Radiological Differentiation of Multi-Drug Resistant and Drug-Sensitive Tuberculosis Using Chest X-Rays

Abstract

Background: Tuberculosis continues to pose a significant global health challenge, with increasing incidence of multidrug-resistant TB (MDR-TB). Radiological features have the potential to distinguish MDR-TB from drug-sensitive TB (DS-TB). Early radiographic identification facilitates timely diagnosis and treatment, particularly in resource-limited settings. Objective: To compare chest X-ray findings between cases of multidrug-resistant TB (MDR-TB) and drug-sensitive TB (DS-TB). Methodology: This retrospective comparative study included 240 pulmonary TB patients (120 with MDR-TB and 120 with DS-TB). Chest X-rays were assessed for lesion size, cavitation, consolidation, and non-parenchymal changes. Findings were compared between groups based on lung zones and cavity characteristics. Data analysis was performed using SPSS, with p < 0.05 considered statistically significant. Results: Patients with MDR-TB exhibited a higher prevalence of large lesions (93.3%) and multiple cavities (68.3%). Consolidation and fibrosis were more frequently observed in MDR-TB, whereas infiltrates were predominant in DS-TB. The upper lung zones were primarily affected in MDR-TB, often with extensive bilateral involvement. Non-parenchymal features such as pleural thickening and tracheal deviation occurred more frequently in MDR-TB. Conclusion: Chest X-rays demonstrate distinct radiographic patterns in MDR-TB compared to DS-TB. The presence of large lesions, multiple cavitations, and chronic fibrotic changes is suggestive of drug resistance. Recognition of these radiological differences can facilitate early suspicion of MDR-TB. Radiographic assessment continues to be a valuable tool for TB evaluation, particularly in low-resource settings.