Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Chest Radiographs and CT Findings during Healthcare Workers' Tuberculosis Screening Using Interferon- Gamma Release Assay: Retrospective Observational Study

인터페론-감마 분비 검사를 이용한 의료 종사자의 결핵 스크리닝에서 흉부 X선 사진 및 CT 소견: 후향적 관찰 연구

  • Ye Ra Choi (Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center) ;
  • Jung-Kyu Lee (Division of Pulmonary and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center) ;
  • Eun Young Heo (Division of Pulmonary and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center) ;
  • Deog Kyeom Kim (Division of Pulmonary and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center) ;
  • Kwang Nam Jin (Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center)
  • 최예라 (서울특별시보라매병원 영상의학과 ) ;
  • 이정규 (서울특별시보라매병원 호흡기내과) ;
  • 허은영 (서울특별시보라매병원 호흡기내과) ;
  • 김덕겸 (서울특별시보라매병원 호흡기내과) ;
  • 진광남 (서울특별시보라매병원 영상의학과 )
  • Received : 2020.09.04
  • Accepted : 2021.03.03
  • Published : 2021.11.01
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Abstract

Purpose To investigate the incidence of tuberculosis (TB) in healthcare workers (HCWs) with positive interferon-gamma release assay (IGRA) results based on chest X-ray (CXR) and CT findings and determine the role of imaging in the diagnosis of TB. Materials and Methods Among 1976 hospital personnel screened for TB using IGRA, IGRApositive subjects were retrospectively investigated. Clustered nodular and/or linear streaky opacities in the upper lung zone were considered positive on CXR. The CT findings were classified as active, indeterminate, inactive, or normal. The active or indeterminate class was considered CT-positive. Results IGRA was positive in 255 subjects (12.9%). CXR and CT were performed in 249 (99.2%) and 113 subjects (45.0%), respectively. CXR- and CT-positive findings were found in 7 of 249 (2.8%) and 9 of 113 (8.0%) patients, respectively. Among the nine CT-positive subjects, active and indeterminate TB findings were found in 6 (5.3%) and 3 (2.7%) patients, respectively. Microbiological tests, including acid-fast bacilli staining, culture, and polymerase chain reaction for TB, were negative in all nine CT-positive subjects. Empirical anti-TB medications were administered to 9 CT-positive subjects, and 3 of these nine subjects were CXR-negative for pulmonary TB.

목적 인터페론-감마 분비 검사(interferon-gamma release assay; 이하 IGRA) 결과가 양성인 의료종사자의 흉부 X선(chest X-ray; 이하 CXR) 및 CT 결과를 기반으로 결핵의 발생률을 조사하고, 결핵 진단에서 진단 영상의 추가적인 역할을 알아보고자 하였다. 대상과 방법 IGRA를 시행 받은 1976명의 의료 종사자 중에서 IGRA 양성자를 후향적으로 조사하였다. 상부 폐야의 군집 결절 또는 선형 음영을 흉부 X선 양성으로 간주하였고, CT 결핵소견은 활성, 활동성미정, 비활동성, 정상으로 분류하였다. 활성 또는 활동성미정을 CT 양성으로 정의하였다. 결과 IGRA 검사 결과 255명(12.9%)에서 양성이었다. CXR과 CT는 각각 249명(99.2%)과 113명(45.0%)에서 시행되었다. CXR 양성 소견은 249명 중 7명(2.8%), CT 양성 소견은 113명 중 9명(8.0%)에서 각각 나왔다. 9명의 CT 양성 대상자 중 활성 또는 활동성미정 결핵 소견은 각각 6명(5.3%)과 3명(2.7%)에서 발견되었다. Acid-fast bacilli 염색, 배양 및 결핵에 대한 polymerase chain reaction을 포함한 미생물적 검사는 9명의 CT 양성 피험자 모두에서 음성이었다. CT 양성 피험자 9명은 경험적 항결핵약물 치료를 받았고, 이 9명 중 3명은 CXR 음성 소견이었다. 결론 IGRA 양성 의료 종사자에서 CT 검사는 무증상 결핵을 진단하는 데 도움을 주었다.

Keywords

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