The role of CT imaging for management of COVID-19 in epidemic area: early experience from a University Hospital

Vikram Rao Bollineni,Nico Buls,Koenraad Hans Nieboer,Johan De Mey,Seema Döring

doi:10.1186/s13244-020-00957-5

Vikram Rao Bollineni, Nico Buls + Show 3 more

Open Access

https://doi.org/10.1186/s13244-020-00957-5

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Abstract

BackgroundTo evaluate the clinical value of the chest CT scan compared to the reference standard real-time polymerase chain reaction (RT-PCR) in COVID-19 patients.MethodsFrom March 29th to April 15th of 2020, a total of 240 patients with respiratory distress underwent both a low-dose chest CT scan and RT-PCR tests. The performance of chest CT in diagnosing COVID-19 was assessed with reference to the RT-PCR result. Two board-certified radiologists (mean 24 years of experience chest CT), blinded for the RT-PCR result, reviewed all scans and decided positive or negative chest CT findings by consensus.ResultsOut of 240 patients, 60% (144/240) had positive RT-PCR results and 89% (213/240) had a positive chest CT scans. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of chest CT in suggesting COVID-19 were 100% (95% CI: 97–100%, 144/240), 28% (95% CI: 19–38%, 27/240), 68% (95% CI: 65–70%) and 100%, respectively. The diagnostic accuracy of the chest CT suggesting COVID-19 was 71% (95% CI: 65–77%). Thirty-three patients with positive chest CT scan and negative RT-PCR test at baseline underwent repeat RT-PCR assay. In this subgroup, 21.2% (7/33) cases became RT-PCR positive.ConclusionChest CT imaging has high sensitivity and high NPV for diagnosing COVID-19 and can be considered as an alternative primary screening tool for COVID-19 in epidemic areas. In addition, a negative RT-PCR test, but positive CT findings can still be suggestive of COVID-19 infection.

Highlights

A novel coronavirus, named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), causes an acute respiratory infectious disease, which was recently found in humans, commonly known as Coronavirus disease (COVID)-19 [1]
We evaluated the value of the chest CT scan compared to the reference standard real-time polymerase chain reaction in COVID-19 patients at initial presentation
The specificity of the chest CT for COVID-19 patients may be underestimated considering relatively low sensitivity of the reference standard real-time polymerase chain reaction (RT-PCR) assay at baseline, a negative RT-PCR test, but positive CT findings are still highly suggestive of COVID-19 infection

Summary

Introduction

A novel coronavirus, named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), causes an acute respiratory infectious disease, which was recently found in humans, commonly known as COVID-19 [1]. Recent studies have shown that the CT imaging can demonstrate typical characteristic radiological findings such as multiple ground-glass opacities, patchy pulmonary consolidations and crazy-paving pattern, typically involving peripheral, sub-pleural and basal areas of the lung in COVID-19 patients [5, 7, 8]. To this end, a chest CT scan may aid a faster diagnosis of COVID-19 and assess the severity of the disease. We evaluated the value of the chest CT scan compared to the reference standard real-time polymerase chain reaction in COVID-19 patients at initial presentation. To evaluate the clinical value of the chest CT scan compared to the reference standard real-time polymerase chain reaction (RT-PCR) in COVID-19 patients

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