The Cochrane Systematic Review on Thoracic Imaging Tests for the Diagnosis of COVID-19.

Abstract

HomeRadiologyVol. 299, No. 3 Previous CommunicationsFree AccessLetters to the EditorRole of Imaging in Diagnosing COVID-19Lee Treanor, Nayaar Islam, Sanam Ebrahimzadeh, Matthew D. F. McInnes Lee Treanor, Nayaar Islam, Sanam Ebrahimzadeh, Matthew D. F. McInnes Author AffiliationsDepartment of Radiology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, 1053 Carling Ave, Ottawa Hospital Civic Campus, Room c159, Ottawa, ON, Canada K1Y 4E9e-mail: [email protected]Lee TreanorNayaar IslamSanam EbrahimzadehMatthew D. F. McInnes Published Online:Apr 13 2021https://doi.org/10.1148/radiol.2021210564MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack Citations ShareShare onFacebookTwitterLinked In Editor:We thank Dr Kanne and colleagues for their excellent review on the role of imaging in diagnosing COVID-19 pneumonia (1) published in-press online in February 2021 in Radiology. The authors state that there is limited use for CT chest in the diagnosis of COVID-19 pneumonia because of low specificity (1). They cite the initial version of the "living" Cochrane Database Systematic Review regarding the diagnostic accuracy of imaging tests for COVID-19, published in September 2020, which identified that chest CT had a specificity of 18.1% (95% CI: 3.71%, 55.8%) and a sensitivity of 86.2% (95% CI: 71.9%, 93.8%) (2).Because research on this topic is advancing rapidly, this "living" Cochrane Database Systematic Review will strive to keep pace with the evidence. The first update was published in November 2020 (3) and the second was published in March 2021 (4). Notably, the specificity of chest CT has increased substantially with unchanged sensitivity. In the latest update, the specificity of chest CT was 80.0% (95% CI: 74.9%, 84.3%) and the sensitivity was 87.9% (95% CI: 84.6%, 90.6%); estimates were derived from 41 studies and 16 133 participants (4). Possible explanations for improved specificity are better definitions for index test positivity (eg, scoring systems such as COVID-19 Report and Data System) and that studies conducted later in the pandemic have the benefit of improved knowledge about the disease (3). Additionally, in the latest update, chest radiography and chest US for the diagnosis of COVID-19 pneumonia were investigated (4). The specificity of chest radiography was 71.5% (95% CI: 59.8%, 80.8%) and the sensitivity was 80.6% (95% CI: 69.1%, 88.6%); estimates were derived from nine studies and 3694 participants (4). The specificity of chest US was 54.6% (95% CI: 35.3%, 72.6%) and the sensitivity was 86.4% (95% CI: 72.7%, 93.9%); estimates were derived from five studies and 466 participants (4).These findings should be considered in light of high or unclear risk of bias in many studies included in the review. We hope that future studies will prioritize methodologic rigor and transparent reporting. Furthermore, because there was a low number of included studies for chest radiography and US, future updates of the review will aim to increase the precision around the accuracy estimates for these imaging modalities.Disclosures of Conflicts of Interest: L.T. disclosed no relevant relationships. N.I. disclosed no relevant relationships. S.E. disclosed no relevant relationships. M.D.F.M. Activities related to the present article: disclosed research grant from the Government of Ontario Ministry of Health COVID-19 Rapid Response Program. Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships.