EVALUATING THE DIAGNOSTIC PERFORMANCE OF LOW-DOSE CHEST CT FOR PULMONARY TUBERCULOSIS IN HIGH-RISK POPULATIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Main Article Content
Keywords
low-dose CT, pulmonary tuberculosis, high-risk populations, diagnostic accuracy, meta-analysis
Abstract
Background: Pulmonary tuberculosis (TB) remains a major global health concern, particularly in high-risk populations such as immunocompromised individuals, children, and close contacts of TB patients. While chest X-ray (CXR) is the conventional screening tool, its sensitivity is limited. Low-dose chest computed tomography (LDCT) may offer improved diagnostic accuracy with reduced radiation exposure compared to standard CT. This study evaluates the diagnostic performance of LDCT for pulmonary TB in high-risk populations.
Methods: We conducted a systematic review and meta-analysis of studies published from January 2000 to June 2025 across PubMed, Embase, Scopus, Cochrane Library, and Web of Science. Eligible studies evaluated LDCT (defined as radiation dose ≤1.5 mSv) for pulmonary TB diagnosis in high-risk populations using a valid reference standard. Data were pooled using a bivariate random-effects model to estimate sensitivity, specificity, diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic curve (AUC).
Results: Fifteen studies (n = 6,274 participants) met inclusion criteria. The pooled sensitivity and specificity of LDCT for pulmonary TB were 91.3% (95% CI: 87.0–94.6%) and 88.2% (95% CI: 83.7–91.9%), respectively. The diagnostic odds ratio was 78.5 (95% CI: 43.2–142.5), with an AUC of 0.94. Subgroup analyses showed slightly higher sensitivity in HIV-positive individuals (93.1%) and children (94.7%) compared to general high-risk cohorts. Heterogeneity was moderate (I² = 53.6%), primarily due to differences in CT protocol and patient demographics.
Conclusions: LDCT demonstrates high diagnostic accuracy for pulmonary TB in high-risk populations, outperforming CXR in sensitivity while minimizing radiation exposure. These findings support the integration of LDCT into TB diagnostic algorithms, especially in settings where rapid, early detection is critical. Further research is needed to validate cost-effectiveness and implementation strategies.
References
2. Ahmad Khan F, Verkuijl S, Parrish A, et al. Performance of chest X-ray in the detection of pulmonary tuberculosis: a systematic review and meta-analysis. PLoS One. 2022;17(2):e0264090. doi:10.1371/journal.pone.0264090
3. Silva M, Pastorino U, Sverzellati N, et al. Long-term accuracy of low-dose computed tomography for lung cancer screening. Ann Oncol. 2015;26(7):1484–90. doi:10.1093/annonc/mdv127
4. Goo JM. Radiation risks from screening CT of the chest: what a radiologist needs to know. Korean J Radiol. 2008;9(4):297–302. doi:10.3348/kjr.2008.9.4.297
5. National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395–409. doi:10.1056/NEJMoa1102873
6. Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwinderman AH. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol. 2005;58(10):982–90. doi:10.1016/j.jclinepi.2005.02.022
7. Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529–36. doi:10.7326/0003-4819-155-8-201110180-00009
8. Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol. 2005;58(9):882–93. doi:10.1016/j.jclinepi.2005.01.016
9. Nishikiori N, Osuga K, Yamaguchi T, et al. Use of low-dose computed tomography (LDCT) for active tuberculosis screening: a retrospective cohort study in Japan. Int J Infect Dis. 2021;102:64–71. doi:10.1016/j.ijid.2020.10.059
10. Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH. Thoracic sequelae and complications of tuberculosis. Radiographics. 2001;21(4):839–58. doi:10.1148/radiographics.21.4.g01jl06839
11. Lee KS, Song KS, Lim TH, Kim PN, Kim IY, Kim H. Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans. AJR Am J Roentgenol. 1993;160(4):753–8. doi:10.2214/ajr.160.4.8456655
12. Yoon SH, Esmaili A, Kim HY, et al. Use of low-dose chest CT for diagnosing tuberculosis in immunocompromised patients: a comparative study with standard-dose CT. Clin Radiol. 2020;75(5):400.e11–8. doi:10.1016/j.crad.2020.01.013
13. Choi H, Lee HJ, Lee CH, et al. Diagnostic performance of low-dose chest CT compared to chest radiography in screening for pulmonary tuberculosis among close contacts. J Thorac Imaging. 2021;36(3):W27–33. doi:10.1097/RTI.0000000000000542
14. Khoo KL, Kung YH, Chen KY, et al. Clinical and radiographic features of pulmonary tuberculosis in children compared to adults. Pediatr Infect Dis J. 2020;39(1):29–34. doi:10.1097/INF.0000000000002474
15. Heuvelings CC, de Vries SG, Greve PF, et al. Chest radiography and tuberculosis screening: a systematic review of current guidelines and practices. Eur Respir J. 2017;49(5):1602122. doi:10.1183/13993003.02122-2016
16. Lee SW, Jang YS, Park CM, et al. The role of chest CT scanning in TB outbreak investigation. Chest. 2010;137(5):1050–6. doi:10.1378/chest.09-1689
17. Lee E, Han J, Song JW, et al. CT findings of pulmonary tuberculosis: patterns of disease and differential diagnosis. Clin Imaging. 2013;37(3):431–8. doi:10.1016/j.clinimag.2012.10.002
18. Song Q, Shi Z, Zhong Z, et al. Diagnostic value of chest low-dose CT in early tuberculosis: a prospective multicenter study. Infect Drug Resist. 2021;14:3957–65. doi:10.2147/IDR.S327083
19. Van Cleeff MR, Kivihya-Ndugga LE, Githui WA, et al. A comprehensive comparison of different methods for the diagnosis of pulmonary tuberculosis in Nairobi, Kenya. Int J Tuberc Lung Dis. 2003;7(7):610–6. PMID:12870931
20. Ryu YJ. Diagnosis of pulmonary tuberculosis: recent advances and diagnostic algorithms. Tuberc Respir Dis (Seoul). 2015;78(2):64–71. doi:10.4046/trd.2015.78.2.64
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr Natasha Naseer
Khawaja Muhammad Safdar Medical College, Sialkot, University of Health Sciences, Lahore, Pakistan.
Dr Nida Iqbal
University of Karachi (Liaquat National Medical College), Karachi, Pakistan; FCPS (Family Medicine), Aga Khan University Hospital, Karachi, Pakistan.
Dr Rashid Ali
MBBS, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan; FCPS.
Dr Syeda Malika Haider
Jinnah Sindh Medical University, Karachi, Pakistan; MBA (Healthcare and Hospital Management).
Dr Mahwish Rizwan
Sindh Medical College, Karachi, Pakistan; MBBS, FCPS (Diagnostic Radiology), CHPE.
Dr Amber Shams
MBBS, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan; Professional Diploma in Gynaecology & Obstetrics, Royal College of Physicians of Ireland (RCPI).