Imaging of possible tuberculosis: ACR Appropriateness Criteria
Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis (MTB). Tuberculosis generally affects the lungs, but can also affect other parts of the body. Most infections do not have symptoms, in which case it is known as latent tuberculosis. About 10% of latent infections progress to active disease which, if left untreated, kills about half of those infected. The classic symptoms of active TB are a chronic cough with blood-containing sputum, fever, night sweats, and weight loss. The historical term "consumption" came about due to the weight loss. Infection of other organs can cause a wide range of symptoms.
In 2016, ACR Appropriateness Criteria® imaging of possible tuberculosis has been issued by the American College of Radiology. Following are the major recommendations :
ACR Appropriateness Criteria®
Clinical Condition: Imaging of Possible Tuberculosis
Variant 1: Suspect active tuberculosis.
| Radiologic Procedure | Rating | Comments | RRL* |
| X-ray chest | 9 | ||
| CT chest without IV contrast | 7 | This procedure is recommended if x-ray is equivocal. | |
| CT chest with IV contrast | 6 | ||
| CT chest without and with IV contrast | 3 | ||
| MRI chest without IV contrast | 3 | O | |
| MRI chest without and with IV contrast | 3 | O |
| Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate | *Relative Radiation Level |
Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.
Variant 2: Newly positive PPD or IGRA OR positive PPD or IGRA with unknown prior status. No clinical symptoms.
| Radiologic Procedure | Rating | Comments | RRL* |
| X-ray chest | 9 | ||
| CT chest with IV contrast | 4 | ||
| CT chest without IV contrast | 3 | ||
| MRI chest without IV contrast | 2 | O | |
| MRI chest without and with IV contrast | 2 | O | |
| CT chest without and with IV contrast | 1 |
| Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate | *Relative Radiation Level |
Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.
Variant 3: PPD not available. Placement in group home or skilled nursing facility. No clinical symptoms.
| Radiologic Procedure | Rating | Comments | RRL* |
| X-ray chest | 9 | ||
| CT chest with IV contrast | 2 | ||
| CT chest without IV contrast | 2 | ||
| MRI chest without IV contrast | 2 | O | |
| CT chest without and with IV contrast | 1 | ||
| MRI chest without and with IV contrast | 1 | O |
| Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate | *Relative Radiation Level |
You can read the full Guideline by clicking on the link :
Ravenel JG, Chung JH, Ackman JB, de Grott PM, Johnson GB, Jokerst C, Maldonado F, McComb BL, Steiner RM, Mohammed TL, Expert Panel on Thoracic Imaging. ACR Appropriateness Criteria® imaging of possible tuberculosis. Reston (VA): American College of Radiology (ACR); 2016. 6 p. [22 references]
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