Helical Rotation length Full Exposure time 7 sec Scan direction Cranio-caudal Phase of respiration Full inspiration Slice thickness 0.6 mm The maximum radiation dose given was in the range 3  5 mSv. The average radiation dose was 4.2 mSv (±1S.D.) DATA ANALYSIS Image processing: The reconstructed image data from scans was networked to the real time interactive workstation Image analysis: We investigated the following HRCT findings: centrilobular nodules, other nodules, fine reticular pattern, large nodules, branching linear opacities, tree-in-bud appearance, lobular consolidation, interlobular septal thickening, consolidation, ground-glass opacities, cavities, bronchiectasis, pleural effusion, lymph node enlargement, and the presence of a main lesion in apical segment, anterior segment of bilateral upper lobes and apical segment of bilateral lower lobes. We divided the small nodules of <8mm into centrilobular nodules and other nodules, that are interstitially or randomly distributed. Nodules of >8mm and <30mm were regarded as large nodules. Fine linear nodular opacities associated with vessels or lymphatic lesions were regarded as a fine reticular pattern. Areas of consolidation demarcated by sharp margins corresponding to 1 or 2 lobules were regarded as lobular consolidation. The diagnosis of active pulmonary tuberculosis was based on any one of the following: 1. Detection of TB bacilli in bronchial washings/ BAL. Sputum culture or bronchial washing/ BAL culture was done by BACTEC MGIT (Mycobacteria Growth Indicator Tube) 960 systems. 2. Detection of TB bacilli in cultures of sputum or bronchial 3. Demonstration of non-caseating granuloma on FNAC or TBLB suggestive of TB. DATA COLLECTION AND METHODS The data was recorded on the pre-structured proforma especially designed for the study. STATISTICAL ANALYSIS The sensitivity, specificity, positive predictive value, negative predictive value was calculated in the present study. MedCalc statistical software was used. Microsoft excel was used to prepare the master charts. FINANCIAL INPUTS AND FUNDING The patients are managed according to the protocol of the institution laid down for the management of the disease. All the charges as per the institution norms will be borne by the patient, but no additional investigations / tests will be conducted for the specific requirement of the study. Hence, there is no financial burden on the patient or the institution. Also, all study related expenditures will be borne by the investigator himself. ETHICAL AND LEGAL CONSIDERATIONS The protocol of the present study was submitted to the Ethics Committee of Sri Aurobindo Medical College & Postgraduate Institute, Indore. After getting their due approval, the study was initiated in the institute. A patient information and consent form was given to the parents in their local language which, when all their queries were satisfactorily answered and when they were willing to participate, signature of the patient and/or his/her legally acceptable representative was obtained and then only study related procedures were initiated. OBSERVATION The present was conducted in Department of Radio-diagnosis, SAMC and PG institute with the primary objective to evaluate patterns of findings of pulmonary tuberculosis and its mimickers on multi-detector computed tomography. The present study comprised of 100 sputum negative patients who were clinically suspected as having pulmonary tuberculosis. Following observations were made in our study. The patients were divided into 8 groups on basis of age. (Table No. 1, Graph 1) Table No. 1 Age wise distribution of cases (N=100) Graph No. 1 Majority of the patients in our study were in the age group 21-30 years (38.0%). Mean age of patients was 35.416. 4 years with age range of 18 years to 85 years. Patients were categorized on basis of gender. (Table No. 2, Graph 2). Table No. 2 Gender wise distribution of patients (N=100) 596 www.worldwidejournals. com Volume-6 | Issue-11 | November-2017 | ISSN 2250-1991 | IF : 5.761 | IC Value : 79.96 PARIPEX INDIAN JOURNAL OF RESEARCH S.No. Age Group Number Percentage