Diagnostic Value of High-Resolution Computed Tomography Scan in COVID-19: Do We Need to Think Outside the Box?

Abstract

Background and objectiveThe ambiguous nature and high infectivity of the coronavirus disease 2019 (COVID-19) have caused soaring morbidity and mortality worldwide. Real-time polymerase chain reaction (RT-PCR) is preferred for detecting COVID-19. However, its poor sensitivity and the emerging use of high-resolution CT (HRCT) scan for disease severity make the use of RT-PCR quite obsolete. In light of this, our study aimed to explore the beneficial role of HRCT and compare the HRCT findings across various patient demographics and parameters. MethodsThis cross-sectional study included 100 patients with clinical suspicion of COVID-19. All patients underwent a chest HRCT scan preceded by RT-PCR testing. We used the CT severity score (CTSS) of the chest to calculate disease severity. Demographical data and results of radiological findings were tabulated and compared across RT-PCR positivity, age, and gender. Independent samples t-test and chi-square test were used to analyze the data. ResultsGlass ground opacity was the most prevalent finding in 99% of the patients, followed by lymph node involvement, consolidation, and crazy-paving pattern. Pleural effusion was observed in only 10% of the patients while pericardial effusion and hiatal hernia were present in 5%. In RT-PCR-positive patients, the posterior basal segment of the lower lobe of the right and left lungs were found to be dominantly involved; however, the upper and middle lobes of the right lung were more commonly involved than the left lung. The mean CTSS was significantly higher in patients aged above 50 years (p<0.001). The mean CTSS of RT-PCRnegative patients was higher than that of p=0.537). ConclusionRT-PCR has a limited role in the diagnosis of COVID-19. The HRCT scan can detect typical COVID-19 findings even in patients with negative RT-PCR results. Moreover, the use of HRCT scan in determining the disease severity and extent of lung damage can lead to a better assessment of critically ill patients.

Computed Tomography Severity Scoring on High-Resolution Computed Tomography Thorax and Inflammatory Markers With COVID-19 Related Mortality in a Designated COVID Hospital

“…The mean age in the current study was 51.69 ± 16.02 years, and most of the study participants were male. In comparison to the current study, Khan et al [ 15 ] found the mean age of the patients as 54.0 ± 14.0 years (range: 24-83 years). All the laboratory parameters like mean ferritin level, LDH levels, erythrocyte sedimentation rate, D-dimer, interleukin-6, and neutrophil-to-lymphocyte ratio were highly altered in the present study.…”

Diagnostic Accuracy of Right Bronchial Infiltration on Chest X-rays in Diagnosing COVID-19 Patients in the Early Stage of the Disease

“…This feature was reported in a recent study mentioning that the posterior basal segment of the right lower lobe was relatively more affected than the left (89.7% vs 64.2%). Adding further, apical (67.9% vs 46.2%), anterior (59.7% vs 48.7%) and posterior (85.9% vs 66.7%) of the upper lobe were more affected in the right side compared to the left [ 15 ].…”

“…It may begin early with reticular changes in the lungs but soon this progress to ground-glass opacities, crazy paving pattern, lobar and segmental involvement, mediastinal lymph node swelling and extra-pulmonary manifestations such as pericardial effusion [ 14 ]. However, the only drawback HRCT has is that the imaging modality is not as widely available in developing countries and depending on it for the final diagnosis leads to a lot of burden on healthcare [ 15 , 16 ]. Every single scan takes a certain amount of time and it cannot be as robust and quick as a chest X-ray (CXR).…”