Coronavirus Disease 2019: Initial Detection on Chest CT in a Retrospective Multicenter Study of 103 Chinese Patients

Abstract

statement: In patients suspected of having COVID-19, the initial chest CT showed high sensitivity, but low specificity. Key Results:(1) The sensitivity, specificity, positive predictive value, and negative predictive value (with 95% confidence intervals) were 93% (85-97%), 53% (27-77%), 92% (83-96%), 42% (18-70%), respectively. Similar results were shown in both geographic regions studied.(2) There were no significant differences in the distribution of positive rates of tests in the two geographic regions between CT (P=0.423) and reverse transcription polymerase chain reaction testing (P=0.931). AbbreviationsPPV= positive predictive value (PPV) NPV= negative predictive value (NPV) 95% CI=95% confidence interval RT-PCR = reverse transcription polymerase chain reaction CT=computed tomography (CT) Abstract Background: Coronavirus disease 2019 (COVID-19) is a new viral respiratory disease that has recently emerged from China, becoming a pandemic. However, few studies have analyzed 3data regarding the clinical performance of chest computed tomography (CT) obtained in subjects with suspected COVID-19 at the initial presentation to medical facilities. Objective:The purpose of the present study was to evaluate the performance of chest CT the initial presentation of patients with suspected COVID-19.Methods: Data from 103 patients who were under investigation for COVID-19 based on inclusion criteria according to WHO Interim Guidance were retrospectively collected from January 21, 2020 to February 14, 2020. All patients underwent chest CT scanning and reverse transcription polymerase chain reaction testing (RT-PCR) for COVID-19 at hospital presentation. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) (with 95% confidence intervals) were calculated to evaluate the performance of CT. Subgroup analyses were also performed based on the geographical distribution of these cases in the province of Henan, China.Results: There were 88 /103 (85%) patients with COVID-19 confirmed by RT-PCR. The overall sensitivity, specificity, PPV, and NPV were 93% (85-97%), 53% (27-77%), 92% (83-96%), and 42% (18-70%), respectively. Similar results were shown in both geographic regions. The respective sensitivity, specificity, PPV, and NPV for chest CT in the districts of Xinyang and Zhumadian (n = 56) were 92% (80-97%), 63% (26-90%), 93% (81-98%), and 56% (23-85%), while these indicators in the district of Anyang (n = 47) were 95% (81-99%), 43% (12-80%), 90% (76-97%), and 60% (17-93%). There were no significant differences in the prevalence of positive exams in the two geographic subgroups for CT (P=0.423) or RT-PCR (P=0.931). 4Conclusion: Although initial chest CT obtained at hospital presentation showed high sensitivity in patients under investigation for COVID-19 in the two geographic regions in Henan province, the NPV was only modest, suggesting low value of CT as a screening tool.

Radiological Society of North America Expert Consensus Document on Reporting Chest CT Findings Related to COVID-19: Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA

“…Early reports of RT-PCR sensitivity vary considerably, ranging from 42% to 71% (26,27), and an initially negative RT-PCR may take up to 4 days to convert in a patient with COVID-19 (26). The reported sensitivities and specificities of CT for COVID-19 vary widely (60 to 98% and 25% to 53%, respectively) (26)(27)(28)(29), likely due to the retrospective nature of the currently published studies, including lack of strict diagnostic criteria for imaging and procedural differences for confirming infection. The positive and negative predictive value of chest CT for COVID-19 are estimated at 92% and 42%, respectively, in a population with high pretest probability for the disease (e.g., 85% prevalence by RT-PCR) (27).…”

“…The reported sensitivities and specificities of CT for COVID-19 vary widely (60 to 98% and 25% to 53%, respectively) (26)(27)(28)(29), likely due to the retrospective nature of the currently published studies, including lack of strict diagnostic criteria for imaging and procedural differences for confirming infection. The positive and negative predictive value of chest CT for COVID-19 are estimated at 92% and 42%, respectively, in a population with high pretest probability for the disease (e.g., 85% prevalence by RT-PCR) (27). The relatively low negative predictive value suggests that CT may not be valuable as a screening test for COVID-19 at least in earlier stages of the disease.…”

Differential Diagnosis in Patients with HRCT Patterns Suspected for COVID-19 Pneumonia and RT-PCR Negative: A Multidisciplinary Approach for an Appropriate Management

“…other types of viral pneumonia), which have the same imaging characteristics of COVID-19 pneumonia [15]. As evidence of this, several studies have demonstrated that the diagnostic performance of chest CT scan shows a wide margin of variability, with high sensitivity (93% [6] and 97% [7]) but with low speci city (53% [6] and 25% [7]) and therefore it is an investigation burdened by the problem of differential diagnosis with other respiratory diseases. Moreover, about half of patients diagnosed with COVID-19 pneumonia may have normal HRTC in the rst two days after onset of symptoms [16].…”

“…HRCT has a high sensitivity in detecting lesions (sensitivity range that varies between 93% [6] and 97% [7]) but low speci city (53% [6] and 25% [7]).…”

Acute Pulmonary Embolism In Non-Hospitalized Covid-19 Patients Referred To CTPA By Emergency Department

“…The diagnosis of COVID-19 is essential to limit the spread of the virus and is confirmed by RT-PCR (Reverse Transcriptase Polymerase Chain Reaction) SARS-CoV-2. The sensitivity of the RT-PCR test was evaluated between 42 and 71% [3][4]. Non-contrast chest CT has shown better sensitivity (up to 98%) than RT-PCR for the diagnosis of COVID-19 pneumonia [5].…”