Chest CT for Detecting COVID-19: A Systematic Review and Meta-Analysis of Diagnostic Accuracy

Abstract

OBJECTIVE: The purpose of this article was to perform a systematic review and meta- analysis regarding the diagnostic test accuracy of chest CT for detecting Coronavirus Disease 2019 (COVID-19).METHODS: PubMed, EMBASE, Web of Science and CNKI were searched up to March 12, 2020. We included studies providing information regarding diagnostic test accuracy of chest CT for COVID-19 detection. The methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies–2 tool. Sensitivity and specificity were pooled.RESULTS: Ten studies (n = 2657 patients) were included. The risks of bias in all studies were moderate in general. Pooled sensitivity was 93% (95% CI: 85 - 97%), and only one study reported specificity (25%, 95% CI:22-30%). There was substantial heterogeneity according to the Cochran Q test (p < 0.01) and Higgins I2 heterogeneity index (96% for sensitivity). After dividing the studies into two groups based on the study site, we found that the sensitivity of chest CT was great in Wuhan (the most affected city by the epidemic) and the sensitivity values were very close to each other (97%, 96% and 99%, respectively). In the regions other than Wuhan, the sensitivity varied from 69% to 98%.CONCLUSION: Chest CT offers the great sensitivity for detecting COVID-19, especially in region with severe epidemic situation. However, the specificity is low. In the context of emergency disease control, chest CT provide a fast, convenient and effective method to early recognize suspicious cases and might contribute to confine epidemic.

Chest X-ray in the emergency department during COVID-19 pandemic descending phase in Italy: correlation with patients’ outcome

“…In our opinion, a specificity of 83%, with a negative predictive value of 81%, although not high as those reported by Hare and not high as those reported for CT scans, reveal quite a good ability of CXR to rule out others cardiopulmonary affections mimicking COVID-19 at clinical presentation (Fig. 5 ) [ 8 , 21 , 22 ]. Our correlation of CXR findings with the final diagnosis of COVID-19 infection identified GGO, a peripheral and a diffuse distribution of lung alterations, as the ones highly related to COVID-19 final diagnosis ( P values < 0.001).…”

“…While the high diagnostic accuracy of chest CT in detecting COVID-19 alterations has already been evaluated, with a specificity ranging, according to different studies, from 95 to 99%, and a sensitivity varying from 61 to 98%, to our knowledge, only Hare and colleagues has evaluated CXR specificity [ 7 , 8 , 21 – 24 ]. They have showed, in their recent work, a CXR specificity of 100% and a sensitivity of 44% in diagnosing COVID 19 infection using the British Society of Thoracic Imaging issued guidelines for the categorization of chest radiographs [ 25 ].…”

Role of diagnostic imaging technologists during the COVID-19 pandemic: The importance of organization and planning in the first line

“… 1 Although reverse transcription-polymerase chain reaction (RT-PCR) in nasal and pharyngeal secretion samples is considered the test of choice for diagnosis, 2 radiological tests, especially chest X-ray and computed tomography (CT), are vitally important tools for the diagnosis, prognosis and monitoring of patients with COVID-19. 3 , 4 , 5 This demonstrates the validity and enormous usefulness of these techniques in the face of new diagnostic challenges.…”

“…As a result of the increase in specific demand and the resulting forced redistribution of the healthcare burden within the radiodiagnosis department, a reorganisation of technical resources and staff was needed. The prominent role of radiological tests in the diagnosis and follow-up of pneumonia 3 , 4 , 5 required a change in structure and work dynamics in which support for the Emergency Department, ICU and different wards admitting COVID-19 patients was prioritised. This led to the cancellation of tests considered non-essential in times of crisis (such as population-based breast cancer screening).…”

Papel del personal técnico superior en imagen para el diagnóstico durante la pandemia COVID-19: importancia de la organización y planificación en la primera línea

“…La radiología tiene un papel destacado dentro del manejo multidisciplinario de la enfermedad COVID-19 1 . Si bien la RT-PCR (reacción en cadena de la polimerasa) en muestras de secreción nasal y faríngea es considerada como prueba de elección para el diagnóstico 2 , las pruebas radiológicas, en especial la radiografía y la tomografía computarizada (TC) de tórax, son herramientas de vital importancia a la hora de realizar el diagnóstico, pronóstico y seguimiento del paciente con COVID-19 3 , 4 , 5 . Esto demuestra la vigencia y enorme utilidad de estas técnicas ante nuevos desafíos diagnósticos.…”