Chest Computed Tomography for SARS-CoV-2 Screening before Bariatric and Metabolic Surgery during the COVID-19 Pandemic

Abstract Introduction: Given that obesity is a risk factor for adverse outcomes in COVID-19, bariatric and metabolic surgery (BMS) has become increasingly critical. Computed tomography (chest CT scan) may be a valuable preoperative screening method for BMS candidates during this COVID-19 pandemic.Methods: A prospective, single-center study was conducted in June 2020. Two study cohorts were evaluated: a surgical team group and a BMS patient group. Screening was performed with RT-PCR and a CT scan. The COVID-19 Reporting and Data System (CO-RADS) assessment was used as mandatory COVID-19 screening. Patients classified as category 1 and 2 were considered safe to undergo BMS; category ≥3 surgery was canceled. The BMS patient group was monitored for 28 days after surgery for SARS-CoV-2 infection. Additionally, postoperative complications, adverse effects, and deaths were tracked.Results: The study included 240 participants, comprising the surgical team group (n = 6) and the BMS patient group (n = 234). In total, 213 were female (88.8%), the median age was 40 years, and the median weight and BMI were 111.1 kg and 40.23 kg/m2 respectively. Only CO-RADS category 1 was reported in the surgical team group, while in the BMS patient group, category 1 was reported in 231 participants (98.7%). In the BMS patient group, during the follow-up period, only two participants (0.83%) tested positive for COVID-19 (RT-PCR). No deaths were reported. Conclusion: Chest CT scans are useful for detecting SARS-CoV-2 in patients undergoing BMS, therefore enable healthcare and surgical teams to perform surgeries safely during this COVID-19 pandemic.

Download Full-text

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

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.331 ◽

2020 ◽

Vol 41 (12) ◽

pp. 1375-1377 ◽

Cited By ~ 1

Author(s):

Aditya S. Shah ◽

Lara A. Walkoff ◽

Ronald S. Kuzo ◽

Matthew R. Callstrom ◽

Michael J. Brown ◽

...

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Tertiary Care ◽

Case Series ◽

Chest Ct ◽

Study Cohort ◽

Rt Pcr ◽

Chest Computed Tomography ◽

Tertiary Care Medical Center ◽

Asymptomatic Patients

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.

Download Full-text

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.

Download Full-text

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.

Download Full-text

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.

Download Full-text

Cancer surgery during the COVID‐19 pandemic: The experience of a comprehensive cancer center performing preoperative screening by RT‐PCR and chest CT scan

Journal of Surgical Oncology ◽

10.1002/jso.26335 ◽

2021 ◽

Vol 123 (4) ◽

pp. 815-822

Author(s):

Joanne Guerlain ◽

Fabienne Haroun ◽

Alexandra Voicu ◽

Charles Honoré ◽

Franck Griscelli ◽

...

Keyword(s):

Ct Scan ◽

Chest Ct ◽

Cancer Surgery ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Preoperative Screening ◽

Rt Pcr ◽

Chest Ct Scan

Download Full-text

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.

Download Full-text

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

Insights into Imaging ◽

10.1186/s13244-020-00957-5 ◽

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.

Download Full-text

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.

Download Full-text

(F)utility of computed tomography of the chest in the presence of pleural effusion

Pleura and Peritoneum ◽

10.1515/pp-2017-0019 ◽

2017 ◽

Vol 2 (4) ◽

pp. 181-186 ◽

Cited By ~ 1

Author(s):

Tilak Pathak ◽

Malvinder S. Parmar

Keyword(s):

Computed Tomography ◽

Pleural Effusion ◽

Ct Scan ◽

Clinical Management ◽

Chest Ct ◽

X Ray ◽

Contrast Enhanced ◽

Plain Chest ◽

Chest X Ray ◽

Chest Ct Scan

AbstractBackgroundPleural effusion is common and can cause significant morbidity. The chest X-ray is often the initial radiological test, but additional tests may be required to reduce uncertainty and to provide additional diagnostic information. However, additional exposure and unnecessary costs should be prevented. The objective of the study was to assess the clinical benefit of an additional chest computed tomography (CT) scan over plain chest X-ray alone in the management of patients with pleural effusion.MethodsRetrospective analysis in 94 consecutive patients with pleural effusion who underwent chest X-ray and CT scan over an 18-month period in a single institution. All chest X-ray and CT scan reports were compared and correlated with clinical parameters in order to assess their utility in the clinical management. No blinding was applied.ResultsIn 75 chest CT scan reports (80 %), information provided by the radiologist did not change clinical management when compared to plain chest X-ray alone and did not provide any additional information over chest X-ray. Only 2/49 (4 %) of the native chest CT scan reports provided clinically relevant information as compared to 17/45 (38 %) contrast-enhanced chest CT scan reports (p<0.001).ConclusionsIn this retrospective cohort of patients with pleural effusion, an additional chest CT scan was not useful in the majority of patients. However, if a chest CT scan is required, then a contrast-enhanced study after pleural aspiration should be performed. Further prospective studies are required to confirm these findings.

Download Full-text

Role of the Bronchoalveolar Lavage in Noncritically Ill Patients during the SARS-CoV-2 Epidemic

Pulmonary Medicine ◽

10.1155/2020/9012187 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Olivier Taton ◽

Emmanuelle Papleux ◽

Benjamin Bondue ◽

Christiane Knoop ◽

Sébastien Van Laethem ◽

...

Keyword(s):

Health Care ◽

Bronchoalveolar Lavage ◽

Ct Scan ◽

Chest Ct ◽

Care Staff ◽

Immunocompromised Patients ◽

Care Providers ◽

Rt Pcr ◽

The Impact ◽

Chest Ct Scan

Background. Bronchoalveolar lavage (BAL) is currently not recommended in noncritically ill patients for the diagnosis of SARS-CoV-2 infection. Indeed, the diagnosis is based on the RT-PCR test on a nasopharyngeal swab (NPS) and abnormal findings on the chest CT scan. However, the sensitivity of the NPS and the specificity of the chest CT scan are low. Results of BAL in case of negative NPS testing are underreported, especially in the subgroup of immunocompromised patients. Objectives. The added value of BAL in the management of unstable, but noncritically ill patients, suspected of having SARS-CoV-2 infection despite one previous negative NPS and the side effects of the procedure for the patients and the health-care providers, were assessed during the epidemic peak of the COVID-19 outbreak in Belgium. Methods. This multicentric study included all consecutive noncritically ill patients hospitalized with a clinical and radiological suspicion of SARS-CoV-2 infection but with a negative NPS. BAL was performed according to a predefined decisional algorithm based on their state of immunocompetence, the chest CT scan features, and their respiratory status. Results. Among the 55 patients included in the study, 14 patients were diagnosed with a SARS-CoV-2 infection. Interestingly, there was a relationship between the cycle threshold of the RT-PCR and the interval of time between the symptom onset and the BAL procedure ( Pearso n ’ s correlation coefficient = 0.8 , p = 0.0004 ). Therapeutic management was changed in 33 patients because another infectious agent was identified in 23 patients or because an alternative diagnosis was made in 10 patients. In immunocompromised patients, the impact of BAL was even more marked (change in therapy for 13/17 patients). No significant adverse event was noted for patients or health-care staff. All health-care workers remained negative for SARS-CoV-2 NPS and serology at the end of the study. Conclusions. In this real-life study, BAL can be performed safely in selected noncritically ill patients suspected of SARS-CoV-2 infection, providing significant clinical benefits that outweigh the risks.

Download Full-text