Descriptive analysis of a comparison between lung ultrasound and chest radiography in patients suspected of COVID-19

Abstract Background Lung ultrasound (LUS) and chest radiography (CXR) are the most used chest imaging tools in the early diagnosis of COVID-19 associated pneumonia. However, the relationship between LUS and CXR is not clearly defined. The aim of our study was to describe the comparison between LUS interpretation and CXR readings in the first approach to patients suspected of COVID-19. Methods In the time of the first COVID-19 pandemic surge, we prospectively evaluated adult patients presenting to an emergency department complaining of symptoms raising suspicion of COVID-19. Patients were studied by LUS and only those performing also CXR were analyzed. All the patients performed viral reverse transcriptase-polymerase chain reaction (RT-PCR). LUS studies were classified in 4 categories of probabilities, based on the presence of typical or alternative signs of COVID-19-associated interstitial pneumonia. Accordingly, the CXR readings were retrospectively adapted by 2 experts in 4 categories following the standard language that describes the computed tomography (CT) findings. Patients were divided in two groups, based on the agreement of the LUS and CXR categories. Results were also compared to RT-PCR and, when available, to CT studies. Results We analyzed 139 cases (55 women, mean age 59.1 ± 15.5 years old). The LUS vs CXR results disagreed in 60 (43.2%) cases. RT-PCR was positive in 88 (63.3%) cases. In 45 cases, a CT scan was also performed and only 4 disagreed with LUS interpretation versus 24 in the comparison between CT and CXR. In 18 cases, LUS detected signs of COVID-19 pneumonia (high and intermediate probabilities) while CXR reading was negative; in 14 of these cases, a CT scan or a RT-PCR-positive result confirmed the LUS interpretation. In 6 cases, LUS detected signs of alternative diagnoses to COVID-19 pneumonia while CXR was negative; in 4 of these cases, CT scan confirmed atypical findings. Conclusion Our study demonstrated a strong disagreement between LUS interpretation and CXR reading in the early approach to patients suspected of COVID-19. Comparison with CT studies and RT-PCR results seems to confirm the superiority of LUS over a second retrospective reading of CXR.

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A meta-analysis of accuracy and sensitivity of chest CT and RT-PCR in COVID-19 diagnosis

Scientific Reports ◽

10.1038/s41598-020-80061-2 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Fatemeh Khatami ◽

Mohammad Saatchi ◽

Seyed Saeed Tamehri Zadeh ◽

Zahra Sadat Aghamir ◽

Alireza Namazi Shabestari ◽

...

Keyword(s):

Polymerase Chain Reaction ◽

Reverse Transcriptase ◽

Ct Scan ◽

Predictive Value ◽

Meta Analysis ◽

Chest Ct ◽

Rt Pcr ◽

Chain Reaction ◽

Polymerase Chain ◽

Chest Ct Scan

AbstractNowadays there is an ongoing acute respiratory outbreak caused by the novel highly contagious coronavirus (COVID-19). The diagnostic protocol is based on quantitative reverse-transcription polymerase chain reaction (RT-PCR) and chests CT scan, with uncertain accuracy. This meta-analysis study determines the diagnostic value of an initial chest CT scan in patients with COVID-19 infection in comparison with RT-PCR. Three main databases; PubMed (MEDLINE), Scopus, and EMBASE were systematically searched for all published literature from January 1st, 2019, to the 21st May 2020 with the keywords "COVID19 virus", "2019 novel coronavirus", "Wuhan coronavirus", "2019-nCoV", "X-Ray Computed Tomography", "Polymerase Chain Reaction", "Reverse Transcriptase PCR", and "PCR Reverse Transcriptase". All relevant case-series, cross-sectional, and cohort studies were selected. Data extraction and analysis were performed using STATA v.14.0SE (College Station, TX, USA) and RevMan 5. Among 1022 articles, 60 studies were eligible for totalizing 5744 patients. The overall sensitivity, specificity, positive predictive value, and negative predictive value of chest CT scan compared to RT-PCR were 87% (95% CI 85–90%), 46% (95% CI 29–63%), 69% (95% CI 56–72%), and 89% (95% CI 82–96%), respectively. It is important to rely on the repeated RT-PCR three times to give 99% accuracy, especially in negative samples. Regarding the overall diagnostic sensitivity of 87% for chest CT, the RT-PCR testing is essential and should be repeated to escape misdiagnosis.

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The use of chest ultrasonography in suspected cases of COVID-19 in the emergency department

Future Science OA ◽

10.2144/fsoa-2020-0127 ◽

2021 ◽

Vol 7 (1) ◽

pp. FSO635

Author(s):

Enrico Allegorico ◽

Carlo Buonerba ◽

Giorgio Bosso ◽

Antonio Pagano ◽

Giovanni Porta ◽

...

Keyword(s):

Lung Ultrasound ◽

Initial Assessment ◽

Rt Pcr ◽

Chain Reaction ◽

Variable Model ◽

Chest Ultrasonography ◽

History Of ◽

Ultrasound Score ◽

Polymerase Chain ◽

Or History

Aim: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus-specific reverse transcriptase-polymerase chain reaction (RT-PCR) represents the diagnostic gold standard. We explored the value of chest ultrasonography to predict positivity to SARS-CoV-2 on RT-PCR in suspected COVID-19 cases. Patients & methods: Consecutive patients with suspect COVID-19 were included if they had fever and/or history of cough and/or dyspnea. Lung ultrasound score (LUSS) was computed according to published methods. Results: A total of 76 patients were included. A 3-variable model based on aspartate transaminase (AST) > upper limit of normal, LUSS >12 and body temperature >37.5°C yielded an overall accuracy of 91%. Conclusion: A simple LUSS-based model may represent a powerful tool for initial assessment in suspected cases of COVID-19.

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The exact place of PCR and chest CT in screening, staging, and diagnosis of Covid-19: A meta-analysis

10.21203/rs.3.rs-32961/v1 ◽

2020 ◽

Author(s):

Fatemeh Khatami ◽

Mohammad Saatchi ◽

Seyed Saeed Tamehri Zadeh ◽

Zahra Sadat Aghamir ◽

Alireza Namazi Shabestari ◽

...

Keyword(s):

Polymerase Chain Reaction ◽

Reverse Transcriptase ◽

Ct Scan ◽

Predictive Value ◽

Meta Analysis ◽

Chest Ct ◽

Rt Pcr ◽

Chain Reaction ◽

Polymerase Chain ◽

Chest Ct Scan

Abstract Introduction: Nowadays there is an ongoing acute respiratory outbreak causing by the novel highly contagious coronavirus (nCoV). There are two diagnostic protocol based on chest CT scan and quantitative reverse-transcription polymerase chain reaction (RT-PCR) which their diagnostic accuracy is under the debate. We designed this meta-analysis study to determine the diagnostic value of initial chest CT scan in patients with nCoV infection in comparison with RT- PCR.Search strategy and statistical analysis: Three main databases the PubMed (MEDLINE), Scopus, and EMBASE was systematically searched for all published literatures from January 1st, 2019, to the 27th march 2020 with key grouping of “COVID19 virus”, “2019 novel coronavirus”, “Wuhan coronavirus”, “2019-nCoV”, “X-Ray Computed Tomography”, “Polymerase Chain Reaction”, “Reverse Transcriptase PCR”, and “PCR Reverse Transcriptase”. All relevant case- series, cross-sectional, and cohort studies were selected. Data extraction was done in Excel 2007 (Microsoft Corporation, Redmond, CA) and their analysis was performed using STATA v.14.0SE (College Station, TX, USA) and RevMan 5.Result: From first recruited 668 articles we end up to the final 47 studies, which comprised a total sample size of 4238 patients. In compare to RT-PCR, the overall sensitivity, specificity, positive predictive value, and negative predictive value of chest CT scan were 86% (95% CI: 83% -90%), 43 % (95% CI: 26% -60%), 67% (95% CI: 57% -78%), and 84% (95% CI: 74% -95%) respectively. However the RT-PCR should be repeated for three times in order to give the 99% accuracy especially in negative samples.Conclusion: According to the acceptable sensitivity of chest CT scan, it can be employed complement to RT-PCR to diagnosis patients who are clinically suspicious for nCoV.

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Analysis of the demand for detection of SARSCoV-2 in a health area of Spain

Revista Española de Quimioterapia ◽

10.37201/req/089.2020 ◽

2000 ◽

Vol 33 (6) ◽

pp. 422-429

Author(s):

Jesús García-Cruces ◽

Raúl López Izquierdo ◽

Marta Domínguez-Gil ◽

Luis López-Urrutia ◽

Mónica de Frutos ◽

...

Keyword(s):

Primary Care ◽

Polymerase Chain Reaction ◽

Positive Result ◽

Diagnostic Performance ◽

Descriptive Analysis ◽

Rt Pcr ◽

Chain Reaction ◽

Health Area ◽

Reference Hospital ◽

Polymerase Chain

Introduction. Since the discovery of the SARS-CoV-2 virus, the polymerase chain reaction technique (RT-PCR) has become the fundamental method for diagnosing the disease in its acute phase. The objective is to describe the demand-based series of RT-PCR determinations received at a Microbiology Service at a third-level reference hospital for a health area for three months spanning from the onset of the epidemic by SARS-CoV-2. Methods. A retrospective analysis of the total of the RT-PCR requested in the Microbiology Service analyzed from 02/25/2020 to 05/26/2020 (90 days) has been carried out. They have been grouped by epidemiological weeks and by the petitioner service. A descriptive analysis was carried out by age, gender and number of requests for each patient. In the tests carried out, a confidence level of 95% (p <0.05) was considered significant. Results. A total of 27,106 requests was received corresponding to 22,037 patients. Median age 53.7 (RIC 40.9-71.7) years, women: 61.3%. Proportion of patients with any positive RT-PCR: 14%. Of the total requests for RT-PCR, positive 3,710. Week 13 had the highest diagnosis performance (39.0%). The primary care has been the service thar has made the most requests (15,953). Patients with 3 or more RT-PCR: 565, of them, 19 patients had a positive result after previously having a negative one. Conclusions. Requests have been increasing depending on the evolution of the epidemic. The RT-PCR has a high diagnostic performance in the phases of highest contagiousness and / or transmissibility of the virus.

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Computed Tomography of the Chest in COVID-19: A Pictorial Review of Indian Patients

Annals of the National Academy of Medical Sciences (India) ◽

10.1055/s-0041-1728973 ◽

2021 ◽

Author(s):

Kumble Seetharama Madhusudhan ◽

Deep Narayan Srivastava ◽

Kushagra V. Garg ◽

Niranjan Khandelwal

Keyword(s):

Computed Tomography ◽

Polymerase Chain Reaction ◽

Severe Acute Respiratory Syndrome ◽

Ct Scan ◽

High Accuracy ◽

Rt Pcr ◽

Chain Reaction ◽

Pictorial Review ◽

The Common ◽

Polymerase Chain

AbstractThe Coronavirus disease 2019, caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), has evolved into a pandemic and has affected more than 130 million people globally to date and continues to infect more. The disease primarily involves the respiratory system and manifests as fever, dry cough, dyspnea, and myalgia. Nearly half of the infected patients may be asymptomatic. The real-time reverse transcriptase polymerase chain reaction (RT-PCR) performed on the blood or respiratory samples is the diagnostic test with high accuracy. Although imaging with CT is not routinely indicated in this disease, this modality may provide a quick answer and assist in making a diagnosis in certain situations. In addition, imaging with CT also aids in evaluating the progress of the disease and in prognostication. A thorough knowledge of the common findings on the CT scan helps a radiologist in suggesting a diagnosis when it is performed in unsuspected patients. In this review, we describe the common and uncommon chest findings of COVID-19 on the CT scan.

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Peran pemeriksaan radiologis pada diagnosis Coronavirus disease 2019

Jurnal Kedokteran Syiah Kuala ◽

10.24815/jks.v20i1.18300 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Budi Yanti ◽

Ulfa Hayatun

Keyword(s):

Polymerase Chain Reaction ◽

Ct Scan ◽

Real Time ◽

False Negative ◽

Ground Glass Opacity ◽

Rt Pcr ◽

Chain Reaction ◽

Lung Abnormalities ◽

Polymerase Chain ◽

Radiological Examinations

Abstrak. Coronavirus Disease 19 (COVID-19) telah menjadi pandemi di seluruh dunia dengan angka kejadian yang terus meningkat di beberapa negara. Kecepatan dan ketepatan diagnosis diperlukan untuk mencegah perburukan kondisi pasien. Real-Time Transcription Polymerase Chain Reaction (RT-PCR) sampai saat ini masih menjadi baku emas untuk menegakkan diagnosis COVID-19, namun uji diagnostik ini dilaporkan banyak menunjukkan hasil negatif palsu. Pemeriksaan radiologi berupa foto toraks dan CT-Scan dada banyak dilakukan untuk menunjang diagnosis COVID-19. Gambaran foto toraks yang paling sering ditemukan adalah konsolidasi, ground-glass opacity (GGO), distribusi bilateral, perifer dan di lobus bawah paru-paru, namun pemeriksaan ini dianggap tidak sensitif untuk menemukan kelainan paru pada tahap awal penyakit. Meskipun demikian, foto toraks dapat digunakan untuk memantau perkembangan kelainan paru akibat COVID-19, salah satunya dengan metode Brixia Score. Pada sisi lain,CT-scan dada dinilai lebih sensitif daripada foto toraks serta mampu menunjukkan kelainan paru tahap awal pada pasien dengan hasil RT-PCR yang negatif. Gambaran pada CT-scan dada umumnya menunjukkan GGO, konsolidasi, crazy-paving stone, dan air bronchogram. CT-scan dapat mengurangi angka negatif palsu pada RT-PCR dan sebagai alat skrining pada pasien yang dicurigai COVID-19 di lokasi epidemis saat hasil RT-PCR tidak tersedia. Penggunaan pemeriksaan radiologi dan RT-PCR dapat menghemat waktu serta membantu diagnosis dan manajemen COVID-19. Kata Kunci: Pencitraan COVID-19, Radiologi SARS-CoV-2Abstract. Coronavirus Disease 19 (COVID-19) has become a worldwide pandemic with an increasing incidence in several countries. Speed and accuracy of diagnosis are needed to prevent worsening of patient's condition. Real-Time Transcription Polymerase Chain Reaction (RT-PCR) is still a gold standard of COVID-19 diagnosis, however, this test shown false negative results in several case. Radiological examinations, chest X-Ray (CXR) and CT scan, are used to support the diagnosis. The most commonly found in CXR are consolidation, ground-glass opacity (GGO), bilateral distribution, peripheral and in the lower lobe, but this examination is insensitive to find lung abnormalities in early stages of disease. However, CXR can be used to monitor the development of lung abnormalities due to COVID-19, such as the Brixia Score method. On the other hand, CT-Scan is more sensitive than CXR and able to show early lung abnormalities in negative RT-PCR results. CT scan show the presence of GGO, consolidation, crazy-paving stone, and air bronchogram. CT-scanning can reduce the false-negative rate on RT-PCR and become a screening tool in suspected COVID-19 patients at epidemic area where RT-PCR is not available. The use of radiological examinations and RT-PCR can save the time and help in the diagnosis and management of COVID-19.Keywords: COVID-19’s Radiology, Imaging of SARS-CoV-2

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147 A Meta-Analysis Comparing the Diagnostic Accuracy of Initial RT-PCR And CT Scan in Suspected COVID-19 Patients

British Journal of Surgery ◽

10.1093/bjs/znab134.040 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

S Siddiqui ◽

M Mair ◽

M Hussain ◽

S Das

Keyword(s):

Diagnostic Accuracy ◽

Ct Scan ◽

Meta Analysis ◽

Included Study ◽

Computed Tomography Scan ◽

Rt Pcr ◽

Chain Reaction ◽

Polymerase Chain ◽

Tomography Scan

Abstract Introduction Reverse transcriptase Polymerase chain reaction(RT-PCR) is considered as the gold standard diagnostic test for COVID-19 infection. It’s accuracy has been doubted and subsequently had effects on planning, performing operations causing. Research has suggested the use of Computed Tomography Scan instead. In this study we performed a meta-analysis comparing the diagnostic accuracy of CT compared to RTPCR. Method Our systematic review and meta-analysis were undertaken as per PRISMA guidelines. The methodological quality of each included study was assessed using the QUADAS-2 tool on RevMan 5.3. We performed data analyses using Stata version 12. Results Sensitivity estimates for CT scan ranged from 0.69 to 1.00 and for RT-PCR varied ranging from 0.47 to 1.00. The pooled estimate of sensitivity for CT was 0.95 (95% CI – 0.88-0.98) and specificity was 0.31 (95% CI – 0.035-0.84). It was found that specificity of initial RT-PCR(100%) was higher than CT(31%). With respect to sensitivity, CT(95%) was superior to RT-PCR(91%) p (0.000) Conclusions Sensitivity of CT is significantly higher than RT-PCR for detecting COVID-19 infection, however as CT findings are not specific. Since CT scans are readily available, protocols can be developed to utilise it to minimalize delay in planning surgery.

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Descriptive Analysis of Chest Computed Tomography Scan in Coronavirus Disease 2019 Pneumonia: Correlation with Reverse Transcription-polymerase Chain Reaction and Clinical Features

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.6224 ◽

2021 ◽

Vol 9 (B) ◽

pp. 865-871

Author(s):

Rusli Muljadi ◽

Mira Yuniarti ◽

Ricardo Tan ◽

Teodorus Alfons Pratama ◽

Ignatius Bima Prasetya ◽

...

Keyword(s):

Social Sciences ◽

Ct Scan ◽

Cross Sectional Study ◽

Chest Ct ◽

Rt Pcr ◽

Chain Reaction ◽

Cross Sectional ◽

The Social ◽

Polymerase Chain ◽

Chest Ct Scan

BACKGROUND: Reverse transcriptase-polymerase chain reaction (RT-PCR) is the primary diagnostic tool to confirm coronavirus disease 2019 (COVID-2019) due to its high specificity. However, it has relatively low sensitivity and time consuming. In contrast, chest computed tomography (CT) has high sensitivity and achieves quick results. It may, therefore, play a critical role in screening and diagnosing COVID-19. A cross-sectional study was done in 212 patients with confirmed cases and patients under surveillance for COVID-19 tested for RT-PCR and chest CT scan. Statistical analysis was performed using SPSS Version 23 (Statistical Package for the Social Sciences, IBM Corp., Armonk, NY, USA). AIM: We aim to investigate the diagnostic value of chest CT in correlation to RT-PCR in Indonesia. METHODS: A cross-sectional study was done in 212 patients with confirmed cases and patients under surveillance for COVID-19 tested for RT-PCR and chest CT scan. Statistical analysis was performed using SPSS Version 23 (Statistical Package for the Social Sciences, IBM Corp., Armonk, NY, USA). RESULTS: From a total of 212 patients, 92% of them were diagnosed as confirmed cases of COVID-19. It was found that the sensitivity of CT scan for COVID-19 patients was 72.3% (65.5% and 78.5%) with positive predictive value (PPV) of 93.9% (90.9% and 96.0%) and the sensitivity and PPV improve in symptomatic patients. Typical chest CT scan lesions were 8.0 times which were more likely (3.9–16.4; p <0.001) to be detected in symptomatic patients while patients with severe CT scan findings were 4.4 times more likely (3.0–6.5; p <0.001) to be admitted to the intensive care unit. CONCLUSION: A high PPV suggests that a chest CT scan can detect COVID-19 lesions, but the absence of the lesions would not exclude the disease’s presence.

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Upregulation of the miRNA-155, miRNA-210, and miRNA-20b in psoriasis patients and their relation to IL-17

International Journal of Immunopathology and Pharmacology ◽

10.1177/2058738420933742 ◽

2020 ◽

Vol 34 ◽

pp. 205873842093374 ◽

Cited By ~ 1

Author(s):

Mohamed El-Komy ◽

Iman Amin ◽

Marwa Safwat El-Hawary ◽

Dina Saadi ◽

Olfat Shaker

Keyword(s):

Serum Levels ◽

Enzyme Linked Immunosorbent Assay ◽

Epigenetic Mechanisms ◽

Rt Pcr ◽

Chain Reaction ◽

Lesional Skin ◽

Immune Mediated ◽

Elisa Technique ◽

Polymerase Chain ◽

The Relationship

Psoriasis is an immune-mediated disease, with genetic background and triggering environmental factors; however, several gaps are still present in understanding the intertwined relationship between these elements. Epigenetic mechanisms, including microRNAs (miRNAs), play an important role in the pathogenesis of psoriasis. The relationship between interleukin (IL)-17, a key cytokine in psoriasis, and these epigenetic mechanisms still needs to be elucidated. This study aimed at assessing the expression of miRNA-155, miRNA-210, and miRNA-20b in skin and sera of psoriasis patients in relation to IL-17 levels. For 20 psoriasis patients and 20 matching controls, the expression of miRNA-155, miRNA-210, and miRNA-20b was assessed using real-time polymerase chain reaction (RT-PCR), whereas IL-17/IL-17A levels were measured using quantitative enzyme-linked immunosorbent assay (ELISA) technique. MiRNA-155 expression was significantly higher in lesional skin compared to controls ( P = 0.001). MiRNA-210 expression was significantly higher in both, lesional skin ( P = 0.010) and sera of patients ( P = 0.001) in comparison with controls. A statistically significant positive correlation was found between serum miRNA-210 expression and serum levels of IL-17/IL-17A ( P = 0.010, rs = 0.562). MiRNA-20b lesional and non-lesional expression was significantly higher than controls ( P < 0.001; P = 0.018). In conclusion, the expression of miRNA-155, miRNA-210, and miRNA-20b is exaggerated in psoriasis and they may be involved in disease pathogenesis. A possible relationship between miRNA-210 and IL-17 may be suggested; however, further studies are still needed to verify this relation.

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