Comparison of the Computed Tomography Findings in COVID-19 and Other Viral Pneumonia in Immunocompetent Adults: A Systematic Review and Meta-Analysis

Abstract

Background: As the coronavirus disease 2019 (COVID-19) present at chest computed tomography (CT) as other viral pneumonia, our purpose was to evaluate imaging features that could distinguish them. Methods: In this meta-analysis, MEDLINE, EMBASE, and Cochrane databases were searched through March 31, 2020. Studies were eligible if they had included immunocompetent adults with up to 14 days of viral pneumonia and described their chest CT findings. Subjects should have in a respiratory tract sample positive identification of COVID-19, adenovirus, influenza A, rhinovirus, parainfluenza, or respiratory syncytial virus. We included controlled or observational studies, and case series with more than ten patients. Studies were excluded if presence of immunocompromised and/or non-adults subjects; letters to the editor, reviews, or case series with less than ten patients; not in English. We calculated the pooled prevalences of the included variables and their corresponding 95% confidence intervals (95%CI). Findings: From 2263 studies identified, 33 were eligible for inclusion, with a total of 1930 patients (COVID, n=934; 48.4%; non-COVID, n=996; 51.6%). Frequent CT features for all viral pneumonia were a mixed pattern of ground-glass opacity (GGO) and consolidation (COVID-19, 0.37;0.17-0.56; non-COVID, 0.50;0.39-0.62). bilateral distribution (COVID, 0.81;0.77-0.85; non-COVID, 0.70;0.55-0.85), and presence in lower lobes (COVID, 0.88; 0.80-0.95; non-COVID, 0.66;0.50-0.82). COVID-19 pneumonia presented a higher prevalence GGO predominance (0.42;0.28-0.55; non-COVID 0.21;0.14-0.27), peripheral distribution (0.77;0.67-0.87), and involvement of upper (0.77;0.65-0.88) and middle lobes (0.61;0.47-0.76). Interpretation: Although COVID-19 might present a higher prevalence of GGO predominance, involvement of upper and middle lobes, and peripheral distribution, most CT findings overlap with other viral pneumonia. Thus, chest CT should not be encouraged as a first-line test for COVID-19 diagnosis in the general population. Funding Statement: None. Declaration of Interests: The authors declare no competing interests.