Efficacy of Chest CT for COVID-19 Pneumonia Diagnosis in France

Abstract

Background The role and performance of chest CT in the diagnosis of the coronavirus disease 2019 (COVID-19) pandemic remains under active investigation. Purpose To evaluate the French national experience using Chest CT for COVID-19, results of chest CT and RT-PCR were compared together and with the final discharge diagnosis used as reference standard. Materials and Methods A structured CT scan survey (NCT04339686) was sent to 26 hospital radiology departments in France between March 2 and April 24 2020. These dates correspond to the peak of the national COVID-19 epidemic. Radiology departments were selected to reflect the estimated geographical prevalence heterogeneities of the epidemic. All symptomatic patients suspected of having a COVID-19 pneumonia who underwent within 48 hours both initial chest CT and at least one RT-PCR testing were included. The final discharge diagnosis, based on multiparametric items, was recorded. Data for each center were prospectively collected and gathered each week. Test efficacy was determined by using Mann-Whitney Test, Student’s t-test, Chi-square test and Pearson’s correlation. A p value <.05 determined statistical significance. Results Twenty-six of 26 hospital radiology departments responded to the survey with 7500 patients entered; 2652 did not have RT-PCR results or had unknown or excess delay between RT-PCR and CT. After exclusions, 4824 patients (mean age 64, ± 19 yrs, 2669 males) were included. Using final diagnosis as the reference, 2564 of the 4824 patients were positive for COVID-19 (53%). Sensitivity, specificity, NPV and PPV of chest CT for diagnosing COVID-19 were 2319/2564 (90%, 95% confidence interval [CI]: 89, 91), 2056/2260 (91%, 95%CI: 91, 92%), 2056/2300 (89%, 95%CI; 87, 90%) and 2319/2524 (92%, 95%CI 91, 93%) respectively. There was no significant difference for chest CT efficacy among the 26 geographically separate sites, each with varying amounts of disease prevalence. Conclusion Use of chest CT for the initial diagnosis and triage of suspected COVID-19 patients was successful.

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“…Radiology has remained at the center of patient' care since the COVID-19 outbreak began. Chest computed tomography (CT) is sensitive at detecting COVID-19 pneumonia though specificities vary between studies, 1 2 and was used in the diagnosis of COVID-19 combined with clinico-epidermiological features in Wuhan where the use of reverse transcription-polymerase chain reaction (RT-PCR) is limited. 3 Chest radiograph is less sensitive than chest CT 4 5 but is useful to access the need for hospitalization in young to middle-aged patients, 6 and to predict progression to critical illness.…”

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“…Two are the major clinical impications of our study. First, due to its high sensitivity, CT has been proposed as the primary diagnostic tool in epidemic areas (13,40). Moreover, the WHO recommended chest imaging for the diagnostic workup of symptomatic patients with suspected COVID-19 if RT-PCR testing was unavailable or delayed or when initial RT-PCR testing was negative but patients had high clinical suspicion of COVID-19 (41).…”

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“…It was my pleasure to read the recently published article "Efficacy of Chest CT for Pneumonia in France" by Herpe and colleagues (1). The authors found no significant difference for sensitivity of chest CT among regions with varying disease prevalence and concluded that chest CT was used successfully in suspicious patients for COVID-19 pneumonia as an initial diagnostic tool.…”