AKURASI SISTIM SKORING CT SCAN TORAKS TANPA KONTRAS POTONGAN TERBATAS UNTUK MENEGAKKAN DIAGNOSIS TUBERKOLOSIS PARU DEWASA

Background: Tuberculosis (TB) is still a malo- CCl'JSeof morbidity and mortality in Indonesia. Thus we need a fast and accurate method in diagnosing pulmonary TB especially in adult smear negative TB cases. The limited slice non-enhanced thoracic CT and a standardized method of expertise, such as a scoring system, could be a fast, effective and relatively easy alternative to provide a greater accuracy in diagnosing adult pulmonary TB. Objective: This study was performed to determine the accuracy of a scoring system using the limited slice non-enhanced thoracic CT in diagnosing adult pulmonary TB. Methods: This cross sectional study was conducted in Department of Radiology, Persahabatan hospital, Jakarta, Indonesia and starting from September 2012 to June 2013. The subjects comprised of 130 patients suspected of having smear negative pulmonary TB. A limited slice nonenhanced thoracic CT was performed to assess the diagnostic value based on a scoring system. Pulmonary TB was diagnosed in 84 subjects compare to reference standard. The scoring system was calculated using bivariate and multivariate cox regression analysis. The variables included in the analysis were the patient's age, history of previous contact with pulmonary TB patients, history of smoking and 9 characteristic chest CT patterns of TB. The ROC analysis was done to found the cutoff point score prediction pulmonary TB value. Results: Based on limited slice non enhanced thoracic CT and done by scoring system, a total score of equal or more than 29 could diagnose pulmonary TB with the accuracy 96.1% (95%Cls 91.3-98.3), sensitivity 96,5% (95%Cls 90.1-98,8), specificity 95.6% (95%Cls 90.1-98.8), PPV 97.6% (95%Cls 91.7-99.3%), NPV of 93.5% ( (95%Cls 82.5- 97.8), LRP 21.7 (95%Cls 8.1-57.9) and LRN 0.04 (95%Cls 0.02- 0.07)compared to reference standard. Limited slice non-enhanced thoracic CT could also provide information regarding pulmonary abnormalities other than TB Conclusion: Scoring system performed in limited slice non-enhanced thoracic CT has a highly comparable accuracy with the reference standard for the diagnosis of adult pulmonary TB Keyword: Limited slice non enhanced thoracic CT, Scoring system, Adult pulmonary TB.