Abstract
BackgroundAlthough typical and atypical CT image findings of COVID-19 are reported in current studies, the CT image features of COVID-19 overlap with those of viral pneumonia and other respiratory diseases. Hence, it is difficult to make an exclusive diagnosis.MethodsThirty confirmed cases of COVID-19 and forty-three cases of other aetiology or clinically confirmed non-COVID-19 in a general hospital were included. The clinical data including age, sex, exposure history, laboratory parameters and aetiological diagnosis of all patients were collected. Seven positive signs (posterior part/lower lobe predilection, bilateral involvement, rounded GGO, subpleural bandlike GGO, crazy-paving pattern, peripheral distribution, and GGO +/− consolidation) from significant COVID-19 CT image features and four negative signs (only one lobe involvement, only central distribution, tree-in-bud sign, and bronchial wall thickening) from other non-COVID-19 pneumonia were used. The scoring analysis of CT features was compared between the two groups (COVID-19 and non-COVID-19).ResultsOlder age, symptoms of diarrhoea, exposure history related to Wuhan, and a lower white blood cell and lymphocyte count were significantly suggestive of COVID-19 rather than non-COVID-19 (p < 0.05). The receiver operating characteristic (ROC) curve of the combined CT image features analysis revealed that the area under the curve (AUC) of the scoring system was 0.854. These cut-off values yielded a sensitivity of 56.67% and a specificity of 95.35% for a score > 4, a sensitivity of 100% and a specificity of 23.26% for a score > 0, and a sensitivity of 86.67% and a specificity of 67.44% for a score > 2.ConclusionsWith a simple and practical scoring system based on CT imaging features, we can make a hierarchical diagnosis of COVID-19 and non-COVID-19 with different management suggestions.
Highlights
Typical and atypical CT image findings of COVID-19 are reported in current studies, the CT image features of COVID-19 overlap with those of viral pneumonia and other respiratory diseases
Characteristics and clinical laboratory findings This retrospective study included 73 patients, of which 30 were confirmed as COVID-19 positive by real-time fluorescence polymerase chain reaction (RT-PCR), and 43 were classified as non-COVID-19 who were confirmed by RT-PCR as COVID-19-negative and positive for other pathogens or clinical treatment (Table 1)
The majority of the COVID-19 group had an exposure history related to Wuhan (n = 24, 80%) while most patients (n = 30, 69.8%) of non-COVID-19 group had no history of Hubei contact or cluster onset
Summary
Typical and atypical CT image findings of COVID-19 are reported in current studies, the CT image features of COVID-19 overlap with those of viral pneumonia and other respiratory diseases. The medical care for quarantined patients and isolation for people with whom they have had close contact requires larger public health surveillance and response systems with an enormous medical burden. Typical and atypical CT image findings are reported in several papers [2, 6,7,8,9,10,11,12,13,14,15], overlapping CT image features with viral pneumonia and other respiratory diseases make an exclusion diagnosis difficult. We attempted to develop a simple and practical method to stratify cases requiring different repetition times of RT-PCR to identify highly suspicious cases and highly excluded cases
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