Chest CT in patients suspected of COVID-19 infection: A reliable alternative for RT-PCR

Majidi, Hadi; Niksolat, Fatemeh

doi:10.1016/j.ajem.2020.04.016

Cited by 41 publications

(37 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The same mistake has also been made by other authors regarding the use of chest computed tomography (CT) scans as a diagnostic method. 6,7 In this situation, the best strategy would be to measure the degree of agreement (using the Kappa coefficient measures 8 ) between the two tests, i.e. neither of the two tests is considered to be the reference and therefore, any discrepancies could be linked to either of the tests.…”

Section: Dear Editormentioning

confidence: 99%

Should RT‐PCR be considered a gold standard in the diagnosis of COVID‐19?

Dramé

Teguo

Proye

et al. 2020

Journal of Medical Virology

179

146

View full text Add to dashboard Cite

To the Editor, To face the new coronavirus disease 2019 (COVID-19) pandemic, the need for early and accurate diagnosis of the disease among suspected cases quickly became obvious for effective management, and for better control of the spread of the disease in the population. Since the beginning of this disease epidemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), reverse transcriptase-polymerase chain reaction (RT-PCR) has routinely been used to confirm the diagnosis. However, several authors have pointed out the poor performance of this technique, particularly in terms of sensitivity. 1,2 Indeed, according to some authors, sensitivity could be as low as 38% 3 (ie, not better than chance). This made it necessary to find a more sensitive test, given the contagiousness of SARS-CoV-2. We, therefore, read with great interest the article published in your journal by Cassaniti et al. 4 This article deals with the diagnosis of COVID-19 by serology (immunoglobulin m/immunoglobulin G) as a complementary approach to RT-PCR to improve its sensitivity. According to Cassaniti et al 4 and Xiang et al, 5 serology is faster to implement, less expensive, easier to use, and more accessible to staff with no specific laboratory training. 5 The article describes the metrological performances of

show abstract

Section: Dear Editormentioning

confidence: 99%

Should RT‐PCR be considered a gold standard in the diagnosis of COVID‐19?

Dramé

Teguo

Proye

et al. 2020

Journal of Medical Virology

179

146

View full text Add to dashboard Cite

show abstract

“…However, these benefits must be balanced against the cost of CT, medical radiation dangers, or practical limitations in busy hospitals with hourly trauma and stroke arrivals and potentially time-dependent emergencies juxtaposed against advised CT shutdowns for COVID-19 cleaning requiring 30 or more minutes. 91,92 This cleaning time would also delay access to CT for every patient in the ED, thereby prolonging potential exposure to those in the ED to other patients with COVID-19. 92 Some propose that COVID-19 patients wear N95 masks and plastic bags over their heads to eliminate or reduce these cleaning times.…”

Section: Antigen Testsmentioning

confidence: 99%

“…91,92 This cleaning time would also delay access to CT for every patient in the ED, thereby prolonging potential exposure to those in the ED to other patients with COVID-19. 92 Some propose that COVID-19 patients wear N95 masks and plastic bags over their heads to eliminate or reduce these cleaning times. 27 Pragmatically, among those detected by CT no defined benefit, such as reduced mortality or faster resolution of COVID-19 symptoms has been described.…”

Section: Antigen Testsmentioning

confidence: 99%

Diagnosing COVID‐19 in the Emergency Department: A Scoping Review of Clinical Examinations, Laboratory Tests, Imaging Accuracy, and Biases

Carpenter

Mudd

West

et al. 2020

Academic Emergency Medicine

View full text Add to dashboard Cite

Objective Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) emerged as a global pandemic in early 2020 with rapidly evolving approaches to diagnosing the clinical illness called coronavirus disease (COVID‐19). The primary objective of this scoping review is to synthesize current research of the diagnostic accuracy of history, physical examination, routine laboratory tests, real‐time reverse transcription–polymerase chain reaction (rRT‐PCR), immunology tests, and computed tomography (CT) for the emergency department (ED) diagnosis of COVID‐19. Secondary objectives included a synopsis of diagnostic biases likely with current COVID‐19 research as well as corresponding implications of false‐negative and false‐positive results for clinicians and investigators. Methods A Preferred Reporting Items for Systematic Reviews and Meta‐Analyses–Scoping Review (PRISMA‐ScR)–adherent synthesis of COVID‐19 diagnostic accuracy through May 5, 2020, was conducted. The search strategy was designed by a medical librarian and included studies indexed by PubMed and Embase since January 2020. Results A total of 1,907 citations were screened for relevance. Patients without COVID‐19 are rarely reported, so specificity and likelihood ratios were generally unavailable. Fever is the most common finding, while hyposmia and hypogeusia appear useful to rule in COVID‐19. Cough is not consistently present. Lymphopenia is the mostly commonly reported laboratory abnormality and occurs in over 50% of COVID‐19 patients. rRT‐PCR is currently considered the COVID‐19 criterion standard for most diagnostic studies, but a single test sensitivity ranges from 60% to 78%. Multiple reasons for false‐negatives rRT‐PCR exist, including sample site tested and disease stage during which sample was obtained. CT may increase COVID‐19 sensitivity in conjunction with rRT‐PCR, but guidelines for imaging patients most likely to benefit are emerging. IgM and IgG serology levels are undetectable in the first week of COVID‐19, but sensitivity (range = 82% to 100%) and specificity (range = 87% to 100%) are promising. Whether detectable COVID‐19 antibodies correspond to immunity remains unanswered. Current studies do not adhere to accepted diagnostic accuracy reporting standards and likely report significantly biased results if the same tests were to be applied to general ED populations with suspected COVID‐19. Conclusions With the exception of fever and disorders of smell/taste, history and physical examination findings are unhelpful to distinguish COVID‐19 from other infectious conditions that mimic SARS‐CoV‐2 like influenza. Routine laboratory tests are also nondiagnostic, although lymphopenia is a common finding and other abnormalities may predict severe disease. Although rRT‐PCR is the current criterion standard, more inclusive consensus‐based criteria will likely emerge because of the high false‐negative rate of PCR tests. The role of serology and CT in ED assessments remains undefined.

show abstract

“…The differences of prior probabilities might affect the results in differential diagnosis by chest CT, caused by factors including the region COVID-19 prevalence 10 . Meanwhile, widespread CT screening would definitely increases burden on medical expenses and pose significant risk for hospital staffs 22 .…”

Section: Discussionmentioning

confidence: 99%

“…This was consistent with previous studies and clinical experiences. Majidi et al 22 did pooled analysis of chest CT manifestation with occurrence rate as follows: GGO 74%, bilateral distribution 76%, peripheral distribution 66%, consolidation 36%, pleural effusion 7%, crazy paving appearance 21%, lymphadenopathy 5%. However, the imaging findings reported for COVID-19 were similar to other virus pneumonia, including severe acute respiratory syndrome (SARS)-CoV and Middle East respiratory syndrome (MERS)-CoV 23 .…”

Section: Discussionmentioning

confidence: 99%

The performance of Chest CT and Its Imaging Features for Diagnosing Coronavirus Disease 2019: a Meta-analysis

Zhang

Zhao

et al. 2020

Preprint

View full text Add to dashboard Cite

Early diagnosis and isolation of cases are particularly crucial for coronavirus disease 2019 (COVID-19) in global pandemic. The aim of this study is to determine the diagnostic performance of chest computed tomography (CT) and imaging features for diagnosing COVID-19. Diagnostic accuracy studies of CT and RT-PCR in patients with clinically suspected COVID-19, which were published up to April 25th, 2020 from MEDLINE, EMBASE, and the Cochrane Library. Twelve studies (n=2,204) were included. The pooled sensitivity, specificity, likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) of chest CT for detecting COVID-19 were 94.5% (95% confidence interval (CI) 89.5 to 97.2%) and 41.8% (95% CI 24.2 to 61.6%), 1.6 (95% CI: 1.6-2.3), 0.13 (95% CI: 0.06-0.31), and 12.4 (95% CI: 4.0-38.5), respectively. Initial RT-PCR revealed a better diagnostic performance. Peripheral lesions, bilateral involvement, multiple lesions, and ground-glass opacities (GGO), revealed to be with better diagnostic value than other CT manifestations. Using chest CT for COVID-19 diagnosis has a high sensitivity and a relatively low specificity. Bilateral multiple peripheral lesions and GGO revealed to be with better diagnostic value. For areas with high prevalence, chest CT could be a good screening test to preliminary screen patients with COVID-19 quickly.

show abstract

Chest CT in patients suspected of COVID-19 infection: A reliable alternative for RT-PCR

Cited by 41 publications

References 18 publications

Should RT‐PCR be considered a gold standard in the diagnosis of COVID‐19?

Should RT‐PCR be considered a gold standard in the diagnosis of COVID‐19?

Diagnosing COVID‐19 in the Emergency Department: A Scoping Review of Clinical Examinations, Laboratory Tests, Imaging Accuracy, and Biases

The performance of Chest CT and Its Imaging Features for Diagnosing Coronavirus Disease 2019: a Meta-analysis

Contact Info

Product

Resources

About