BACKGROUND: Only limited evidence has been available to date on the accuracy of systematic low-dose chest computed tomography (LDCT) use in the diagnosis of COVID-19 in patients with non-specific clinical symptoms. METHODS: The COVID-19 Imaging Registry Study Aachen (COVID-19-Bildgebungs-Register Aachen, COBRA) collects data on imaging in patients with COVID-19. Two of the COBRA partner hospitals (RWTH Aachen University Hospital and Dueren Hospital) systematically perform reverse transcriptase polymerase chain reaction (RT-PCR) from nasopharyngeal swabs as well as LDCT in all patients presenting with manifestations that are compatible with COVID-19. In accordance with the COV-RADS protocol, the LDCT scans were prospectively evaluated before the RT-PCR findings were available in order to categorize the likelihood of COVID-19. RESULTS: From 18 March to 5 May 2020, 191 patients with COVID-19 manifestations (117 male, age 65 ± 16 years) underwent RT-PCR testing and LDCT. The mean time from the submission of the sample to the availability of the RT-PCR findings was 491 minutes (interquartile range [IQR: 276-1066]), while that from the performance of the CT to the availability of its findings was 9 minutes (IQR: 6-11). A diagnosis of COVID-19 was made in 75/191 patients (39%). The LDCT was positive in 71 of these 75 patients and negative in 106 of the 116 patients without COVID-19, corresponding to 94.7% sensitivity (95% confidence interval [86.9; 98.5]), 91.4% specificity [84.7; 95.8], positive and negative predictive values of 87.7% [78.5; 93.9] and 96.4% [91.1; 98.6], respectively, and an AUC (area under the curve) of 0.959 [0.930; 0.988]. The initial RT-PCR test results were falsely negative in six patients, yielding a sensitivity of 92.0% [83.4; 97.0]; these six patients had positive LDCT findings. 47.4% of the LDCTs that were negative for COVID-19 (55/116) exhibited pathological pulmonary changes, including infiltrates, that were correctly distinguished from SARS-CoV-2 related changes. CONCLUSION: In patients with symptoms compatible with COVID-19, LDCT can esablish the diagnosis of COVID-19 with comparable sensitivity to RT-PCR testing. In addition, it offers a high specificity for distinguishing COVID-19 from other diseases associated with the same or similar clinical symptoms. We propose the systematic use of LDCT in addition to RT-PCR testing because it helps correct false-negative RT-PCR results, because its results are available much faster than those of RT-PCRtesting, and because it provides additional diagnostic information useful for treatment planning regardless of the type of the infectious agent.
BACKGROUND: Only limited evidence has been available to date on the accuracy of systematic low-dose chest computed tomography (LDCT) use in the diagnosis of COVID-19 in patients with non-specific clinical symptoms. METHODS: The COVID-19 Imaging Registry Study Aachen (COVID-19-Bildgebungs-Register Aachen, COBRA) collects data on imaging in patients with COVID-19. Two of the COBRA partner hospitals (RWTH Aachen University Hospital and Dueren Hospital) systematically perform reverse transcriptase polymerase chain reaction (RT-PCR) from nasopharyngeal swabs as well as LDCT in all patients presenting with manifestations that are compatible with COVID-19. In accordance with the COV-RADS protocol, the LDCT scans were prospectively evaluated before the RT-PCR findings were available in order to categorize the likelihood of COVID-19. RESULTS: From 18 March to 5 May 2020, 191 patients with COVID-19 manifestations (117 male, age 65 ± 16 years) underwent RT-PCR testing and LDCT. The mean time from the submission of the sample to the availability of the RT-PCR findings was 491 minutes (interquartile range [IQR: 276-1066]), while that from the performance of the CT to the availability of its findings was 9 minutes (IQR: 6-11). A diagnosis of COVID-19 was made in 75/191 patients (39%). The LDCT was positive in 71 of these 75 patients and negative in 106 of the 116 patients without COVID-19, corresponding to 94.7% sensitivity (95% confidence interval [86.9; 98.5]), 91.4% specificity [84.7; 95.8], positive and negative predictive values of 87.7% [78.5; 93.9] and 96.4% [91.1; 98.6], respectively, and an AUC (area under the curve) of 0.959 [0.930; 0.988]. The initial RT-PCR test results were falsely negative in six patients, yielding a sensitivity of 92.0% [83.4; 97.0]; these six patients had positive LDCT findings. 47.4% of the LDCTs that were negative for COVID-19 (55/116) exhibited pathological pulmonary changes, including infiltrates, that were correctly distinguished from SARS-CoV-2 related changes. CONCLUSION: In patients with symptoms compatible with COVID-19, LDCT can esablish the diagnosis of COVID-19 with comparable sensitivity to RT-PCR testing. In addition, it offers a high specificity for distinguishing COVID-19 from other diseases associated with the same or similar clinical symptoms. We propose the systematic use of LDCT in addition to RT-PCR testing because it helps correct false-negative RT-PCR results, because its results are available much faster than those of RT-PCRtesting, and because it provides additional diagnostic information useful for treatment planning regardless of the type of the infectious agent.
Authors: Patricia A Carney; Jay Parikh; Edward A Sickles; Stephen A Feig; Barbara Monsees; Lawrence W Bassett; Robert A Smith; Robert Rosenberg; Laura Ichikawa; James Wallace; Khai Tran; Diana L Miglioretti Journal: Radiology Date: 2013-01-07 Impact factor: 11.105
Authors: Constantine A Raptis; Mark M Hammer; Ryan G Short; Amar Shah; Sanjeev Bhalla; Andrew J Bierhals; Peter D Filev; Michael D Hope; Jean Jeudy; Seth J Kligerman; Travis S Henry Journal: AJR Am J Roentgenol Date: 2020-04-16 Impact factor: 3.959
Authors: Victor M Corman; Olfert Landt; Marco Kaiser; Richard Molenkamp; Adam Meijer; Daniel Kw Chu; Tobias Bleicker; Sebastian Brünink; Julia Schneider; Marie Luisa Schmidt; Daphne Gjc Mulders; Bart L Haagmans; Bas van der Veer; Sharon van den Brink; Lisa Wijsman; Gabriel Goderski; Jean-Louis Romette; Joanna Ellis; Maria Zambon; Malik Peiris; Herman Goossens; Chantal Reusken; Marion Pg Koopmans; Christian Drosten Journal: Euro Surveill Date: 2020-01
Authors: Sanam Ebrahimzadeh; Nayaar Islam; Haben Dawit; Jean-Paul Salameh; Sakib Kazi; Nicholas Fabiano; Lee Treanor; Marissa Absi; Faraz Ahmad; Paul Rooprai; Ahmed Al Khalil; Kelly Harper; Neil Kamra; Mariska Mg Leeflang; Lotty Hooft; Christian B van der Pol; Ross Prager; Samanjit S Hare; Carole Dennie; René Spijker; Jonathan J Deeks; Jacqueline Dinnes; Kevin Jenniskens; Daniël A Korevaar; Jérémie F Cohen; Ann Van den Bruel; Yemisi Takwoingi; Janneke van de Wijgert; Junfeng Wang; Elena Pena; Sandra Sabongui; Matthew Df McInnes Journal: Cochrane Database Syst Rev Date: 2022-05-16
Authors: Tang Xiongfeng; Zhang Cheng; He Meng; Ma Chi; Guo Deming; Qi Huan; Chen Bo; Yang Kedi; Shen Xianyue; Wong Tak-Man; Lu William Weijia; Qin Yanguo Journal: Front Bioeng Biotechnol Date: 2022-06-28
Authors: Nayaar Islam; Sanam Ebrahimzadeh; Jean-Paul Salameh; Sakib Kazi; Nicholas Fabiano; Lee Treanor; Marissa Absi; Zachary Hallgrimson; Mariska Mg Leeflang; Lotty Hooft; Christian B van der Pol; Ross Prager; Samanjit S Hare; Carole Dennie; René Spijker; Jonathan J Deeks; Jacqueline Dinnes; Kevin Jenniskens; Daniël A Korevaar; Jérémie F Cohen; Ann Van den Bruel; Yemisi Takwoingi; Janneke van de Wijgert; Johanna Aag Damen; Junfeng Wang; Matthew Df McInnes Journal: Cochrane Database Syst Rev Date: 2021-03-16
Authors: Carlos Metz; Torben Rixecker; Sebastian Mang; André Becker; Alexander Maßmann; Sören L Becker; Cihan Papan; Barbara Gärtner; Frederik Seiler; Guy Danziger; Robert Bals; Philipp M Lepper Journal: Case Rep Pulmonol Date: 2021-05-29