Thoracic imaging tests for the diagnosis of COVID-19

Abstract

Background Our March 2021 edition of this review showed thoracic imaging computed tomography (CT) to be sensitive and moderately specific in diagnosing COVID‐19 pneumonia. This new edition is an update of the review. Objectives Our objectives were to evaluate the diagnostic accuracy of thoracic imaging in people with suspected COVID‐19; assess the rate of positive imaging in people who had an initial reverse transcriptase polymerase chain reaction (RT‐PCR) negative result and a positive RT‐PCR result on follow‐up; and evaluate the accuracy of thoracic imaging for screening COVID‐19 in asymptomatic individuals. The secondary objective was to assess threshold effects of index test positivity on accuracy. Search methods We searched the COVID‐19 Living Evidence Database from the University of Bern, the Cochrane COVID‐19 Study Register, The Stephen B. Thacker CDC Library, and repositories of COVID‐19 publications through to 17 February 2021. We did not apply any language restrictions. Selection criteria We included diagnostic accuracy studies of all designs, except for case‐control, that recruited participants of any age group suspected to have COVID‐19. Studies had to assess chest CT, chest X‐ray, or ultrasound of the lungs for the diagnosis of COVID‐19, use a reference standard that included RT‐PCR, and report estimates of test accuracy or provide data from which we could compute estimates. We excluded studies that used imaging as part of the reference standard and studies that excluded participants with normal index test results. Data collection and analysis The review authors independently and in duplicate screened articles, extracted data and assessed risk of bias and applicability concerns using QUADAS‐2. We presented sensitivity and specificity per study on paired forest plots, and summarized pooled estimates in tables. We used a bivariate meta‐analysis model where appropriate. Main results We included 98 studies in this review. Of these, 94 were included for evaluating the diagnostic accuracy of thoracic imaging in the evaluation of people with suspected COVID‐19. Eight studies were included for assessing the rate of positive imaging in individuals with initial RT‐PCR negative results and positive RT‐PCR results on follow‐up, and 10 studies were included for evaluating the accuracy of thoracic imaging for imagining asymptomatic individuals. For all 98 included studies, risk of bias was high or unclear in 52 (53%) studies with respect to participant selection, in 64 (65%) studies with respect to reference standard, in 46 (47%) studies with respect to index test, and in 48 (49%) studies with respect to flow and timing. Concerns about the applicability of the evidence to: participants were high or unclear in eight (8%) studies; index test were high or unclear in seven (7%) studies; and reference standard were high or uncle...

Inter-rater Variability in the Evaluation of Lung Ultrasound on Videos Acquired from COVID-19 Patients

“…Easy-to-access and reliable diagnostic methods which can accurately guide management in COVID-19 are vital in nonhospital settings and areas with limited resources [5]. Some studies start to point out that LUS could be a first-line diagnostic tool alternative to conventional chest X-ray and CT scans since there is no exposure to ionizing radiation [4,6,13]. Moreover, it can be considered in vulnerable populations such as pregnant women and children.…”

“…LUS has the potential to refashion healthcare delivery and enables an augmented clinical interpretation of patient's status in real-time, which can have an immediate impact on clinical decisions, and even be used to monitor response to therapy and evolution [2][3][4]. Also, LUS devices are typically less expensive than conventional radiological equipment such as X-ray or computed tomography (CT) machines, making them ideal for locations with limited access to these resources [5,6].…”

“…As LUS allows doctors to examine COVID-19 patients at the bedside, even those who are in serious conditions, it has been a convenient method for detecting and monitoring lung involvement, as well as predicting admission to the intensive care unit (ICU) and mortality [3,4,7,11,12]. Furthermore, LUS reduces the risk of infection compared to other imaging modalities as these portable devices can be easily sanitized after the patient's examination [6,13]. However, LUS is an operator-dependent modality, and its utility depends on accurate acquisition and interpretation by bedside physicians [14][15][16][17].…”

Weight loss in patients with COVID-19 and Influenza in comorbidity with NCDs: a pilot prospective clinical trial

“…(66,67) Many radiology professional societies recommend against performing chest CT as a primary technique for the diagnosis of COVID pneumonia. (68) In patients with ARDs, CT findings should be interpreted in combination with a clinical context.…”

Revisiting Chest X-ray potency as a gold standard candidate for early screening of clinical diagnosis for COVID-19 infection

“…10,11 The appearance of pulmonary infiltration on the AP chest X-ray confirmed in patients with COVID-19 infection due to alveolar injury. [12][13][14] Several reports regarding the sensitivity of chest X-ray examinations are still controversial. Our findings show that some patients with COVID-19 infection who had PCR negative, exhibited the appearance of pneumonia.…”