A Case of COVID-19 Suspected from the Findings of Chest CT, with the Diagnosis Confirmed by a Second PCR Test；Unknown Infection Route

Abstract Background To evaluate the clinical value of the chest CT scan compared to the reference standard real-time polymerase chain reaction (RT-PCR) in COVID-19 patients. Methods From March 29th to April 15th of 2020, a total of 240 patients with respiratory distress underwent both a low-dose chest CT scan and RT-PCR tests. The performance of chest CT in diagnosing COVID-19 was assessed with reference to the RT-PCR result. Two board-certified radiologists (mean 24 years of experience chest CT), blinded for the RT-PCR result, reviewed all scans and decided positive or negative chest CT findings by consensus. Results Out of 240 patients, 60% (144/240) had positive RT-PCR results and 89% (213/240) had a positive chest CT scans. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of chest CT in suggesting COVID-19 were 100% (95% CI: 97–100%, 144/240), 28% (95% CI: 19–38%, 27/240), 68% (95% CI: 65–70%) and 100%, respectively. The diagnostic accuracy of the chest CT suggesting COVID-19 was 71% (95% CI: 65–77%). Thirty-three patients with positive chest CT scan and negative RT-PCR test at baseline underwent repeat RT-PCR assay. In this subgroup, 21.2% (7/33) cases became RT-PCR positive. Conclusion Chest CT imaging has high sensitivity and high NPV for diagnosing COVID-19 and can be considered as an alternative primary screening tool for COVID-19 in epidemic areas. In addition, a negative RT-PCR test, but positive CT findings can still be suggestive of COVID-19 infection.

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DIAGNOSTIC ROLE OF CHEST CT USING CO-RADS CATEGORIZATION IN SARS-COV-2 INFECTION WITH EMPHASIS ON IMPACT OF CT IN PATIENTS WITH DELAYED OR NEGATIVE INITIAL RTPCR TEST

10.36106/ijar/9301921 ◽

2021 ◽

pp. 51-52

Author(s):

Tharani Putta ◽

Kaushik Deconda

Keyword(s):

Diagnostic Performance ◽

Virus Disease ◽

Vital Role ◽

Chest Ct ◽

Lung Involvement ◽

Test Results ◽

Rt Pcr ◽

Diagnostic Role ◽

Pcr Test

BACKGROUND AND OBJECTIVE: Role of chest CT in diagnosis of corona virus disease 2019 (COVID-19) has been controversial. The purpose of this study is to evaluate the diagnostic performance of chest CT when utilizing COVID-19 Reporting and Data System (CO-RADS). METHODOLOGY: Retrospective study including consecutive patients with positive SARS-CoV-2 RT-PCR test (initial or repeat test) and chest CT done in our institute between June and September 2020. Spectrum of CT ndings, CO-RADS score and 25 point CT severity score (CTSS) were recorded. RESULTS: A total of 300 consecutive patients with SARS-CoV-2 infection were included in the analysis. Out of the 168 patients who underwent CT prior to positive RT-PCR result, 125 (74.4%) had CO-RADS 3, 4 or 5 score on chest CT. 32 study patients (10.6%) had initial negative RT-PCR of which 24 (75%) had CO-RADS 4 or 5 score. Of the total patients with CO-RADS 3 to 5 score (227), 20 (8.8%) had severe lung involvement (CTSS 18-25), 83 (36.6%) had moderate lung involvement (CTSS 8-17) and 124 (54.6%) had mild lung involvement (CTSS 1-7). The mean CTSS was 7.9 with mean lobar score being higher in lower lobes (RLL=1.82, LLL=1.78) compared to the upper and middle lobes (RUL=1.61, RML=1.19, LUL=1.53). CONCLUSION:CT using CO-RADS scoring system has good diagnostic performance. In addition to assessing disease severity, it plays a vital role in triage of patients with suspected COVID-19 especially when there is limited availability of SARS-CoV-2 RT-PCR tests, delay in RT-PCR test results or in negative RT-PCR cases when there is high index of clinical suspicion.

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Eosinopenia in COVID-19 Patients: A Retrospective Analysis

Microorganisms ◽

10.3390/microorganisms8121929 ◽

2020 ◽

Vol 8 (12) ◽

pp. 1929

Author(s):

Narcisse Ndieugnou Djangang ◽

Lorenzo Peluso ◽

Marta Talamonti ◽

Antonio Izzi ◽

Pierre Alain Gevenois ◽

...

Keyword(s):

Ct Scan ◽

Retrospective Analysis ◽

Predictive Accuracy ◽

Laboratory Finding ◽

Laboratory Data ◽

High Body Mass Index ◽

Chest Ct ◽

Diagnostic Methods ◽

Chest Ct Scan ◽

Pcr Test

Objectives: The aim of this study was to assess the diagnostic role of eosinophils count in COVID-19 patients. Methods: Retrospective analysis of patients admitted to our hospital with suspicion of COVID-19. Demographic, clinical and laboratory data were collected on admission. Eosinopenia was defined as eosinophils < 100 cells/mm3. The outcomes of this study were the association between eosinophils count on admission and positive real-time reverse transcription polymerase chain reaction (rRT-PCR) test and with suggestive chest computerized tomography (CT) of COVID-19 pneumonia. Results: A total of 174 patients was studied. Of those, 54% had positive rRT-PCR for SARS-CoV-2. A chest CT-scan was performed in 145 patients; 71% showed suggestive findings of COVID-19. Eosinophils on admission had a high predictive accuracy for positive rRT-PCR and suggestive chest CT-scan (area under the receiver operating characteristic—ROC curve, 0.84 (95% CIs 0.78–0.90) and 0.84 (95% CIs 0.77–0.91), respectively). Eosinopenia and high LDH were independent predictors of positive rRT-PCR, whereas eosinopenia, high body mass index and hypertension were predictors for suggestive CT-scan findings. Conclusions: Eosinopenia on admission could predict positive rRT-PCR test or suggestive chest CT-scan for COVID-19. This laboratory finding could help to identify patients at high-risk of COVID-19 in the setting where gold standard diagnostic methods are not available.

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Chest CT changes in COVID-19 patients with hypertension comorbidities

10.21203/rs.3.rs-30394/v1 ◽

2020 ◽

Author(s):

Wei Li ◽

Wenjun Yu ◽

Jianwei Liao ◽

Yijie Fang ◽

Lin Yao ◽

...

Keyword(s):

Global Health ◽

Clinical Features ◽

Clinical Data ◽

Clinical Characteristics ◽

Ground Glass Opacity ◽

Chest Ct ◽

Ground Glass ◽

Rt Pcr ◽

Relationship Of ◽

Pcr Test

Abstract AIMTo summarize the chest CT and clinical features of COVID-19 pneumonia patients with hypertension comorbidities.METHODSThe initial chest CT imaging and clinical data of 15 confirmed COVID-19 patients with hypertension comorbidities treated in our hospital were analyzed retrospectively from January 1, 2019 to February 14, 2020. The chest CT images and clinical data were reviewed and their relationship of the disease was analyzed.RESULTSTotally 15 COVID-19 patients diagnosed with hypertension comorbidities were included. In terms of clinical characteristics, 14/15 (93.3%) of patients had characteristics of clustering onset, and the positive rates of the first RT-PCR test and the initial CT were 80% and 93% respectively. The most frequent CT abnormality observed was ground glass opacity (GGO) (13/15, 86.7%), including patchy/ punctate GGO and large/multiple GGO. Most of the lesions were multiple, and 60% of them involved 4-5 lobes. Most patients present with bilateral CT onset (12,80.0%), and most present with subpleural distribution (10,66.7%). The average CT score is 13.7, and 40% of the patients exceeded 20 points.CONCLUSIONThe common chest CT findings in COVID-19 patients with hypertension comorbidities are GGO, most of which at present with bilateral CT onset and subpleural distribution. CT is indispensable in the diagnosis and evaluation of this global health emergency.

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Diagnostic value of Chest CT and Initial Real-Time RT-PCR in COVID-19 Infection

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.1.2956 ◽

2020 ◽

Vol 37 (1) ◽

Author(s):

Ugur Kostakoglu ◽

Aydın Kant ◽

Serhat Atalar ◽

Barış Ertunç ◽

Şükrü Erensoy ◽

...

Keyword(s):

Real Time ◽

Diagnostic Value ◽

Chest Ct ◽

Symptom Duration ◽

Shortness Of Breath ◽

Rt Pcr ◽

Ct Findings ◽

Group I ◽

Group Ii ◽

Pcr Test

Objectives: To evaluate the diagnostic value of the rtRT-PCR test and CT in patients presenting with typical clinical symptoms of COVID-19. Methods: The study with the participation of four center in Turkey was performed retrospectively from 20 March-15 April 2020 in 203 patients confirmed for COVID-19. The initial rtRT-PCR test was positive in 142 (70.0%) of the patients (Group-I) and negative in 61 patients (Group-II). Results: The mean age of the patients in Group-I was 49.7±18.0 years and the time between the onset of symptoms and admission to the hospital was 3.6±2.0 days; whereas the same values for the patients in Group-II were 58.1±19.9 and 5.3±4.2, respectively (p=0.004; p=0.026). Initial rtRT-PCR was found positive with 83.5% sensitivity and 74.1% PPV in patients with symptom duration of less than five days. It was found that rtRT-PCR positivity correlated negatively with the presence of CT findings, age, comorbidity, shortness of breath, and symptom duration, while rtRT-PCR positivity correlated positively with headache. Presence of CT findings was positively correlated with age, comorbidity, shortness of breath, fever, and the symptom duration. Conclusions: It should be noted that a negative result in the rtRT-PCR test does not rule out the possibility of COVID-19 diagnosis in patients whose symptom duration is longer than five days, who are elderly with comorbidities and in particular who present with fever and shortness of breath. In these patients, typical CT findings are diagnostic for COVID-19. A normal chest CT is no reason to loosen up measures of isolation in patients with newly beginning symptoms until the results are obtained from the PCR test. doi: https://doi.org/10.12669/pjms.37.1.2956 How to cite this:Kostakoglu U, Kant A, Atalar S, Ertunc B, Erensoy S, Dalmanoglu E, et al. Diagnostic value of Chest CT and Initial Real-Time RT-PCR in COVID-19 Infection. Pak J Med Sci. 2021;37(1):-234-238. doi: https://doi.org/10.12669/pjms.37.1.2956 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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80-year-old man with dyspnoea and bilateral groundglass infiltrates: an elusive case of COVID-19

BMJ Case Reports ◽

10.1136/bcr-2020-236069 ◽

2020 ◽

Vol 13 (5) ◽

pp. e236069

Author(s):

Matthew J Samec ◽

Ali Khawaja ◽

Ashokakumar M Patel ◽

Sagar B Dugani

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Viral Infection ◽

Respiratory Symptoms ◽

Ct Imaging ◽

Chest Ct ◽

Initial Testing ◽

Global Pandemic ◽

Pcr Test

COVID-19 is a novel viral infection caused by severe acute respiratory syndrome-coronavirus-2 virus, first identified in Wuhan, China in December 2019. COVID-19 has spread rapidly and is now considered a global pandemic. We present a case of a patient with minimal respiratory symptoms but prominent bilateral groundglass opacities in a ‘crazy paving’ pattern on chest CT imaging and a negative initial infectious workup. However, given persistent dyspnoea and labs suggestive of COVID-19 infection, the patient remained hospitalised for further monitoring. Forty-eight hours after initial testing, the PCR test was repeated and returned positive for COVID-19. This case illustrates the importance of clinical vigilance to retest patients for COVID-19, particularly in the absence of another compelling aetiology. As COVID-19 testing improves to rapidly generate results, selective retesting of patients may uncover additional COVID-19 cases and strengthen measures to minimise the spread of COVID-19.

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rRT-PCR Test Results Upon Admission Might Be Associated with Outcome in Hospitalized Chest CT-Positive COVID-19 Patients: A Provincial Retrospective Cohort with Active Follow-Up

SSRN Electronic Journal ◽

10.2139/ssrn.3572861 ◽

2020 ◽

Author(s):

Hamid Reza Najari ◽

Saeed Nemati ◽

Anita Eftekharzadeh ◽

Amir Mohammad Kazemifar ◽

Ali Qandian ◽

...

Keyword(s):

Retrospective Cohort ◽

Chest Ct ◽

Test Results ◽

Pcr Test

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Challenges of diagnosis of COVID-19 in trauma patients: A case series

Trauma ◽

10.1177/1460408620950602 ◽

2020 ◽

pp. 146040862095060

Author(s):

Golnar Sabetian ◽

Farnia Feiz ◽

Alireza Shakibafard ◽

Hossein Abdolrahimzadeh Fard ◽

Sepideh Sefidbakht ◽

...

Keyword(s):

Ct Scan ◽

Trauma Center ◽

Chest Trauma ◽

Case Series ◽

Chest Ct ◽

Lung Contusion ◽

Trauma Patients ◽

Type B ◽

Chest Ct Scan ◽

Pcr Test

Background Diagnosis of COVID-19 can be challenging in trauma patients, especially those with chest trauma and lung contusion. Methods We present a case series of patients from February and March 2020 who were admitted to our trauma center at Rajaee Hospital Trauma Center, in Shiraz, Iran and had positive SARS-CoV-2 PCR test or chest CT scan suggestive of COVID-19 and were admitted to the specific ICU for COVID-19. Results Eight COVID-19 patients (6 male) with mean age of 40 (SD = 16.3) years old, were presented. All patients were cases of trauma injuries, with multiple injuries including chest trauma and lung contusion, admitted to our trauma center for management of their injuries, but they were diagnosed with COVID-19 as well. Two of them had coinfection of influenza type-B and SARS-CoV-2. All patients were treated for COVID-19 and three of them died; the rest were discharged from hospital. Conclusion Since PCR for SARS-CoV-2 is not always sensitive enough to confirm the cause of pneumonia, chest CT manifestations can be helpful, though, they are not always differentiable from lung contusion. Therefore, both the CT scan and the clinical and paraclinical presentation and course of improvement can be beneficial in diagnosing COVID-19 in the trauma setting.

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Predictive performance of CT for adverse outcomes among COVID-19 suspected patients: a two-center retrospective study

Bosnian Journal of Basic Medical Sciences ◽

10.17305/bjbms.2020.5466 ◽

2021 ◽

Author(s):

Begümhan Baysal ◽

Mahmut Bilal Dogan ◽

Mutlu Gulbay ◽

Mine Sorkun ◽

Murathan Koksal ◽

...

Keyword(s):

Respiratory Symptoms ◽

Operating Characteristic ◽

Adverse Outcome ◽

Predictive Performance ◽

Median Number ◽

Chest Ct ◽

Adverse Outcomes ◽

Receiver Operating Characteristic Curves ◽

Radiological Society ◽

Pcr Test

To compare the performance of various CT reporting tools, including Zonal CT Visual Score (ZCVS), the number of involved lobes, and Radiological Society of North America (RSNA) categorization in predicting adverse outcomes among patients hospitalized due to lower respiratory symptoms during the COVID-19 pandemic. A total of 405 patients admitted with severe respiratory symptoms who underwent a chest CT were enrolled. The primary adverse outcome was ICU admission of patients. Predictive performances of reporting tools were compared using the area under the receiver operating characteristic curves (AUC ROC). Among the 405 patients, 39 (9.63%) required ICU support during their hospital stay. At least two or more observers reported a typical and indeterminate COVID-19 pneumonia CT pattern according to RSNA categorization in 70% (285/405) of patients. Among these, 63% (179/285) had a positive PCR test for the SARS-CoV-2 virus. The median number of lobes involved according to CT was higher in patients who required ICU support (median [IQR], 5[3; 5] vs. 3[0; 5]). The median ZCVS score was higher among the patients that subsequently required ICU support (median [IQR], 4[0; 12] vs. 13[5.75; 24]). The bootstrap comparisons of AUC ROC showed significant differences between reporting tools, and the ZCVS was found to be superior (AUC ROC, 71 to 75 %). The ZCVS score at the first admission showed a linear and significant association with adverse outcomes among patients with lower respiratory tract symptoms during the COVID-19 pandemic.

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The accuracy of teleradiologists in diagnosing COVID-19 based on a French multicentric emergency cohort

10.21203/rs.3.rs-47674/v1 ◽

2020 ◽

Author(s):

Hubert Nivet ◽

Amandine Crombé ◽

Paul Schuster ◽

Thomas Ayoub ◽

Laurent Pourriol ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Weighted Kappa ◽

Kappa Coefficient ◽

Chest Ct ◽

Observer Agreement ◽

Rt Pcr ◽

Point Scale ◽

High Diagnostic Accuracy ◽

Typical Appearance ◽

Pcr Test

Abstract Objectives: To evaluate the accuracy of diagnoses of COVID-19 based on chest CT as well as inter-observer agreement between teleradiologists during on-call duty and senior radiologists in suspected COVID-19 patients. Materials and Methods: From 03/13/2020 to 04/14/2020, consecutive suspected COVID-19 adult patients who underwent both an RT-PCR test and chest CT from 15 hospitals were included in this prospective study. Chest CTs were immediately interpreted by the on-call teleradiologist and were systematically blind reviewed by a senior radiologist. Readings were categorised using a five-point scale: (1) normal; (2) non-infectious findings; (3) infectious findings but not consistent with COVID-19 infection; (4) consistent with COVID-19 infection; and (5) typical appearance of COVID-19 infection. The diagnostic accuracy of chest CT and inter-observer agreement using the Kappa coefficient were evaluated over the study period.Results: In total, 513 patients were enrolled, of whom 244/513 (47.6%) tested positive for RT-PCR. First readings were scored 4 or 5 in 225/244 (92%) RT-PCR+ patients, and between 1 and 3 in 201/269 (74.7%) RT-PCR- patients. The data were highly consistent (weighted Kappa=0.87) and correlated with RT-PCR (p<0.001, AUC1st-reading=0.89, AUC2nd-reading=0.93). The negative predictive value for scores of 4 or 5 was 0.91–0.92, and the PPV for a score of 5 was 0.89–0.96 at the first and second readings, respectively. Diagnostic accuracy was consistent over the study period, irrespective of a variable prevalence rate.Conclusion: Chest CT demonstrated high diagnostic accuracy with strong inter-observer agreement between on-call teleradiologists with varying degrees of experience and senior radiologists over the study period.

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