Revolutionizing Tuberculosis Detection: High-resolution CT as a Game-Changer in Public Health Surveillance and Early Case Finding

Abstract

Background: Tuberculosis (TB) remains a global health challenge, with conventional chest X-ray (CXR) and immunological assays often failing to detect early or atypical disease. High-resolution computed tomography (HRCT) may help close this diagnostic gap. Methods: A retrospective study was conducted to compare the diagnostic performance of HRCT, CXR, and interferon-gamma release assays (IGRAs: T-SPOT.TB and QuantiFERON-TB Gold) in individuals with suspected TB. Sensitivity, specificity, concordance (kappa statistics), and detection overlap were analyzed. Results: The HRCT identified abnormalities in 58.3% of T-SPOT-positive and 56.9% of QuantiFERON-positive cases, outperforming CXR, which detected 41.6% and 39.2%, respectively. Although CXR demonstrated slightly higher sensitivity (85% vs. 80%), HRCT showed better specificity (85% vs. 80%) and predictive values. Notably, HRCT alone detected 16.7% of TB cases compared with 13.9% by CXR alone. No case was diagnosed by IGRA alone without radiological correlation. Conclusions: The HRCT provides superior diagnostic precision compared with CXR and IGRAs, especially in patients with positive IGRA but normal CXR. Integrating HRCT into TB diagnostic algorithms could improve early detection, reduce missed cases, and strengthen public health surveillance.