Diagnostic value of chest computed tomography imaging for COVID-19 based on reverse transcription-polymerase chain reaction: a meta-analysis

Jing Liu,Jingzhe Liu,Yi Zhu,Yunxian Zhu,Xue Yang,Hongjun Li,Xiantao Zeng

doi:10.1186/s40249-021-00910-8

Abstract

BackgroundThe computed tomography (CT) diagnostic value of COVID-19 is controversial. We summarized the value of chest CT in the diagnosis of COVID-19 through a meta-analysis based on the reference standard.MethodsAll Chinese and English studies related to the diagnostic value of CT for COVID-19 across multiple publication platforms, was searched for and collected. Studies quality evaluation and plotting the risk of bias were estimated. A heterogeneity test and meta-analysis, including plotting sensitivity (Sen), specificity (Spe) forest plots, pooled positive likelihood ratio (+LR), negative likelihood ratio (-LR), dignostic odds ratio (DOR) values and 95% confidence interval (CI), were estimated. If there was a threshold effect, summary receiver operating characteristic curves (SROC) was further plotted. Pooled area under the receiver operating characteristic curve (AUROC) and 95% CI were also calculated.ResultsTwenty diagnostic studies that represented a total of 9004 patients were included from 20 pieces of literatures after assessing all the aggregated studies. The reason for heterogeneity was caused by the threshold effect, so the AUROC = 0.91 (95% CI: 0.89–0.94) for chest CT of COVID-19. Pooled sensitivity, specificity, +LR, -LR from 20 studies were 0.91 (95% CI: 0.88–0.94), 0.71 (95% CI: 0.59–0.80), 3.1(95% CI: 2.2–4.4), 0.12 (95% CI: 0.09–0.17), separately. The I2 was 85.6% (P = 0.001) by Q-test.ConclusionsThe results of this study showed that CT diagnosis of COVID-19 was close to the reference standard. The diagnostic value of chest CT may be further enhanced if there is a unified COVID-19 diagnostic standard. However, please pay attention to rational use of CT.Graphic

Highlights

The computed tomography (CT) diagnostic value of COVID-19 is controversial
Coronavirus disease 2019 (COVID-19) is an acute infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is primarily
The reference standard for diagnosing COVID-19 is reverse transcription-polymerase chain reaction (RTPCR) [10]; it suffers from numerous flaws, such as poor sensitivity [11], producing false negatives, etc., all of which have been noted in the studies [12, 13]

Summary

Introduction

The computed tomography (CT) diagnostic value of COVID-19 is controversial. We summarized the value of chest CT in the diagnosis of COVID-19 through a meta-analysis based on the reference standard. The reference standard for diagnosing COVID-19 is reverse transcription-polymerase chain reaction (RTPCR) [10]; it suffers from numerous flaws, such as poor sensitivity [11], producing false negatives, etc., all of which have been noted in the studies [12, 13]. A study indicated that RT-PCR was not a perfect reference standard [14]. What’s more, a succession of countries [15] had reported the discovery of COVID-19 variant strains, and the proportion is increasing. The most feared of the COVID-19 variants could accelerate the spread of the disease. Feng et al pointed out that the abundance of genomic data made it possible to reassess the applicability of RT-PCR to ensure that it was applicable to mutant strain [16]

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