The accuracy of Aziza’s scoring system in limited slice non-enhanced thoracic CT for the diagnosis of adult pulmonary tuberculosis

  • Aziza Icksan Department of Radiology, Persahabatan Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta
  • Arif Faisal Department of Radiology, Faculty of Medicine, University of Gadjahmada, Yogyakarta
  • Elisna Syahruddin Department of Pulmonology, Faculty of medicine, Universitas Indonesia, Persahabatan Hospital, Jakarta
Keywords: adult PTB, limited slice non-enhanced thoracic CT, Aziza’s scoring system
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Background: Tuberculosis (TB) is still a major cause of morbidity and mortality in Indonesia. Thus, a fast and accurate method in diagnosing pulmonary TB (PTB) is needed, especially in adult smear-negative-TB cases. The purpose of this study was to determine the accuracy of a novel scoring system (Aziza’s score) using clinical data and characteristic abnormalities that are found in the limited slice non-enhanced thoracic CT.

Methods: This was a prospective cross-sectional study. A limited slice non-enhanced thoracic CT was performed to establish a diagnosis of PTB in patients with suspected PTB and to assess the diagnostic value of the scoring system. A reference standard used in this study was the clinical expertise of two pulmonologists. The scoring system was analyzed using bivariate and multivariate Cox regression analysis.

Results: 84 of 130 suspected PTB patients were diagnosed as PTB. They were diagnosed based on pulmonary characteristic abnormalities that were found in the limited slice non-enhanced thoracic CT. The scoring system was analyzed using bivariate and multivariate Cox regression analysis. The total scores which were equal to or more than 29 could diagnose PTB with the accuracy of 96.1% (95% CIs=91.3–98.3), sensitivity of 96.5% (95% CIs=90.1–98.8), and specificity of 95.6% (95% CIs=90.1–98.8), This novel scoring method was name as an Aziza’s scoring system.

Conclusion: Aziza’s scoring system performed in the limited slice non-enhanced thoracic CT has a higher accuracy compared to the reference standard for the diagnosis of adult PTB.


  1. [Internet]. Rencana aksi nasional programmatic management of drug resistence TB pengendalian TB Indonesia: 2011–2014 [update March 2011; cited 2012 Sept]. p. 1-5. Indonesian. Available from:

  2. Yadav C, Gupta A, Tiwari A, Musale P. Role of imaging in management of pulmonary tuberculosis. J Evol Med Dent Sci. 2013;2(20):3457–71.

  3. Siddiqi K, Walley J, Khan MA, Shah K, Safdar N. Clinical guidelines to diagnose smear-negative pulmonary tuberculosis in Pakistan, a country with low-HIV prevalence. Trop Med Int Health. 2006;11(3):323–31.

  4. Pai M, Ramsay A, O'Brien R. Evidence-based tuberculosis diagnosis. PLoS Med. 2008;5(7):1–7.

  5. Icksan A, Luhur R. Radiologi toraks TB paru, 1st ed. Pradana A, ed. Jakarta: CV Sagung Seto; 2008. p. 20–44. Indonesian.

  6. [Internet]. Handbook for using the international standards for tuberculosis care (ISTC): Diagnosis and treatment public health, tuberculosis coalition for technical assistance (TBCTA) [update March 2007; cited 2012 May]. Available from:

  7. Yeh JJ, Chen SC, Teng WB, Chou CH, Hsieh SP, Lee TL, et al. Identifiying the most infectious lesions in pulmonary tuberculosis by high-resolution multi-detector computed tomography. Eur Radiol. 2010;20(9):2135–45.

  8. Karam MB, Masjedi MR, Fadaizadeh L, Dokouhaki P, Tahery SA, Tabatabaii SJ, et al. Role of HRCT in diagnosing active pulmonary tuberculosis. National Research Institute of tuberculosis and lung disease, Maseeh Daneshvary Hospital Teheran; Iran. 2012 [Internet]. [cited 2012 Mei 13]. Available from:

  9. Nam KJ, Jeong YJ, Kim YD, Kim K-II, Lee JW, Park HK, et al. Chronic destructive pulmonary tuberculosis: assessment of disease activity by computed tomography. Actaradiologica. 2012;53(9):1014–9.

  10. Khodabakhshi, Asali A, Behnampour N, Abbasi A, Adel Barkhordar AR, Hashemi Frad A. Diagnostic value of high resolution computed tomographic scan in active pulmonary tuberculosis. J Gorgan Univ Med Sci. 2013;14(4):70–5.

  11. Shaarrawy H, Zeidan M, Nasr A, Nouh M. Assessment of the role of high resolution computed tomography in the diagnosis of suspected sputum smear negative active pulmonary TB. Egyptian J Chest Dis Tuberculosis. 2013;62(2):263–8.

  12. Feng F, Shi YX, Xia GL, Zhu Y, Lu HZ, Zhang ZY. Computed tomography in predicting smear-negative pulmonary tuberculosis in AIDS patients. Chin Med J. 2013;126(17):3228–33.

  13. Yoon JY, Lee IJ, Im HJ, Lee K, Lee Y, Bae SH. CT findings in apical versus basal involvement of pulmonary tuberculosis. Diagn Interv Radiol. 2013;19(2):85–90. DOI: 10.4261/1305-3825.DIR.6025-12.3

  14. Kachelriess M, Schaller S, Kalender WA. Strategies for dose reduction and improved image quality in MSCT in multi detector row CT of the thorax. 3rd ed. Berlin: Springer-verlag Heidelberg; 2004. p. 35–45.

  15. Kalra MK. MDCT radiation dose in MDCT a practical approach book. 1st ed. Italia: Springer verlag; 2006. p. 30–8.

  16. Horie T, Lien LT, Tuan LA, Tuan PL, Sakurada S, Yanai H, et al. A survey of tuberculosis prevalence in Hanoi, Vietnam. Int J Tuberc Lung Dis. 2007;11(5):562–6.

  17. Rasuna V. Pengamatan hasil akhir pengobatan TB paru BTA negative baru di RS Persahabatan Jakarta, Indonesia. [thesis]. Jakarta: Universitas Indonesia; 2008. p. 22-35. Indonesian.

  18. Icksan A, Maryastuti. Karakteristik lesi foto toraks pada TB paru BTA negatif dengan kultur negative dan kultur positif di RSUP Persahabatan Jakarta. Buletin Ilmiah Radiologi. 2014;2(1):80–9. Indonesian.

  19. [Internet]. Global Tuberculosis Report USA [update June 2014; cited 2015 Sept] Available from:

  20. den Boon S, van Lill SW, Borgdorff MW, Verver S, Bateman ED, Lombard CJ, et al. Association between smoking and tuberculosis infection: a population survey in a high tuberculosis incidence area. Thorax. 2005;60(7):555–7.

  21. den Boon S, White NW, van Lill SW, Borgdorff MW, Verver S, Lombard CJ, et al. An evaluation of symptom and chest radiographic screening in tuberculosis prevalence survey. Int J Tuberc Lung Dis. 2006;10(8):876–82.

  22. Whiting P, Rutjes Anne AW, Reitsma JB, Bossuyt PM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Method. 2003;3:25.

  23. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, et al. The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Ann Intern Med. 2003;138(1):1–23.

How to Cite
Icksan A, Faisal A, Syahruddin E. The accuracy of Aziza’s scoring system in limited slice non-enhanced thoracic CT for the diagnosis of adult pulmonary tuberculosis. Med J Indones [Internet]. 2017May16 [cited 2024May29];26(1):40-6. Available from:
Clinical Research