CT Scan Features as Predictors of Patient Outcome After Bronchial Intervention in Endobronchial TB

Background: The purpose of this study was to identify the CT scan features that predict patient outcome after reexpansion procedures in patients with the fibrotic stage of endobronchial TB. Methods: We retrospectively enrolled 30 patients (four men, 26 women) aged 32 +/- 11 years who had lobar or whole-lung atelectasis as sequela of endobronchial TB. Patients underwent helical CT scan examinations and subsequent reexpansion procedures for atelectasis, including balloon dilatation (n = 2), stent placement (n = 23), and surgical bronchoplasty (n = 5). Two thoracic radiologists evaluated the location and extent of airway narrowing, the extent of volume loss, parenchymal calcification, mucus plugging, and bronchiectasis within atelectasis on preprocedural CT scans. The success of reexpansion procedures was defined as the recovery of lung volume being > 80% of the estimated original volume as determined during follow-up imaging. Preprocedural CT scans and clinical features were compared for the results of the reexpansion procedures using the Wilcoxon two-sample test or Fisher exact test. Results: Atelectasis was reexpanded in 30% (nine of 30) of patients after reexpansion procedures. The presence of parenchymal calcification and bronchiectasis within atelectasis showed a high tendency of failure in reexpansion procedures (P<.001). Mucus plugging, the extent of airway narrowing, volume loss on CT images, and endobronchial TB activity at the time of intervention did not affect the results (P>.05). Patients with successful results were significantly younger than those with unsatisfactory results. Conclusions: Parenchymal calcification and bronchiectasis within atelectasis are correlated with a high chance of failure in reexpansion procedures. Knowledge of CT scan features may help radiologists to predict the results of lung-conserving therapy to avoid unnecessary interventions. CHEST 2010; 138(2):380-385