reliability and diagnostic performance of ct imaging criteria in the diagnosis of tuberculous meningitis可靠性和诊断ct成像的性能标准的诊断结核性脑膜炎.pdfVIP

Reliability and Diagnostic Performance of CT Imaging Criteria in the Diagnosis of Tuberculous Meningitis 1 2 3 1 2 Hugo Botha , Christelle Ackerman , Sally Candy , Jonathan A. Carr , Stephanie Griffith-Richards , Kathleen J. Bateman1* 1 Division of Neurology, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape, South Africa, 2 Department of Radiodiagnostics, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape, South Africa, 3 Department of Radiology, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape, South Africa Abstract 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 (k range 0.35–0.78) and fair to moderate inter-rater agree