The Diagnostic Value of CT scans in the Process of Diagnosing COVID-19 in medical Centers

2021 ◽  
Author(s):  
Afshin Ostovar ◽  
Elham Ehsani-Chimeh ◽  
Zeinab Fakoorfard
Keyword(s):  
Ct Scan ◽  
Sensitivity And Specificity ◽  
Clinical Decision Making ◽  
Diagnostic Value ◽  
Chest Ct ◽  
Rapid Review ◽  
Ct Scans ◽  
Rt Pcr ◽  
Medical Centers ◽  
Pcr Test

Background: Coronavirus disease (COVID-19) has spread around the world since the beginning of 2020. The definitive diagnosis of COVID-19 is the RT-PCR laboratory test. However, because of low sensitivity, the chest CT scan has become important for the rapid diagnosis and clinical decision-making. Objectives: This study aims to define CT scan’ diagnostic value in diagnosing COVID-19 in medical centers. Methods: This study is a rapid health technology assessment (HTA) and had two major phases. In phase 1, a rapid review was done for defining the sensitivity and specificity rate of CT. During this phase, studies related to the diagnostic and technical data on the use of CT in the diagnosis of COVID-19 were reviewed, and the sensitivity and specificity of CT in these studies were extracted. In phase 2, sequential testing was run to evaluate the diagnostic value of chest CT to diagnose COVID-19 according to two scenarios before and after adding RT-PCR test results. Results: CT scan has a high sensitivity for diagnosing cases of COVID-19. Due to its low specificity, relying on CT scans to diagnose COVID-19 alone in medical centers can lead to a significant proportion of false-positive cases. This study showed that if the probability of COVID-19 before the CT scan were about 50%, with a positive CT scan, this probability would be between 60 and 70% depending on the CT specificity. Conclusions: With the available evidence, the use of a CT scan alone is not sufficient for diagnosis. The RT-PCR test is also necessary to improve the diagnosis and continue the treatment and isolation of patients.

scholarly journals The role of CT imaging for management of COVID-19 in epidemic area: early experience from a University Hospital

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Vikram rao Bollineni ◽  
Koenraad Hans Nieboer ◽  
Seema Döring ◽  
Nico Buls ◽  
Johan de Mey
Keyword(s):  
Ct Scan ◽  
Predictive Value ◽  
Ct Imaging ◽  
Chest Ct ◽  
University Hospital ◽  
Rt Pcr ◽  
Ct Findings ◽  
Epidemic Area ◽  
Chest Ct Scan ◽  
Pcr Test

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.

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

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.

scholarly journals Association Between rRT-PCR Test Results Upon Admission and Outcome in Hospitalized Chest CT-Positive COVID-19 Patients: A Provincial Retrospective Cohort with Active Follow-up

2021 ◽  
Vol 16 (4) ◽  
Author(s):  
Saeed Nemati ◽  
Hamid Reza Najari ◽  
Anita Eftekharzadeh ◽  
Amir Mohammad Kazemifar ◽  
Ali Qandian ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ct Scan ◽  
Retrospective Cohort ◽  
Reference Group ◽  
Case Fatality ◽  
Chest Ct ◽  
Multivariate Logistic Regression Model ◽  
Test Results ◽  
Rt Pcr ◽  
Pcr Test

Background: The coronavirus disease 2019 (COVID-19) pandemic imposed the most devastating challenge on healthcare systems worldwide. Iran was among the first countries that had to confront serious shortages in reverse-transcriptase-polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) and ventilators availabilities throughout the COVID-19 outbreak. Objectives: This study aimed to investigate the clinical course of hospitalized COVID-19 patients with different real-time RT-PCR test results during the first three weeks of the outbreak in Qazvin province, Iran. Methods: In this retrospective cohort study, patients with a positive chest computed tomography (CT) scan for COVID-19 who were admitted to all 12 hospitals across Qazvin province, Iran, between February 20 and March 11, 2020, were included and followed up until March 27, 2020. A multivariate logistic regression model was applied to compare the independent associates of death among COVID-19 patients. Then, patients were categorized into six groups based on admission to the intensive care unit (ICU) and rRT-PCR test status (positive, negative, or no test). Also, multilevel logistic regression was used to compare the odds of surviving in each group against the reference group (PCR negative patients not-received ICU) to show if the rational allocation of ICU occurred while its capacity is limited. Results: In this study, we included 998 patients (57% male; median age: 54 years) with positive chest CT scan changes. Among them, 558 patients were examined with rRT-PCR test and 73.8% tested positive. Case fatality rate (CFR) was 20.68 and 7.53% among hospitalized patients with positive and negative tests, respectively. While only 5.2% of patients were admitted to the ICU, CFR outside ICU was 17.70 and 4.65% in patients with positive and negative results not admitted to the ICU, respectively. Conclusions: Total CFR in all hospitalized COVID-19 patients in Qazvin province during the first three weeks of the pandemic was 11.7%. Also, according to the results, the main risk factors included a positive rRT-PCR test, age more than 70 years, and having two or more comorbidities or just immunodeficiency disorders. Hence, the ICU admission criteria or prioritized ICU beds allocation should be considered with more emphasis on rRT-PCR results when the capacity of ICU beds is low.

scholarly journals How Did Radiologists’ Diagnostic Accuracy Have Changed in Covid-19 Pneumonia; a Single Centre Retrospective Study

2021 ◽  
Author(s):  
Ali Murat Koc ◽  
Levent Altın ◽  
Türker Acar ◽  
Alpay Arı ◽  
Zehra Hilal Adıbelli
Keyword(s):  
Chest Ct ◽  
Ct Scans ◽  
Test Results ◽  
Rt Pcr ◽  
Educational Activities ◽  
Admission Rates ◽  
Interpretation Errors ◽  
Concomitant Factors ◽  
Level Of Experience ◽  
Pcr Test

Aims Delay and false positivity in PCR test results have necessitated accurate chest CT reporting for management of patients with COVID-19 suspected symptoms. Pandemic related workload and level of experience on covid-dedicated chest CT scans might have effected diagnostic performance of on-call radiologists. The aim of this study is to reveal the interpretation errors in chest-CT reports of COVID-19 suspected patients admitted to the ER. Methods COVID-19 dedicated chest-CT scans which were performed between March and June 2020 were re-evaluated and compared with the former reports of these scans and PCR test results. CT scan results were classified into four groups. Parenchymal involvement ratios, radiology departments’ workload, COVID-19 related educational activities have examined. Results Out of 5721 Chest-CT scans, 783 CTs belonging to 664 patients (340 female, 324 male) were included to this study. RT-PCR test was positive in 398; negative in 385 cases. PCR positivity was found to be highest in “normal” and “typical for covid” groups whereas lowest in “atypical for covid” and “not covid” groups. 5-25% parenchymal involvement ratio was found in 84.2% of the cases. Regarding number of chest CT scans performed, radiologists’ workload have found to be increased six-folds compared to the same months of the former year. With the re-evaluation, a total of 145 IEs (18.5%) have been found. IEs were mostly precipitated in the first two months (88.3%) and mostly in “not covid” class (60%) regardless of PCR positivity. COVID-19 and radiology entitled educational activities along with the ER admission rates within the first two months of pandemic have seem to be related with the decline of IEs within time. Conclusion COVID-19 pandemic made a great impact on radiology departments with an inevitable burden of daily chest-CT reporting. This workload and concomitant factors have possible effects on diagnostic challenges in COVID-19 pneumonia.

scholarly journals Sensitivity and specificity of chest CT scan based on RT-PCR in COVID-19 diagnosis

2021 ◽  
Vol 86 (1) ◽  
pp. 74-77
Author(s):  
Alireza Mirahmadizadeh ◽  
Zahra Pourmontaseri ◽  
Sima Afrashteh ◽  
Mehrnaz Hosseinzadeh ◽  
Jalal Karimi ◽  
...  
Keyword(s):  
Ct Scan ◽  
Sensitivity And Specificity ◽  
Chest Ct ◽  
Rt Pcr ◽  
Chest Ct Scan

scholarly journals The sensitivity and specificity of chest CT in the diagnosis of COVID-19

2020 ◽  
Author(s):  
Anita Kovács ◽  
Péter Palásti ◽  
Dániel Veréb ◽  
Bence Bozsik ◽  
András Palkó ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Gold Standard ◽  
Clinical Symptoms ◽  
Close Contact ◽  
Chest Ct ◽  
Added Value ◽  
Ct Scans ◽  
Diagnostic Tools ◽  
Diagnostic Process ◽  
Rt Pcr

Abstract Purpose The identification of patients infected by SARS-CoV-2 is highly important to control the disease; however, the clinical presentation is often unspecific and a large portion of the patients develop mild or no symptoms at all. For this reason, there is an emphasis on evaluating diagnostic tools for screening. Chest CT scans are emerging as a useful tool in the diagnostic process of viral pneumonia cases associated with COVID-19. This review examines the sensitivity, specificity, and feasibility of chest CT in detecting COVID-19 compared with real-time polymerase chain reaction (RT-PCR). Methods Sensitivity and specificity of chest CT in detecting COVID-19 in its various phases was compared using RT-PCR as a gold standard. A “reverse calculation approach” was applied and treated chest CT as a hypothetical gold standard and compared RT-PCR to it point out the flaw of the standard approach. Results High sensitivity (67–100%) and relatively low specificity (25–80%) was reported for the CT scans. However, the sensitivity of RT-PCR was reported to be modest (53–88%), hence cannot serve as an appropriate ground truth. The “reverse calculation approach” showed that CT could have a higher specificity (83–100%) if we consider the modest sensitivity of the RT-PCR. Conclusions The sensitivity and specificity of the chest CT in diagnosing COVID-19 and the radiation exposure have to be judged together. Arguments are presented that chest CT scans have added value in diagnosing COVID-19 especially in patients, who exhibit typical clinical symptoms and have negative RT-PCR results in highly infected regions. Key Points • CT scans have higher specificity if we take into account the low sensitivity of the RT-PCR. • Avoid chest CT as a sole diagnostic approach for COVID-19 infection. • Patients who had negative RT-PCR result with typical clinical symptoms in highly infected regions or with close contact of COVID-19-infected patients; the use of chest CT is warranted.

scholarly journals Meta-analysis: COVID-19 diagnosis in chest CT—master key for radiologists

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Soheil Hassanipour ◽  
Omid Azadbakht ◽  
Zari Dehnavi ◽  
Mohsen Shafiee ◽  
Ahmad Badeenezhad ◽  
...  
Keyword(s):  
Ct Scan ◽  
Early Stage ◽  
Meta Analysis ◽  
Chest Ct ◽  
Observation Level ◽  
Test Sensitivity ◽  
Medical Centers ◽  
Sensitivity Level ◽  
Correct Location ◽  
Pcr Test

Abstract Background COVID-19 was discovered in February in China. Due to the high prevalence of the disease, early detection and rapid isolation of patients are the vital points for controlling the outbreak. The purpose of this study was to determine the correct location of chest CT scan in the diagnosis of COVID-19. Main text The current study is a systematic review and meta-analysis. 2959 papers were found in all national and international databases. The study has been reported based on the PRISMA checklist. All analyses were done by CMA Ver. 2 software. The statistical analysis results show that the GGO observation level in the available shape was 46% in CT scan results, and the consolidation observation level in the general form was 33% in CT scan results. Pleural effusion was 7%, and linear opacity observation level was 24% in CT scan results in the general form. The CT scan test sensitivity level was gained 94.7%, and PCR test sensitivity level was achieved as 94.8%. This level was 89% in the early stage. Conclusion The chest CT has about 24% higher diagnostic sensitivity than the PCR test, in the early stage. GGO revealed a declining process and also indicates that GGO is an early symptom of the disease in CT scan. Linear opacity is the reason behind the initial dyspnea in coronavirus suffering patients referring to the medical centers. The extra-pulmonary lesions increase in the last stage of the disease that makes the patient’s worse.

scholarly journals Radiological Features on HRCT and RT-PCR Testing for the Diagnosis of Coronavirus Disease 2019 (COVID-19) in China: A Comparative Study of 78 Cases in Pregnant Women

2020 ◽  
Author(s):  
Ming Deng ◽  
Wenbo Sun ◽  
Jinxiang Hu ◽  
Liejun Mei ◽  
Dinghu Weng ◽  
...  
Keyword(s):  
Ct Scan ◽  
Pregnant Women ◽  
Predictive Value ◽  
Lower Lobe ◽  
Ct Scans ◽  
Imaging Features ◽  
Rt Pcr ◽  
Double Positive ◽  
Quantitative Parameters ◽  
Pcr Test

Abstract BackgroundIn the past four months, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global health threat. In the context of the coronavirus disease 2019 (COVID-19) epidemic, pneumonia is a critical disease that threatens the health of pregnant women and fetuses. We aimed to evaluate the quantitative parameters of CT scans performed on pregnant women with COVID-19 who had different reverse transcription-polymerase chain reaction (RT-PCR) results.MethodsPregnant women with suspected cases of COVID-19 pneumonia (confirmed by next-generation sequencing or RT-PCR) who underwent high-resolution lung CT scans were retrospectively enrolled. Patients were grouped based on the results of the RT-PCR and the first CT scan: group 1 (double positive patients; positive RT-PCR and CT scan) and group 2 (negative RT-PCR and positive CT scan). The imaging features and their distributions were extracted and compared between the two groups.ResultsSeventy-eight patients were admitted to the hospital between Dec 20, 2019, and Feb 29, 2020. The mean age of the patients was 31.82 years (SD 4.1, ranged from 21 to 46 years). The cohort included 14 (17.95%) patients with a positive RT-PCR test and 64 (82.05%) with a negative RT-PCR test, there were 37 (47.44%) patients with a positive CT scan, and 41 (52.56%) patients with a negative CT scan. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CT-based diagnosis of COVID-19 were 85.71%, 60.94%, 32.40%, 95.12% and 65.38%, respectively. COVID-19 pneumonia mainly involved the right lower lobe of the lung. There were 53 semi-quantitative and 59 quantitative parameters, which were compared between the two groups. There were no significant differences in the quantitative parameters. However, the Hellinger distance was significantly different between the two groups, albeit with a limited diagnostic value (AUC = 0.63).ConclusionsPregnant women with pneumonia usually present with typical abnormal signs on CT. Although multidimensional CT quantitative parameters are somewhat different between groups of patients with different RT-PCR results, it is still impossible to accurately predict whether the RT-PCR will be positive, which would allow for the earlier detection of SARS-CoV-2 infection.

scholarly journals Analysis of factors associated early diagnosis in coronavirus disease 2019 (COVID-19)

2020 ◽  
Author(s):  
Jinwei Ai ◽  
Junyan Gong ◽  
Limin Xing ◽  
Renjiao He ◽  
Fangtao Tian ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Ct Scan ◽  
Lymphocyte Count ◽  
False Negative ◽  
False Negative Rate ◽  
Diagnostic Value ◽  
Rt Pcr ◽  
Likelihood Ratios ◽  
High False Negative Rate ◽  
Pcr Test

AbstractBackgroundThe pandemic of coronavirus disease 2019 (COVID-19) has become the first concern in international affairs as the novel coronavirus (SARS-CoV-2) is spreading all over the world at a terrific speed. The accuracy of early diagnosis is critical in the control of the spread of the virus. Although the real-time RT-PCR detection of the virus nucleic acid is the current golden diagnostic standard, it has high false negative rate when only apply single test.ObjectiveSummarize the baseline characteristics and laboratory examination results of hospitalized COVID-19 patients. Analyze the factors that could interfere with the early diagnosis quantitatively to support the timely confirmation of the disease.MethodsAll suspected patients with COVID-19 were included in our study until Feb 9th, 2020. The last day of follow-up was Mar 20th, 2020. Throat swab real-time RT-PCR test was used to confirm SARS-CoV-2 infection. The difference between the epidemiological profile and first laboratory examination results of COVID-19 patients and non-COVID-19 patients were compared and analyzed by multiple logistic regression. Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to assess the potential diagnostic value in factors, which had statistical differences in regression analysis.ResultsIn total, 315 hospitalized patients were included. Among them, 108 were confirmed as COVID-19 patients and 207 were non-COVID-19 patients. Two groups of patients have significance in comparing age, contact history, leukocyte count, lymphocyte count, C-reactive protein, erythrocyte sedimentation rate (p<0.10). Multiple logistic regression analysis showed age, contact history and decreasing lymphocyte count could be used as individual factor that has diagnostic value (p<0.05). The AUC of first RT-PCR test was 0.84 (95% CI 0.73-0.89), AUC of cumulative two times of RT-PCR tests was 0.92 (95% CI 0.88-0.96) and 0.96 (95% CI 0.93-0.99) for cumulative three times of RT-PCR tests. Ninety-six patients showed typical pneumonia radiological features in first CT scan, AUC was 0.74 (95% CI 0.60-0.73). The AUC of patients’ age, contact history with confirmed people and the decreased lymphocytes were 0.66 (95% CI 0.60-0.73), 0.67 (95% CI 0.61-0.73), 0.62 (95% CI 0.56-0.69), respectively. Taking chest CT scan diagnosis together with patients age and decreasing lymphocytes, AUC would be 0.86 (95% CI 0.82-0.90). The age threshold to predict COVID-19 was 41.5 years, with a diagnostic sensitivity of 0.70 (95% CI 0.61-0.79) and a specificity of 0.59 (95% CI 0.52-0.66). Positive and negative likelihood ratios were 1.71 and 0.50, respectively. Threshold of lymphocyte count to diagnose COVID-19 was 1.53×109/L, with a diagnostic sensitivity of 0.82 (95% CI 0.73-0.88) and a specificity of 0.50 (95% CI 0.43-0.57). Positive and negative likelihood ratios were 1.64 and 0.37, respectively.ConclusionSingle RT-PCR test has relatively high false negative rate. When first RT-PCR test show negative result in suspected patients, the chest CT scan, contact history, age and lymphocyte count should be used combinedly to assess the possibility of SARS-CoV-2 infection.

scholarly journals Chest CT features of COVID-19 in the region of Abu Dhabi, UAE- A single institute study

2020 ◽  
Author(s):  
Ghufran Aref Saeed ◽  
Abeer Ahmed Al Helali ◽  
Safaa Almazrouei ◽  
Asad Shah ◽  
Luai A. Ahmed
Keyword(s):  
Ct Scan ◽  
Diagnostic Performance ◽  
Chest Ct ◽  
Abu Dhabi ◽  
Ground Glass ◽  
Rt Pcr ◽  
Negative Results ◽  
Chest Ct Scan ◽  
Ct Features ◽  
Pcr Test

AbstractOBJECTIVEOur aim is to investigate high resolution CT features of COVID-19 infection in Abu Dhabi, UAE, and to compare the diagnostic performance of CT scan with RT-PCR test.METHODSData of consecutive patients who were suspected to have COVID-19 infection and presented to our hospital, was collected from March 2, 2020, until April 12, 2020. All patients underwent RT-PCR test; out of which 53.8% had chest CT scan done. Using RT-PCR as a standard reference, the sensitivity and specify of CT scan was calculated. We also analyzed the most common imaging findings in patients with positive RT-PCR results.RESULTSThe typical HRCT findings were seen in 50 scans (65.8%) out of total positive ones; 44 (77.2%) with positive RT-PCR results and 6 (31.6%) with negative results. The peripheral disease distribution was seen in 86%, multilobe involvement in 70%, bilateral in 82%, and posterior in 82% of the 50 scans.The ground glass opacities were seen in 50/74 (89.3%) of positive RT-PCR group. The recognized GGO patterns in these scans were: rounded 50%, linear 38%, and crazy-paving 24%.Using RT-PCR as a standard of reference, chest HRCT scan revealed sensitivity of 68.8% and specificity of 70%.CONCLUSIONThe commonest HRCT findings in patients with COVID-19 pneumonia were peripheral, posterior, bilateral, multilobe rounded ground glass opacities.

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