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26-06-2023 | COVID-19 | Original Article

Digital tomosynthesis improves chest radiograph accuracy and reduces microbiological false negatives in COVID-19 diagnosis

Authors: Juana María Plasencia-Martínez, Ana Moreno-Pastor, Marina Lozano-Ros, Cristina Jiménez-Pulido, Ignacio Herves-Escobedo, Gloria Pérez-Hernández, José María García-Santos

Published in: Emergency Radiology | Issue 4/2023

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Abstract

Purpose

Diagnosing pneumonia by radiograph is improvable. We aimed (a) to compare radiograph and digital thoracic tomosynthesis (DTT) performances and agreement for COVID-19 pneumonia diagnosis, and (b) to assess the DTT ability for COVID-19 diagnosis when polymerase chain reaction (PCR) and radiograph are negative.

Methods

Two emergency radiologists with 11 (ER1) and 14 experience-years (ER2) retrospectively evaluated radiograph and DTT images acquired simultaneously in consecutively clinically suspected COVID-19 pneumonia patients in March 2020–January 2021. Considering PCR and/or serology as reference standard, DTT and radiograph diagnostic performance and interobserver agreement, and DTT contributions in unequivocal, equivocal, and absent radiograph opacities were analysed by the area under the curve (AUC), Cohen’s Kappa, Mc-Nemar’s and Wilcoxon tests.

Results

We recruited 480 patients (49 ± 15 years, 277 female). DTT increased ER1 (from 0.76, CI95% 0.7–0.8 to 0.79, CI95% 0.7–0.8; P=.04) and ER2 (from 0.77 CI95% 0.7–0.8 to 0.80 CI95% 0.8–0.8, P=.02) radiograph—AUCs, sensitivity, specificity, predictive values, and positive likelihood ratio. In false negative microbiological cases, DTT suggested COVID-19 pneumonia in 13% (4/30; P=.052, ER1) and 20% (6/30; P=.020, ER2) more than radiograph. DTT showed new or larger opacities in 33–47% of cases with unequivocal opacities in radiograph, new opacities in 2–6% of normal radiographs and reduced equivocal opacities by 13–16%. Kappa increased from 0.64 (CI95% 0.6–0.8) to 0.7 (CI95% 0.7–0.8) for COVID-19 pneumonia probability, and from 0.69 (CI95% 0.6–0.7) to 0.76 (CI95% 0.7–0.8) for pneumonic extension.

Conclusion

DTT improves radiograph performance and agreement for COVID-19 pneumonia diagnosis and reduces PCR false negatives.
Appendix
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Literature
1.
go back to reference Coronavirus disease (COVID-19) – World Health Organization n.d.https://www.who.int/emergencies/diseases/novel-coronavirus-2019 (accessed March 5, 2023) Coronavirus disease (COVID-19) – World Health Organization n.d.https://​www.​who.​int/​emergencies/​diseases/​novel-coronavirus-2019 (accessed March 5, 2023)
Metadata
Title
Digital tomosynthesis improves chest radiograph accuracy and reduces microbiological false negatives in COVID-19 diagnosis
Authors
Juana María Plasencia-Martínez
Ana Moreno-Pastor
Marina Lozano-Ros
Cristina Jiménez-Pulido
Ignacio Herves-Escobedo
Gloria Pérez-Hernández
José María García-Santos
Publication date
26-06-2023
Publisher
Springer International Publishing
Published in
Emergency Radiology / Issue 4/2023
Print ISSN: 1070-3004
Electronic ISSN: 1438-1435
DOI
https://doi.org/10.1007/s10140-023-02153-6

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