Radiological Semiotics of Different Types of Nontuberculous Pulmonary Mycobacterioses

   Objective: to determine, evaluate, and describe different radiological patterns of microbiologically identified nontuberculous pulmonary mycobacterioses (NTPM) based on multislice computed tomography data.
   Material and methods. The study included 102 patients with radiological signs of lung disease and different types of NTPM. Slowly growing types of NTPM were detected in 62 (60.8 %) patients, and rapidly growing NTPM – in 40 (39.2 %). The diagnosis was established considering a patient’s complaints, a specified case history, radiological and clinical laboratory data including microscopic studies of sputum from 63 (61.8 %) patients, bronchoalveolar lavage and different types of bronchial biopsies data from 19 (18.6 %) patients, samples of lung video-assisted thoracoscopic surgery from 17 (16.7%) patients, pleural fluid samples from 2 (1.9 %) patients, and oropharyngeal wash samples from 1 (1 %) patient. We used the Somatom Emotion 16 multislice computed tomograph (Siemens) and the high-resolution algorithm (HRCT) with 0.8 mm slice thickness and 1.5 mm slice increment.
   Results. The HRCT data were highly polymorphic and showed interstitial focal changes, different calibre bronchiectasis, conglomerates or cavities, involvements of vessels or pleural layers. In some patients, changes in the axial interstitium were accompanied by single small focal consolidations located either discretely or in small groups. Peribronchovascular spread of dissemination foci in NTPM was detected by HRCT as irregular infiltration of the axial interstitium (vasculitis type). Changes in the bronchial tree in NTPM were characterized by bronchiolitis symptoms (extensive thickening of bronchial walls, bronchioles) with development of the tree-in-bud sign predominantly in the subpleural lung regions. In some cases, bronchiectatic changes formed conglomerate consolidations of sublobular or lobular extent. Changes of the bronchial tree were detected by HRCT predominantly as signs of deforming bronchitis, cylindrical, varicose, or cystic bronchiectasis, either restricted or spread. Changes might be accompanied by single multi-dimensional cystic bronchiectatic cavities.
   Conclusion. Typical HRCT signs of NTPM are endobronchial and peribronchovascular spread of foci, development of multi-dimensional conglomerates, deforming bronchitis, bronchiectasis, and presence of single multi-dimensional cystic bronchiectatic cavities.

1. Литвинов В. И. Нетуберкулезные микобактерии, микобактериозы / В. И. Литвинов, Е. М. Богородская, С. Е. Борисова ; под ред. С. Е. Борисовой. – М.: Триада, 2014. – 254 с. [Litvinov V. I., Bogorodskaya E. M., Borisova S. E. (Eds). Non-tuberculosis mycobacteria, mycobacterioses. Мoscow: Triada; 2014: 254 pp (in Russ).]

2. Смирнова Т. Г. Мониторинг видового разнообразия нетуберкулезных микобактерий в ряде областей РФ с использованием ДНК-стрипов GenoType Mycobacterium CM/AS (Hain Lifescience, Германия) / Т. Г. Смирнова [и др.] // Туберкулез и болезни легких. – 2017. – 95 (5): 54–9. http://doi.org/10.21292/2075-1230-2017-95-5-54-59. [Smirnovа T. G., Аndreevskаya S. N., Lаrionovа E. E., et al. Monitoring of species diversity of non-tuberculosis mycobacteria in the some Russian regions using DNA-strips of genotype mycobacterium CM/AS (Hain Lifescience, Germany). Tuberculosis and Lung Diseases. 2017; 95 (5): 54–9 (in Russ). http://doi.org/10.21292/2075-1230-2017-95-5-54-59. ]

3. Izumi K., Morimoto K., Hasegawa N., et al. Epidemiology of adults and children treated for nontuberculous mycobacterial pulmonary disease in Japan. Ann Am Thorac Soc. 2019; 16 (3): 341–7. http://doi.org/10.1513/AnnalsATS.201806-366OC.

4. Эргешов А. Э. Нетуберкулезные микобактерии у пациентов с заболеваниями органов дыхания (клинико-лабораторное исследование) / А. Э. Эргешов [и др.] // Пульмонология. – 2016/ – 26 (3): 303–8. http://doi.org/10.18093/0869-0189-2016-26-3-303-308. [Ergeshov A. E., Shmelev E. I., Kovalevskaya M. N., et al. Nontuberculous mycobacteria in patients with respiratory diseases (a clinical study). Pulmonologiya. 2016; 26 (3): 303–8 (in Russ). http://doi.org/10.18093/0869-0189-2016-26-3-303-308. ]

5. Timpe A., Runyon E. H. The relationship of atypical acid-fast bacteria to human disease; a preliminary report. J Lab Clin Med. 1954; 44 (2): 202–9.

6. Griffith D. E., Aksamit T., Brown-Elliott B. A., et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007; 175 (4): 367–416. http://doi.org/10.1164/rccm.200604-571ST.

7. Соколина И. А. Имидж-диагностика микобактериозов легких / И. А. Соколина. – Consilium Medicum. – 2017. – 19 (3): 24–8. [Sokolina I. A. Imaging of pulmonary nontuberculous mycobacterial infection. Consilium Medicum. 2017; 19 (3): 24–8 (in Russ).]

8. Амансахедов Р. Б. Рентгеноморфологическая семиотика нетуберкулезных микобактериозов легких / Р. Б. Амансахедов [и др.] // Вестник рентгенологии и радиологии. – 2018. – 99 (4): 184–90. https://doi.org/10.20862/00424676-2018-99-4-184-190. [Amansakhedov R. B., Lepekha L. N., Dmitrieva L. I., et al. X-ray morphological semiotics of non-tuberculous mycobacterial pulmonary disease. Journal of Radiology and Nuclear Medicine. 2018; 99 (4): 184–90 (in Russ). https://doi.org/10.20862/00424676-2018-99-4-184-190. ]

9. Амансахедов Р. Б. Лучевая семиотика диссеминированного туберкулеза и микобактериозов легких / Р. Б. Амансахедов [и др.] // Вестник ЦНИИТ. – 2021. – 3: 61–70. URL: https://umj.usma.ru/jour/article/view/255/0 [Amansakhedov R. B., Dmitrieva L. I., Komissarova O. G., et al. Radiological signs of disseminated pulmonary TB and disseminated pulmonary mycobacterioses. CTRI Bulletin. 2021; 3: 61–70 (in Russ). URL: https://umj.usma.ru/jour/article/view/255/0 ]

10. Оттен Т. Ф. Микобактериоз / Т. Ф. Оттен, А. В. Васильев. – СПб.: Медицинская пресса, 2005. – 218 с. [Otten T. F., Vasiliev A. V. Mycobacteriosis. Saint Petersburg: Meditsinskaya pressa; 2005: 218 pp. (in Russ).]