Patients with RT-PCR-confirmed COVID-19 and Normal Chest CT

Abstract

helping medical staff members and radiologists around the world improve their understanding of this disease.CT can play a vital role in the early detection and management of COVID-19 (1,2). However, it is worth emphasizing that a patient with reverse-transcription polymerase chain reaction (RT-PCR) confirmed COVID-19 infection may have normal chest CT findings at admission. Bernheim et al (3) reported 20 (56%) of 36 patients imaged 0-2 days after symptom onset had normal CT findings. Fang et al (4) reported one of 51 (2%) patient imaged 3±3 days after symptom onset with normal CT scans. Ai et al (5) reported 21 of 601 (3%) RT-PCR positive patients with clinical symptoms had normal CT scans. In contrast, Pan et al (6) reported four of 21 (19%) patients with first normal CT had lung abnormalities on the follow-up CT approximately 4 days later. In our experience (7), of 17 of 149 (11.4%) symptomatic patients with normal chest CT on admission, 12 remained negative 10 days later with 2-3 follow-up CT examinations; the chest CT scans of the other five patients became positive over an average of 7 days. These reports confirm that a normal chest CT scan cannot exclude the diagnosis of COVID-19, especially for patients with early onset of symptoms.This copy is for personal use only. To order printed copies, contact reprints@rsna.org

A British Society of Thoracic Imaging statement: considerations in designing local imaging diagnostic algorithms for the COVID-19 pandemic

“…10 The use of CT as the main diagnostic tool for COVID-19 over and above RT-PCR in China has been subsequently challenged. 12 It is noteworthy that the fifth edition of the Diagnosis and Treatment Program of 2019 New Coronavirus Pneumonia proposed by The National Health Commission of China included chest CT findings as a diagnostic criterion, 13 but CT was removed in the more recent sixth and seventh versions, 14,15 reflecting the extremely dynamic nature of consensus opinion on this subject.…”

An alternative workflow for molecular detection of SARS-CoV-2 – escape from the NA extraction kit-shortage, Copenhagen, Denmark, March 2020

“…The newly emerged SARS-CoV-2 virus has challenged the global health system in every aspect including the ability to provide sufficient reagents for molecular diagnostic tests [3]. To overcome this shortening of supplies, computerised tomography (CT) scans of lungs have been used for diagnosis, with mixed results and risk of false-negatives especially during the early onsets of symptoms [6]. In a period when the shortage in diagnostic kits in China occurred, the Chinese health institutions resorted to diagnosing COVID-19 in patients based on clinical symptoms alone, which resulted in a major peak in the reported cases on 12 February 2020 [7].…”

Clinical Pathway for Early Diagnosis of COVID-19: Updates from Experience to Evidence-Based Practice

“…RT-PCR was positive in 59 to 78.2% of cases [5,6,61]. This assay may detect the viral RNA in the early stage of clinical symptoms even with negative CT findings [62]. Gene sequencing can identify SARS-CoV-2 accurately, but the major disadvantages are that it is very timeconsuming and expensive.…”