Abstract
BackgroundChest CT scan has an important role in the diagnosis and management of COVID-19 infection. A major concern in radiologic assessment of the patients is the radiation dose. Research has been done to evaluate low-dose chest CT in the diagnosis of pulmonary lesions with promising findings. We decided to determine diagnostic performance of ultra-low-dose chest CT in comparison to low-dose CT for viral pneumonia during the COVID-19 pandemic.Results167 patients underwent both low-dose and ultra-low-dose chest CT scans. Two radiologists blinded to the diagnosis independently examined ultra-low-dose chest CT scans for findings consistent with COVID-19 pneumonia. In case of any disagreement, a third senior radiologist made the final diagnosis. Agreement between two CT protocols regarding ground-glass opacity, consolidation, reticulation, and nodular infiltration were recorded. On low-dose chest CT, 44 patients had findings consistent with COVID-19 infection. Ultra-low-dose chest CT had sensitivity and specificity values of 100% and 98.4%, respectively for diagnosis of viral pneumonia. Two patients were falsely categorized to have pneumonia on ultra-low-dose CT scan. Positive predictive value and negative predictive value of ultra-low-dose CT scan were respectively 95.7% and 100%. There was good agreement between low-dose and ultra-low-dose methods (kappa = 0.97; P < 0.001). Perfect agreement between low-dose and ultra-low-dose scans was found regarding diagnosis of ground-glass opacity (kappa = 0.83, P < 0.001), consolidation (kappa = 0.88, P < 0.001), reticulation (kappa = 0.82, P < 0.001), and nodular infiltration (kappa = 0.87, P < 0.001).ConclusionUltra-low-dose chest CT scan is comparable to low-dose chest CT for detection of lung infiltration during the COVID-19 outbreak while maintaining less radiation dose. It can also be used instead of low-dose chest CT scan for patient triage in circumstances where rapid-abundant PCR tests are not available.
Highlights
Chest Computed tomography (CT) scan has an important role in the diagnosis and management of COVID-19 infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Many medical centers adhered to the proposed strategy, and chest CT imaging was used for the triage of suspected patients
Ultra-low-dose chest CT is an accurate method with less radiation compared to low-dose CT to diagnose lung infiltrations during the COVID-19 pandemic in patients admitted for elective or semi-urgent medical/surgical procedures
Summary
Chest CT scan has an important role in the diagnosis and management of COVID-19 infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)[1]. Chest CT scan has an important role in the diagnosis and management of COVID-19 infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Chest CT was introduced as a highly sensitive method to screen for COVID-19 pneumonia [2]. A previous meta-analysis showed that chest CT scan has a pooled sensitivity of 94% and pooled specificity of 37% in the diagnosis of COVID-19 [3]. Low-dose CT scan is a promising method shown to have acceptable diagnostic accuracy in the diagnosis of COVID-19 pneumonia [4,5,6]. Lowdose chest CT was demonstrated to have a sensitivity of 86.7% and specificity of 93.6% for the diagnosis of COVID-19 [4]. Chest CT scan has an important role in the diagnosis and management of COVID-19 infection. We decided to determine diagnostic perfor‐ mance of ultra-low-dose chest CT in comparison to low-dose CT for viral pneumonia during the COVID-19 pandemic
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