The utility of chest computed tomography (CT) and RT-PCR screening of asymptomatic patients for SARS-CoV-2 prior to semiurgent or urgent hospital procedures

AbstractObjective:Presently, evidence guiding clinicians on the optimal approach to safely screen patients for coronavirus disease 2019 (COVID-19) to a nonemergent hospital procedure is scarce. In this report, we describe our experience in screening for SARS-CoV-2 prior to semiurgent and urgent hospital procedures.Design:Retrospective case series.Setting:A single tertiary-care medical center.Participants:Our study cohort included patients ≥18 years of age who had semiurgent or urgent hospital procedures or surgeries.Methods:Overall, 625 patients were screened for SARS-CoV-2 using a combination of phone questionnaire (7 days prior to the anticipated procedure), RT-PCR and chest computed tomography (CT) between March 1, 2020, and April 30, 2020.Results:Of the 625 patients, 520 scans (83.2%) were interpreted as normal; 1 (0.16%) had typical features of COVID-19; 18 scans (2.88%) had indeterminate features of COVID-19; and 86 (13.76%) had atypical features of COVID-19. In total, 640 RT-PCRs were performed, with 1 positive result (0.15%) in a patient with a CT scan that yielded an atypical finding. Of the 18 patients with chest CTs categorized as indeterminate, 5 underwent repeat negative RT-PCR nasopharyngeal swab 1 week after their initial swab. Also, 1 patient with a chest CT categorized as typical had a follow-up repeat negative RT-PCR, indicating that the chest CT was likely a false positive. After surgery, none of the patients developed signs or symptoms suspicious of COVID-19 that would indicate the need for a repeated RT-PCR or CT scan.Conclusion:In our experience, chest CT scanning did not prove provide valuable information in detecting asymptomatic cases of SARS-CoV-2 (COVID-19) in our low-prevalence population.

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Clinical outcomes of hemodialysis patients infected with severe acute respiratory syndrome coronavirus 2 and impact of proactive chest computed tomography scans

Clinical Kidney Journal ◽

10.1093/ckj/sfaa086 ◽

2020 ◽

Vol 13 (3) ◽

pp. 328-333 ◽

Cited By ~ 3

Author(s):

Rui Wang ◽

Hong He ◽

Cong Liao ◽

Hongtao Hu ◽

Chun Hu ◽

...

Keyword(s):

Computed Tomography ◽

Invasive Mechanical Ventilation ◽

Case Series ◽

Ground Glass Opacity ◽

High Sensitivity ◽

Chest Ct ◽

Maintenance Hemodialysis ◽

Rt Pcr ◽

Chest Computed Tomography ◽

Reactive Protein

Abstract Background Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that first manifested in humans in Wuhan, Hubei Province, China, in December 2019, and has subsequently spread worldwide. Methods We conducted a retrospective, single-center case series of the seven maintenance hemodialysis (HD) patients infected with COVID-19 at Zhongnan Hospital of Wuhan University from 13 January to 7 April 2020 and a proactive search of potential cases by chest computed tomography (CT) scans. Results Of 202 HD patients, 7 (3.5%) were diagnosed with COVID-19. Five were diagnosed by reverse transcription polymerase chain reaction (RT-PCR) because of compatible symptoms, while two were diagnosed by RT-PCR as a result of screening 197 HD patients without respiratory symptoms by chest CT. Thirteen of 197 patients had positive chest CT features and, of these, 2 (15%) were confirmed to have COVID-19. In COVID-19 patients, the most common features at admission were fatigue, fever and diarrhea [5/7 (71%) had all these]. Common laboratory features included lymphocytopenia [6/7 (86%)], elevated lactate dehydrogenase [3/4 (75%)], D-dimer [5/6 (83%)], high-sensitivity C-reactive protein [4/4 (100%)] and procalcitonin [5/5 (100%)]. Chest CT showed bilateral patchy shadows or ground-glass opacity in the lungs of all patients. Four of seven (57%) received oxygen therapy, one (14%) received noninvasive and invasive mechanical ventilation, five (71%) received antiviral and antibacterial drugs, three (43%) recieved glucocorticoid therapy and one (14%) received continuous renal replacement therapy. As the last follow-up, four of the seven patients (57%) had been discharged and three patients were dead. Conclusions Chest CT may identify COVID-19 patients without clear symptoms, but the specificity is low. The mortality of COVID-19 patients on HD was high.

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Evaluation of rapid antibody test and chest computed tomography results of COVID-19 patients: A retrospective study

10.1101/2021.02.15.21251772 ◽

2021 ◽

Author(s):

Ali Ozturk ◽

Taylan Bozok ◽

Tugce Simsek Bozok

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Antibody Test ◽

Chest Ct ◽

Rt Pcr ◽

Serum Samples ◽

Chest Computed Tomography ◽

Ct Data ◽

Chest Ct Scan ◽

Rapid Antibody

AbstractBackgroundThe coronavirus disease 2019 (COVID-19) continues to spread around the world. Therefore, rapid, simpler, and more accurate diagnostic tests are urgently needed to diagnose the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. The purpose of this study was to evaluate the SARS-CoV-2 IgM/ IgG rapid antibody test results in symptomatic patients with COVID-19 and their chest computed tomography (CT) data.MethodsA total of 320 patients admitted to our hospital for different durations due to COVID-19 were included in the study. Serum samples were obtained within 0 to 7 days from COVID-19 patients confirmed by RT-PCR and chest CT scan. According to the SARS-CoV-2 RT-PCR results, the patients included in the study were divided into two groups: PCR positive group (n=46), and PCR negative group (n=274).ResultsOf the 320 COVID-19 serum samples, IgM, IgG, and IgM/IgG were detected in 9.4%, 3.1%, and 17.8% within one week respectively. IgG/IgM antibodies were not detected in 69.7% of the patients. In the study, it was determined that 249 (77.8%) of 320 patients had positive chest CT scans. Four (5.6%) of 100 patients with negative chest CT scan had IgM positive and 2 (2.8%) had both IgM/ IgG positive. IgM was detected in 23 (9.2%), IgG in 1 (0.4%) and IgM/IgG in 35 (14%) of chest CT scan positive patients. The rate of CT findings in patients with antibody positivity (n=97) was found to be significantly higher than those with antibody negativity.ConclusionsThe results of the present study show the accurate and equivalent performance of serological antibody assays and chest CT in detecting SARS-CoV-2 0 to 7 days from the onset of COVID19 symptoms. When the RT-PCR is not available, we believe that the combination of immunochromatographic test and chest CT scan can increase diagnostic sensitivity for COVID-19.

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Prevalence of COVID-19 Diagnostic Output with Chest Computed Tomography: A Systematic Review and Meta-Analysis

Diagnostics ◽

10.3390/diagnostics10121023 ◽

2020 ◽

Vol 10 (12) ◽

pp. 1023

Author(s):

Temitope Emmanuel Komolafe ◽

John Agbo ◽

Ebenezer Obaloluwa Olaniyi ◽

Kayode Komolafe ◽

Xiaodong Yang

Keyword(s):

Computed Tomography ◽

Meta Analysis ◽

Age Groups ◽

Disease Prevalence ◽

Chest Ct ◽

Imaging Features ◽

Rt Pcr ◽

Chest Computed Tomography ◽

Pooled Prevalence ◽

History Of

Background: The pooled prevalence of chest computed tomography (CT) abnormalities and other detailed analysis related to patients’ biodata like gender and different age groups have not been previously described for patients with coronavirus disease 2019 (COVID-19), thus necessitating this study. Objectives: To perform a meta-analysis to evaluate the diagnostic performance of chest CT, common CT morphological abnormalities, disease prevalence, biodata information, and gender prevalence of patients. Methods: Studies were identified by searching PubMed and Science Direct libraries from 1 January 2020 to 30 April 2020. Pooled CT positive rate of COVID-19 and RT-PCR, CT-imaging features, history of exposure, and biodata information were estimated using the quality effect (QE) model. Results: Out of 36 studies included, the sensitivity was 89% (95% CI: 80–96%) and 98% (95% CI: 90–100%) for chest CT and reverse transcription-polymerase chain reaction (RT-PCR), respectively. The pooled prevalence across lesion distribution were 72% (95% CI: 62–80%), 92% (95% CI: 84–97%) for lung lobe, 88% (95% CI: 81–93%) for patients with history of exposure, and 91% (95% CI: 85–96%) for patients with all categories of symptoms. Seventy-six percent (95% CI: 67–83%) had age distribution across four age groups, while the pooled prevalence was higher in the male with 54% (95% CI: 50–57%) and 46% (95% CI: 43–50%) in the female. Conclusions: The sensitivity of RT-PCR was higher than chest CT, and disease prevalence appears relatively higher in the elderly and males than children and females, respectively.

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Chest Computed Tomography Findings in Asymptomatic Patients with COVID-19

Respiration ◽

10.1159/000509334 ◽

2020 ◽

Vol 99 (9) ◽

pp. 748-754 ◽

Cited By ~ 3

Author(s):

Min Cheol Chang ◽

Wonho Lee ◽

Jian Hur ◽

Donghwi Park

Keyword(s):

Computed Tomography ◽

South Korea ◽

Respiratory System ◽

Ground Glass Opacity ◽

Chest Ct ◽

Effective Management ◽

Radiographic Findings ◽

Chest Computed Tomography ◽

Asymptomatic Patients ◽

The Right

Background: Little is known about the damage to the respiratory system in asymptomatic patients with coronavirus disease (COVID-19). Objective: Herein, we evaluate the findings of chest computed tomography (CT) and radiography in patients with COVID-19 who were asymptomatic. Methods: We retrospectively investigated patients with a confirmed diagnosis of COVID-19 but who did not show any symptoms. Among the 139 patients with COVID-19 who were hospitalized in Yeungnam University Hopistal in Daegu, South Korea, 10 (7.2%) were asymptomatic. Their chest CT and radiographic findings were analyzed. Results: In the results, all patients (100%) had ground-glass opacity (GGO) on chest CT. Further, the GGO lesions were predominantly distributed peripherally and posteriorly in all patients. In 9 (90%) patients, the GGO lesions were combined with reticular opacity. Air bronchogram due to bronchiolectasis surrounded by GGO was observed in 8 patients (80%). Additionally, the lung lesions were dominant on the right side in all patients. Conclusions: In conclusion, considering our results that the lung is affected in asymptomatic patients, it will be necessary to extend the indications of COVID-19 testing for effective management of COVID-19 during the pandemic.

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Specificity of chest computed tomography in COVID-19-associated pneumonia: a retrospective study

Almanac of Clinical Medicine ◽

10.18786/2072-0505-2021-49-001 ◽

2021 ◽

Vol 49 (1) ◽

pp. 1-10

Author(s):

T. A. Korb ◽

P. V. Gavrilov ◽

V. Yu. Chernina ◽

I. A. Blokhin ◽

O. O. Aleshina ◽

...

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Coefficient Of Variation ◽

Information Service ◽

Chest Ct ◽

Primary Study ◽

Chest Computed Tomography ◽

Moscow City ◽

Attending Physician ◽

Chest Ct Scan

Aim: To assess the specificity of COVID-19- associated pneumonia detection by radiologists using a chest CT scan.Materials and methods: From mid-February to early March 2020, 65 patients have been retrospectively selected from the Moscow City Clinical Hospital database; all of them had been treated in an inpatient facility with a verified diagnosis of COVID-19. In addition, 75 patients from the Unified Radiological Information Service have been randomly selected. In December 2019, these outpatients had been sent by an attending physician for a chest CT scan with suspected pneumonia. The imaging studies showed non-specific inflammation signs in the lungs. All 140 scans were analyzed by seven radiologists from different Russian cities, who independently categorized each study as “COVID-19” or “Other pneumonia”.Results: Chest computed tomography had a 92% specificity in the differential diagnosis of COVID-19-associated pneumonia, and its specificity in the general population is expected to be at least 80% with a high probability. The inter-rater variability was low (coefficient of variation for specificity 12.6%). The sensitivity in our study was 76.2%, and the coefficient of variation for sensitivity 23.5%. These findings are generally consistent with other studies. The primary study limitation is the absence of a sample with confirmed pneumonia caused by other viruses.Conclusion: Chest CT is highly specific for the detection of COVID-19-associated pneumonia.

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Evaluation of chest computed tomography features in COVID-19: a single-center retrospective study

Journal of Ideas in Health ◽

10.47108/jidhealth.vol4.iss4.172 ◽

2021 ◽

Vol 4 (4) ◽

pp. 588-594

Author(s):

Akshat Sanjay Shukla ◽

Sanjay Rajendraprasad Shukla ◽

Feral Ravi Daruwala

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

False Negative ◽

Chest Ct ◽

Single Center ◽

Rt Pcr ◽

Pulmonary Vessel ◽

Ct Findings ◽

Diagnostic Center ◽

Second Wave

Background: Even though Real-Time Polymerase Chain Reaction (RT-PCR) is a gold standard for confirming COVID-19, it continues to be plagued by a lack of RT-PCR kits and the potential of false-negative results. Hence, during the second wave of COVID-19 in India, Computed Tomography (CT) scan is an emerging diagnostic tool in evaluating the severity of illness in COVID-19 pneumonia. The present study endeavored to assess chest CT features of COVID-19 pneumonia in Indian population. Methods: This was a single-center, retrospective, observational study conducted in 300 consecutive adults RT-PCR confirmed COVID-19 patients from 1, Jan 2021 to 31, March 2021 at a private radio diagnostic center. Data regarding baseline demographics, clinical and laboratory characteristics, extent, pattern, and type of abnormal CT findings were noted. Results: The study population (204 males and 108 females) had mean age of 43.18 ± 8.27 years. Our study's most common clinical presentation was cough (48.1%) and fever (47.1%), respectively. Lung parenchymal abnormalities were found in 294 (94.2%) patients. Abnormal CT findings revealed the involvement of bilateral (45.6%) and multilobar (42.9%) with a predominant peripheral (92.3%) and posterior (80.8%) distribution. According to the type of opacity, Ground Glass Opacity (GGO) was the dominant abnormality found in 270 (91.8%) patients, in which pure GGO (36.7%), GGO with crazy paving pattern (39.8%), and GGO mixed with consolidation (52.0 %) were noted. Peri-lesional or intralesional segmental or subsegmental pulmonary vessel enlargement was found in 192 (65.3 %) patients. Conclusion: During the second wave of COVID-19, a chest CT scan is a modality of choice in diagnosing COVID-19 pneumonia and related lung parenchymal changes.

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Chest Computed Tomography Findings in a Case Series of Coronavirus Disease 2019 (COVID-19) Patients at Siriraj Hospital

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.05.12395 ◽

2021 ◽

Vol 104 (5) ◽

pp. 866-871

Keyword(s):

Computed Tomography ◽

Medical Records ◽

Case Series ◽

Ground Glass Opacity ◽

Chest Ct ◽

Ground Glass ◽

Chest Computed Tomography ◽

Ct Findings ◽

Siriraj Hospital ◽

Chest Ct Scan

Background: Recent evidence has demonstrated the high sensitivity of chest computed tomography (CT) in coronavirus disease 2019 (COVID-19) case detection. However, considering the cost and infection control issues, the experience of chest CT for COVID-19 diagnosis in Thailand is still limited. Objective: To present the characteristics of chest CT findings in COVID-19 patients at Siriraj Hospital and compare them with other reports. Materials and Methods: The authors retrospectively reviewed the COVID-19 patients’ medical records between April and May 2020. All cases with the presence of chest CT performed during admission were recruited. Clinical data were retrieved from the patients’ medical records. All chest imaging results were reported by consensus between the authors. Results: From 103 cases, four cases with a chest CT scan during the admission were recruited. Consistent with previous reports, the common chest CT findings included a ground-glass opacity and consolidation with bilateral involvement. A round-shaped ground-glass opacity or consolidation was evidenced in half of the cases. The only case with the presence of chest CT scan, which was done 77 days after the onset of COVID-19 symptoms, revealed resolution of the abnormal findings. Conclusion: Chest CT findings in four COVID-19 cases at Siriraj Hospital are consistent with previous reports. Common findings include bilateral ground-glass opacity and consolidation. Keywords: COVID-19, SARS-CoV-2, Computed tomography, Case series

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Chest CT versus RT-PCR for the Detection of COVID-19: Systematic Review and Meta-analysis

10.1101/2020.06.22.20136846 ◽

2020 ◽

Author(s):

Mohammad Karam ◽

Sulaiman Althuwaikh ◽

Mohammad Alazemi ◽

Ahmad Abul ◽

Amrit Hayre ◽

...

Keyword(s):

Computed Tomography ◽

Systematic Review ◽

Polymerase Chain Reaction ◽

Meta Analysis ◽

False Negative ◽

Chest Ct ◽

Rt Pcr ◽

Chain Reaction ◽

Chest Computed Tomography ◽

Polymerase Chain

AbstractPurposeTo compare the performance of chest computed tomography (CT) scan versus reverse transcription polymerase chain reaction (RT-PCR) in the initial diagnostic assessment of coronavirus disease 2019 (COVID-19) patients.MethodsA systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A search of electronic information was conducted to identify all relevant studies comparing the diagnostic performance of chest CT scan versus RT-PCR in COVID-19 suspected cases. Sensitivity, specificity and accuracy were primary outcome measures. Secondary outcome measures included other test performance characteristics, discrepant findings between both investigations and main chest CT findings. Random effects modelling was used for the analyses.ResultsEight non-randomised retrospective studies enrolling 1910 patients were identified. Chest CT was more sensitive but less specific than RT-PCR. Accuracy was not statistically significantly different between chest CT and RT-PCR for the identification and exclusion of COVID-19 cases (Odds Ratio [OR] = 0.40, P = 0.15) in the context of hospitalised patients in a pandemic. Chest CT was shown to detect patients with false-negative RT-PCR results and true positives. Ground-glass opacities and consolidations were the most common chest CT manifestations.ConclusionsChest CT is not superior to RT-PCR for the initial detection of COVID-19 and has more false positives. It is likely to be useful in confirming COVID-19 in patients with a suspicious clinical presentation, but who have a false-negative SARS-CoV-2 RT-PCR test.Key Points‐Chest computed tomography (CT) is more sensitive but less specific in detecting and excluding coronavirus disease 2019 (COVID-19) when compared to reverse transcription polymerase chain reaction (RT-PCR).‐Accuracy of chest CT is not significantly different from RT-PCR for COVID-19 cases.‐Chest CT can detect false-negative and true-positive RT-PCR cases.

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CORRELATION BETWEEN CHEST COMPUTED TOMOGRAPHY AND LUNG ULTRASONOGRAPHY IN PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19)

10.1101/2020.05.08.20095117 ◽

2020 ◽

Author(s):

Yale Tung-Chen ◽

Milagros Martí de Gracia ◽

Aurea Díez-Tascón ◽

Sergio Agudo-Fernández ◽

Rodrigo Alonso-González ◽

...

Keyword(s):

Computed Tomography ◽

Positive Predictive Value ◽

Ct Scan ◽

Severity Score ◽

Chest Ct ◽

Lung Ultrasonography ◽

Rt Pcr ◽

Lung Abnormalities ◽

Missed Diagnosis ◽

Similar Accuracy

ABSTRACTINTRODUCTIONThere is growing evidence regarding the imaging findings of Coronavirus Disease 2019 (COVID-19), in chest X-ray and Computed Tomography scan (CT). At this moment, the role of Lung Ultrasonography (LUS) has yet to be explored.OBJECTIVESThe main purpose of this study is to evaluate the correlation between LUS findings and chest CT in confirmed (positive RT-PCR) or clinically highly suspicious (dyspnea, fever, myasthenia, gastrointestinal symptoms, dry cough, ageusia or anosmia) of COVID-19 patients.METHODSProspective study carried out in the emergency department (ED) of confirmed or clinically highly suspicious COVID-19 patients who were subjected to a chest CT and concurrent LUS exam. An experienced ED physician performed the LUS exam blind to the clinical history and results of the CT scan, which were reviewed by two radiologists in consensus for signs compatible with COVID-19 (bilateral ground-glass opacities in peripheral distribution). Compatible LUS exam was considered a bilateral pattern of B-lines, irregular pleural line and subpleural consolidations.RESULTSBetween March and April 2020, fifty-one patients were consecutively enrolled. The indication for CT was a negative or indeterminate RT-PCR test (49.0%) followed by suspicion of pulmonary embolism (41.2%). Radiological signs compatible with COVID-19 were present in thirty-seven patients (72.5%) on CT scan and forty patients (78.4%) on LUS exam. The presence of LUS findings was correlated with a positive CT scan suggestive of COVID-19 (OR: 13.3, 95%CI: 4.539.6, p<0.001) with a sensitivity of 100.0% and a specificity of 78.6%, positive predictive value of 92.5% and negative of 100.0%. There was no missed diagnosis of COVID-19 with LUS compared to CT in our cohort. The LUS Score had a good correlation with CT total severity score (ICC 0.803, 95% CI 0.60-0.90, p<0.001).CONCLUSIONLUS presents similar accuracy compared to chest CT to detect lung abnormalities in COVID-19 patients.Summary StatementLUS presents similar accuracy compared to chest CT to detect lung abnormalities in COVID-19 patients.Key Results-Common LUS findings mirror those previously described for CT: bilateral, peripheral, consolidation and/or ground glass opacities.-LUS findings correlated with CT scan with a sensitivity of 100.0% and a specificity of 78.6%, positive predictive value of 92.5% and negative of 100.0%. The Lung score had a good correlation with CT total severity score (ICC 0.803, 95% CI 0.601-0.903, p < 0.001).-There were no missed diagnosis of COVID-19 with LUS compared to CT in our cohort.

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Coronavirus Disease 2019 (COVID-19) in Italy: features on Chest Computed Tomography using a structured report system

10.21203/rs.3.rs-24312/v1 ◽

2020 ◽

Cited By ~ 3

Author(s):

Grassi Roberto ◽

Fusco Roberta ◽

Belfiore Maria Paola ◽

Montanelli Alessandro ◽

Patelli Gianluigi ◽

...

Keyword(s):

Computed Tomography ◽

Mean Value ◽

Chest Ct ◽

Viral Pneumonia ◽

Mediastinal Lymphadenopathy ◽

Rt Pcr ◽

Chest Computed Tomography ◽

Trunk Diameter ◽

Structured Report ◽

Report System

Abstract OBJECTIVE. To assess the use of a structured report system in the Chest Computed Tomography (CT) reporting of patients with suspicious viral pneumonia by COVID-19 and the evaluation of the main CT patterns.MATERIALS AND METHODS. This study included 134 patients (43 women and 91 men; 68.8 years of mean age, range 29-93 years) with suspicious COVID-19 viral infection evaluated by reverse transcription real-time fluorescence polymerase chain reaction (RT-PCR) test. All patients underwent CT examinations at the time of admission. CT images were reviewed by two radiologists who identified COVID-19 CT patterns using a structured reports.RESULTS. Temporal difference mean value between RT-PCRs and CT scan was 0.18 days ±2.0 days. CT findings were positive for viral pneumonia in 94.0% patients while COVID-19 was diagnosed at RT-PCR in 77.6% patients. Mean value of time for radiologist to complete the structured report was 8.5 min±2.4 min. The disease on chest CT predominantly affected multiple lobes and the main CT feature was GGOs with or without consolidation (96.8%). GGOs was predominantly bilateral (89.3%), peripheral (80.3%), multifocal/patching (70.5%). Consolidation disease was predominantly bilateral (83.9%) with prevalent peripheral (87.1%) and segmental (47.3%) distribution. Additional CT signs were the crazy-paving pattern in 75.4% of patients, the septal thickening in 37.3% of patients, the air bronchogram sign in 39.7% and the “reversed halo” sign in 23.8%. Less frequent characteristics at CT regard discrete pulmonary nodules, increased trunk diameter of the pulmonary artery, pleural effusion and pericardium effusion (7.9%, 6.3%, 14.3% and 16.7%, respectively). Barotrauma sign was absent in all the patients. High percentage (54.8%) of the patients had mediastinal lymphadenopathy.CONCLUSION. Using a Chest CT structured report, with a standardized language, we identified that the cardinal hallmarks of COVID-19 infection were bilateral, peripheral and multifocal/patching ground-glass opacities and bilateral consolidations with peripheral and segmental distribution.

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