Reliability and diagnostic performance of CT imaging criteria in the diagnosis of tuberculous meningitis

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dc.contributor.authorBotha, Hugoen_ZA
dc.contributor.authorAckerman, Christelleen_ZA
dc.contributor.authorCandy, Sallyen_ZA
dc.contributor.authorCarr, Jonathan Aen_ZA
dc.contributor.authorGriffith-Richards, Stephanieen_ZA
dc.contributor.authorBateman, Kathleen Jen_ZA
dc.date.accessioned2015-11-10T14:47:00Z
dc.date.available2015-11-10T14:47:00Z
dc.date.issued2012en_ZA
dc.description.abstractIntroduction Abnormalities on CT imaging may contribute to the diagnosis of tuberculous meningitis (TBM). Recently, an expert consensus case definition (CCD) and set of imaging criteria for diagnosing basal meningeal enhancement (BME) have been proposed. This study aimed to evaluate the sensitivity, specificity and reliability of these in a prospective cohort of adult meningitis patients. METHODS: Initial diagnoses were based on the CCD, classifying patients into: ‘Definite TBM’ (microbiological confirmation), ‘Probable TBM’ (diagnostic score ≥10), ‘Possible TBM’ (diagnostic score 6-9), ‘Not TBM’ (confirmation of an alternative diagnosis) or ‘Uncertain’ (diagnostic score of <6). CT images were evaluated independently on two occasions by four experienced reviewers. Intra-rater and inter-rater agreement were calculated using the kappa statistic. Sensitivities and specificities were calculated using both ‘Definite TBM’ and either ‘Definite TBM’ or ‘Probable TBM’ as gold standards. RESULTS: CT scan criteria for BME had good intra-rater agreement (κ range 0.35-0.78) and fair to moderate inter-rater agreement (κ range 0.20-0.52). Intra- and inter-rater agreement on the CCD components were good to fair (κ  =  ranges 0.47-0.81 and 0.21-0.63). Using ‘Definite TBM’ as a gold standard, the criteria for BME were very specific (61.5%-100%), but insensitive (5.9%-29.4%). Similarly, the imaging components of the CCD were highly specific (69.2-100%) but lacked sensitivity (0-56.7%). Similar values were found when using ‘Definite TBM’ or ‘Probable TBM’ as a gold standard. DISCUSSION: The fair to moderate inter-rater agreement and poor sensitivities of the criteria for BME suggest that little reliance should be placed in these features in isolation. While the presence of the CCD criteria of acute infarction or tuberculoma(s) appears useful as rule-in criteria, their absence is of little help in excluding TBM. The CCD and criteria for BME, as well as any new criteria, need to be standardized and validated in prospective cohort studies.en_ZA
dc.identifier.apacitationBotha, H., Ackerman, C., Candy, S., Carr, J. A., Griffith-Richards, S., & Bateman, K. J. (2012). Reliability and diagnostic performance of CT imaging criteria in the diagnosis of tuberculous meningitis. <i>PLoS One</i>, http://hdl.handle.net/11427/14826en_ZA
dc.identifier.chicagocitationBotha, Hugo, Christelle Ackerman, Sally Candy, Jonathan A Carr, Stephanie Griffith-Richards, and Kathleen J Bateman "Reliability and diagnostic performance of CT imaging criteria in the diagnosis of tuberculous meningitis." <i>PLoS One</i> (2012) http://hdl.handle.net/11427/14826en_ZA
dc.identifier.citationBotha, H., Ackerman, C., Candy, S., Carr, J. A., Griffith-Richards, S., & Bateman, K. J. (2012). Reliability and diagnostic performance of CT imaging criteria in the diagnosis of tuberculous meningitis. PloS one, 7(6), e38982. doi:10.1371/journal.pone.0038982en_ZA
dc.identifier.ris TY - Journal Article AU - Botha, Hugo AU - Ackerman, Christelle AU - Candy, Sally AU - Carr, Jonathan A AU - Griffith-Richards, Stephanie AU - Bateman, Kathleen J AB - Introduction Abnormalities on CT imaging may contribute to the diagnosis of tuberculous meningitis (TBM). Recently, an expert consensus case definition (CCD) and set of imaging criteria for diagnosing basal meningeal enhancement (BME) have been proposed. This study aimed to evaluate the sensitivity, specificity and reliability of these in a prospective cohort of adult meningitis patients. METHODS: Initial diagnoses were based on the CCD, classifying patients into: ‘Definite TBM’ (microbiological confirmation), ‘Probable TBM’ (diagnostic score ≥10), ‘Possible TBM’ (diagnostic score 6-9), ‘Not TBM’ (confirmation of an alternative diagnosis) or ‘Uncertain’ (diagnostic score of <6). CT images were evaluated independently on two occasions by four experienced reviewers. Intra-rater and inter-rater agreement were calculated using the kappa statistic. Sensitivities and specificities were calculated using both ‘Definite TBM’ and either ‘Definite TBM’ or ‘Probable TBM’ as gold standards. RESULTS: CT scan criteria for BME had good intra-rater agreement (κ range 0.35-0.78) and fair to moderate inter-rater agreement (κ range 0.20-0.52). Intra- and inter-rater agreement on the CCD components were good to fair (κ  =  ranges 0.47-0.81 and 0.21-0.63). Using ‘Definite TBM’ as a gold standard, the criteria for BME were very specific (61.5%-100%), but insensitive (5.9%-29.4%). Similarly, the imaging components of the CCD were highly specific (69.2-100%) but lacked sensitivity (0-56.7%). Similar values were found when using ‘Definite TBM’ or ‘Probable TBM’ as a gold standard. DISCUSSION: The fair to moderate inter-rater agreement and poor sensitivities of the criteria for BME suggest that little reliance should be placed in these features in isolation. While the presence of the CCD criteria of acute infarction or tuberculoma(s) appears useful as rule-in criteria, their absence is of little help in excluding TBM. The CCD and criteria for BME, as well as any new criteria, need to be standardized and validated in prospective cohort studies. DA - 2012 DB - OpenUCT DO - 10.1371/journal.pone.0038982 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2012 T1 - Reliability and diagnostic performance of CT imaging criteria in the diagnosis of tuberculous meningitis TI - Reliability and diagnostic performance of CT imaging criteria in the diagnosis of tuberculous meningitis UR - http://hdl.handle.net/11427/14826 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14826
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0038982
dc.identifier.vancouvercitationBotha H, Ackerman C, Candy S, Carr JA, Griffith-Richards S, Bateman KJ. Reliability and diagnostic performance of CT imaging criteria in the diagnosis of tuberculous meningitis. PLoS One. 2012; http://hdl.handle.net/11427/14826.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDivision of Radiologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2012 Botha et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherComputed axial tomographyen_ZA
dc.subject.otherHydrocephalusen_ZA
dc.subject.otherDiagnostic medicineen_ZA
dc.subject.otherInfarctionen_ZA
dc.subject.otherMeningitisen_ZA
dc.subject.otherCharge-coupled devicesen_ZA
dc.subject.otherCerebrospinal fluiden_ZA
dc.subject.otherTuberculosisen_ZA
dc.titleReliability and diagnostic performance of CT imaging criteria in the diagnosis of tuberculous meningitisen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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