Preoperative Chest Computed Tomography Screening for Coronavirus Disease 2019 in Asymptomatic Patients Undergoing Cardiac Surgery

Commentary: Preoperative Screening CT: Not Ready for Primetime in The COVID-19 Era

“… 9 Other limitations include the low number of patients, variable use of RT-PCR, and protocol deviation in 25% of patients with a “positive” CT. Despite these shortcomings, the results reported by Knol and colleagues 2 are consistent with those of a recent meta-analysis which showed a good sensitivity of chest CT but low specificity, and a low PPV (1.5–48.8%), which in turn is influenced by prevalence (lower PPV in low-prevalence areas). 10 In contrast, the PPV of RT-PCR was much higher (47.3–98.3%).…”

“… 11 , 12 Thoracic CT screening appears to be valuable in differentiating COVID-19 from viral pneumonitis not related to COVID-19. 13 The findings of Knol and colleagues 2 lend further support to current guidelines 14 which recommend that thoracic CT should not be performed as a COVID-19 screening tool, but order to assess potential pulmonary involvement in light of clinical history, the presence of symptoms, and the results of SARS-CoV-2 RT-PCR. Further studies are needed to investigate the diagnostic and prognostic values of preoperative chest CT in patients referred for cardiac surgery who could have developed pulmonary sequelae after recovering from COVID-19.…”

“…In this issue of the journal, Knol and colleagues 2 reported the results of a prospective observational study in which they evaluated the role of preoperative thoracic computed tomography: (CT) to screen patients scheduled for cardiac surgery and asymptomatic for COVID-19. Among the 109 patients who underwent CT the day before surgery, abnormal findings, evaluated using a specific grading system (CO-RADS score), were observed in n = 8 (7.3%).…”

“…However, the utility of chest CT in the screening of asymptomatic patients remains controversial, due to the fact that characteristic imaging features of COVID-19 have been shown to be time-related, and nearly 60% of patients will have a normal CT study during the early phase after the onset of symptoms. 7 , 8 Of note, the scoring system used in the study by Knol and colleagues 2 was primarily devised in order to assess pulmonary involvement in patients with at least moderate COVID-19-related symptoms. 9 Other limitations include the low number of patients, variable use of RT-PCR, and protocol deviation in 25% of patients with a “positive” CT.…”

Commentary: Do radiological findings play a role in the screening of COVID-19 in patients undergoing cardiac surgery?

“…In this issue of the journal, Knol and colleagues shed the light on the potential role of screening Chest-CT in identifying latent COVID-19 infection in 109, low-risk, asymptomatic individuals undergoing cardiac surgery in Erasmus Medical Center, Netherlands. 5 The authors used the CO-RADs Chest-CT scoring system that was developed by the Dutch radiological society to identify radiological findings suspicious for COVID-19 infection. Radiological findings suspicious for COVID-19 infection were found in 8 patients (7%).…”