Chest CT versus RT-PCR for the detection of COVID-19: systematic review and meta-analysis of comparative studies

Abstract

Objectives To compare the performance of chest computed tomography (CT) scan versus reverse transcription polymerase chain reaction (RT-PCR) as the reference standard in the initial diagnostic assessment of coronavirus disease 2019 (COVID-19) patients. Design A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A search of electronic information was conducted using the following databases: MEDLINE, EMBASE, EMCARE, CINAHL and the Cochrane Central Register of Controlled Trials. Setting Studies that compared the diagnostic performance within the same patient cohort of chest CT scan versus RT-PCR in COVID-19 suspected patients. Participants Thirteen non-randomised studies enrolling 4092 patients were identified. Main outcome measures Sensitivity, specificity and accuracy were primary outcome measures. Secondary outcomes included other test performance characteristics and discrepant findings between both investigations. Results Chest CT had a median sensitivity, specificity and accuracy of 0.91 (range 0.82–0.98), 0.775 (0.25–1.00) and 0.87 (0.68–0.99), respectively, with RT-PCR as the reference. Importantly, early small, China-based studies tended to favour chest CT versus later larger, non-China studies. Conclusions A relatively high false positive rate can be expected with chest CT. It is possible it may still be useful to provide circumstantial evidence, however, in some patients with a suspicious clinical presentation of COVID-19 and negative initial Severe Acute Respiratory Syndrome Coronavirus 2 RT-PCR tests, but more evidence is required in this context. In acute cardiorespiratory presentations, negative CT scan and RT-PCR tests is likely to be reassuring.

The Role of Community-Level Factors on Disparities in COVID-19 Infection Among American Indian/Alaska Native Veterans

“…Our dependent variable was an indicator of whether Veterans tested positive or negative for COVID-19 based on COVID-19 polymerase chain reaction tests from nasopharyngeal swab specimens measured between 3/1/2020 and 8/25/2020. This is considered the gold standard COVID-19 diagnostic test [ 31 ]. For individuals with multiple tests, individuals were considered positive for COVID-19 virus if any of their tests were positive, and negative if all their tests were negative.…”

The diagnostic performance of lung ultrasound for detecting COVID‐19 in emergency departments: A systematic review and meta‐analysis

“…2 The subgroup analysis results of the studies that used LCT along to a recently published meta-analysis that reports that the CT has pooled sensitivity of 91% (95% CI: 82%-98%) and specificity of 77.5% (95% CI: 25%-100%). 37 The LCT has greater pooled specificity than LUS that could be because LUS can illustrate only the peripheral lung areas. LUS only display the peripheral lung areas, which is 1/16 of lung size, and it is challenging to view pneumonia far from the pleura or apical area.…”

The Role of Ionizing Radiation for Diagnosis and Treatment against COVID-19: Evidence and Considerations

“…Comparing chest CT and RT-PCR assays for COVID-19 detection, Karam et al [82] carried out a comprehensive systematic review [82]. This review evaluated and presented data from 13 previously conducted comparative studies.…”

“…The authors concluded that 79.2% of patients who initially tested negative for COVID-19 (but later tested positive) had a CT scan indicative of COVID-19. They concluded that chest CT scans are capable of detecting the majority of RT-PCR diagnosed cases that initially tested negative and subsequently positive for COVID-19 [82]. Additionally, when compared to RT-PCR tests, low-dose chest CT demonstrated superior sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for COVID-19 diagnosis in emergency room patients, and especially in patients with clinical symptoms lasting more than 48 h. Disease likelihood increased from 43.2% (pre-test probability) to 91.1% or 91.4% (post-test probability) in patients with a positive CT result, while in patients with a negative CT result, the likelihood of disease was reduced to 9.6% or 3.7% for all patients or for those patients experiencing clinical symptoms for longer than 48 h [83].…”