Abstract Rationale The Philippines ranks fourth globally in tuberculosis incidence with an estimated 739,000 cases and 37,000 deaths in 2023. A significant diagnostic challenge arises when patients cannot produce sputum, impeding TB GeneXpert testing and delaying treatment initiation, thereby increasing healthcare burden in resource-limited settings. Methods A retrospective cross-sectional analysis reviewed 667 records from a tertiary hospital in Cebu City (January 2020-December 2024). One hundred patients aged ≥18 years with complete sputum GeneXpert and chest Computed Tomography (CT) results were included. Exclusion criteria included prior anti-TB treatment, endobronchial TB without parenchymal involvement, and mimics of TB. Demographic data, comorbidities, and imaging findings were analyzed using Jamovi 2.4.7 (p 0.05 considered significant). Results Among 100 patients (33 GeneXpert-positive, 67 GeneXpert-negative), the mean age was 50-59 years with male predominance (62%). Tobacco smoking was more prevalent in positive patients (51.5% vs. 32.8%; p = 0.072). Hypertension (43%) was the most common comorbidity. Cavitation occurred significantly more in GeneXpert-positive patients (42.4% vs. 17.9%; p = 0.039), predominantly in upper lobes. Reticulonodular densities showed strong association with positivity (90.9% vs. 58.2%; p = 0.003). Selective lymphadenopathy patterns demonstrated robust correlation with active TB: precarinal (27.3% vs. 10.4%; p = 0.031), aortopulmonary/paraaortic (30.3% vs. 3.0%; p 0.001), and perivascular (18.2% vs. 4.5%; p = 0.024) lymphadenopathy were significantly more prevalent in positive patients. Pleural effusions (38%) and ground glass opacities (4%) showed no significant associations with GeneXpert status and lack diagnostic specificity. Conclusion This study demonstrates that specific chest CT findings, particularly cavitation and reticulonodular densities, exhibit significant correlation with GeneXpert positivity in pulmonary tuberculosis patients. Additionally, selective lymphadenopathy patterns—including precarinal, aortopulmonary/paraaortic, and perivascular involvement—strongly associate with molecular confirmation of active TB infection. Notably, these radiologic features provide valuable diagnostic adjuncts, particularly in patients with negative sputum production who cannot undergo conventional molecular testing. The upper lobar predominance of cavitary and reticulonodular lesions aligns with classical tuberculosis pathology, reinforcing the diagnostic utility of chest CT imaging. While features such as calcified nodules, fibrotic bands, and pleural effusions are common, they lack specificity for distinguishing active TB from inactive disease. These findings underscore the critical role of integrating chest CT imaging with molecular diagnostics to facilitate timely identification and treatment initiation of active pulmonary tuberculosis in resource-limited settings. In the Philippines’ high TB-burden context, leveraging radiologic patterns can bridge diagnostic gaps when sputum-based confirmation is unavailable, ultimately improving patient outcomes and reducing disease transmission. This abstract is funded by: None
Beldad et al. (Fri,) studied this question.