REPEATED CT EXAMINATIONS OF CHILDREN AND ADOLESCENTS DURING DIAGNOSIS AND TREATMENT FOR PULMONARY TUBERCULOSIS: OPTIMIZATION OF INDICATIONS AND CLINICAL SIGNIFICANCE

 

Petrakova I.Yu. 1, Tyurin I.E. 2,3, Gubkina M.F. 1,4, Ovsyankina E.S. 1

 

1 - Central TB Research Institute.

2 - Russian Medical Academy of Continuous Professional Education.

3 - N.N. Blokhin National Medical Research Center of Oncology.

4 - N.I. Pirogov Russian National Research Medical University. Moscow, Russia.

T

o optimize CT examinations in diagnosis and treatment for pulmonary tuberculosis (TB) in children and adolescents.

Materials and methods. A retrospective observational one-step study included 455 patients aged 2-17 years with active pulmonary TB or post-TB changes. We studied the reasons of patient referrals for repeated CT examinations and their clinical significance.

Results. Totally 163 patients (35.8%) underwent repeated CT examinations. They were justified by either diagnostic reasons (84 patients, 18.4%) or delays in hospitalization or transfer to a federal hospital (79 patients,17.4%). At the diagnostic stage important information for the determination of treatment tactics was obtained to differentiate between pronounced intrathoracic lymphadenopathy and oncological changes, and to diagnose minimal changes in the lung tissue in children with early primary TB infection (13 out of 84 patients, 15%) and exclude non-specific inflammation. For patients with pronounced changes in the lung tissue or primary TB with consolidation and calcification (71 out of 84 patients, 85%), risk factors of TB and microbiology studies had the determining role in diagnosing TB, not the repeated CT examinations. Upon hospitalization most patients with established TB, either complicated intrathoracic lymphadenopathy (ITLN) TB or pulmonary TB, one month after conservative treatment demonstrated CT dynamics, which changed the view on the scope and nature of pathological changes, which could distort the assessment of treatment effectiveness in repeated control. For surgery patients with large residual post-TB changes (n=38) hospitalized two months after CT examinations, repeated CT examinations provided important information, which influenced indications for surgery oftener than for patients with a one-month interval between CT examinations: 6 out of 21 patients (29%) and 0 out of 17 patients (0%) respectively, р<0.05.

Discussion. We have detected an essential share of repeated CT examinations during diagnostics and hospitalization; however, their justification depends on the clinical situation and the interval after the previous CT examination.

Conclusions. 1. Among the studied patients repeated CT examinations were performed before treatment initiation in 35.8% of cases (in 18.4% for diagnostic purposes, in 17.4% due to delayed hospitalization). 2. At the diagnostic stage repeated CT examinations played a supporting role in patients with pronounced changes in the lung tissue or primary TB in the phase of consolidation and calcification (71 out of 84 patients, 85%). Repeated CT examinations provided significant information

 

 

in patients with pronounced intrathoracic lymphadenopathy or children with minimal changes in the lung tissue in the early stage of primary TB infection (13 out of 84 patients, 15%). 3. At delayed hospitalization repeated CT examination one month after the previous examination is indicated for patients who receive conservative treatment for pulmonary TB or complicated ITLN TB, and two months after the previous examination – for patients with non-complicated ITLN TB and surgery patients with large residual post-TB changes.

 

Keywords: TB, computed tomography, children, adolescents.

 


Corresponding author: Petrakova I.Yu., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Petrakova I.Yu., Tyurin I.E., Gubkina M.F., Ovsyankina E.S. Repeated CT examinations of children and adolescents during diagnosis and treatment for pulmonary tuberculosis: optimization of indications and clinical significance. REJR 2024; 14(4):57-68. DOI: 10.21569/2222-7415-2024-14-4-57-68.

Received:        04.09.24                 Accepted: 10.10.24