Top

Published in:

01-12-2020 | Computed Tomography | Chest

Accuracy of CT in a cohort of symptomatic patients with suspected COVID-19 pneumonia during the outbreak peak in Italy

Authors: Giulia Besutti, Paolo Giorgi Rossi, Valentina Iotti, Lucia Spaggiari, Riccardo Bonacini, Andrea Nitrosi, Marta Ottone, Efrem Bonelli, Tommaso Fasano, Simone Canovi, Rossana Colla, Marco Massari, Ivana Maria Lattuada, Laura Trabucco, Pierpaolo Pattacini, the Reggio Emilia COVID-19 Working Group

Published in: European Radiology | Issue 12/2020

Abstract

Objective

To assess sensitivity/specificity of CT vs RT-PCR for the diagnosis of COVID-19 pneumonia in a prospective Italian cohort of symptomatic patients during the outbreak peak.

Methods

In this cross-sectional study, we included all consecutive patients who presented to the ER between March 13 and 23 for suspected COVID-19 and underwent CT and RT-PCR within 3 days. Using a structured report, radiologists prospectively classified CTs in highly suggestive, suggestive, and non-suggestive of COVID-19 pneumonia. Ground-glass, consolidation, and visual extension of parenchymal changes were collected. Three different RT-PCR-based reference standard definitions were used. Oxygen saturation level, CRP, LDH, and blood cell counts were collected and compared between CT/RT-PCR classes.

Results

The study included 696 patients (41.4% women; age 59 ± 15.8 years): 423/454 (93%) patients with highly suggestive CT, 97/127 (76%) with suggestive CT, and 31/115 (27%) with non-suggestive CT had positive RT-PCR. CT sensitivity ranged from 73 to 77% and from 90 to 94% for high and low positivity threshold, respectively. Specificity ranged from 79 to 84% for high positivity threshold and was about 58% for low positivity threshold. PPV remained ≥ 90% in all cases. Ground-glass was more frequent in patients with positive RT-PCR in all CT classes. Blood tests were significantly associated with RT-PCR and CT classes. Leukocytes, lymphocytes, neutrophils, and platelets decreased, CRP and LDH increased from non-suggestive to suggestive CT classes.

Conclusions

During the outbreak peak (in a high-prevalence setting), CT presented high PPV and may be considered a good reference to recognize COVID-19 patients while waiting for RT-PCR confirmation.

Key Points

• During the epidemic peak, CT showed high positive predictive value and sensitivity for COVID-19 pneumonia when compared with RT-PCR.

• Blood tests were significantly associated with RT-PCR and CT classes.

Available only for authorised users

Guan WJ, Ni ZY, Hu Y et al (2020) China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. https://doi.org/10.1056/NEJMoa2002032

Wu Z, McGoogan JM (2020) Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. https://doi.org/10.1001/jama.2020.2648

Grasselli G, Zangrillo A, Zanella A et al (2020) COVID-19 Lombardy ICU Network. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA. https://doi.org/10.1001/jama.2020.5394

Saglietto A, D’Ascenzo F, Zoccai GB, De Ferrari GM (2020) COVID-19 in Europe: the Italian lesson. Lancet;s0140-6736: 30690–5. https://doi.org/10.1016/S0140-6736(20)30690-5

Patel R, Babady E, Theel ES et al (2020) Report from the American Society for Microbiology COVID-19 International Summit, 23 March 2020: Value of Diagnostic Testing for SARS-CoV-2/COVID-19. mBio 11(2):e00722-20. https://doi.org/10.1128/mBio.00722-20CrossRefPubMedPubMedCentral

Winichakoon P, Chaiwarith R, Liwsrisakun C et al (2020) Negative nasopharyngeal and oropharyngeal swab does not rule out COVID-19. J Clin Microbiol. https://doi.org/10.1128/JCM.00297-20

Wu J, Wu X, Zeng W et al (2020) Chest CT findings in patients with corona virus disease 2019 and its relationship with clinical features. Invest Radiol. https://doi.org/10.1097/RLI.0000000000000670

Zhao W, Zhong Z, Xie X, Yu Q, Liu J (2020) Relation between chest CT findings and clinical conditions of coronavirus disease (COVID-19) pneumonia: a multicenter study. AJR Am J Roentgenol 3:1–6. https://doi.org/10.2214/AJR.20.22976

Pan Y, Guan H, Zhou S et al (2020) Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol. https://doi.org/10.1007/s00330-020-06731-x

10.

Revel MP, Parkar AP, Prosch H et al (2020) COVID-19 patients and the radiology department - advice from the European Society of Radiology (ESR) and the European Society of Thoracic Imaging (ESTI). Eur Radiol:1–7. https://doi.org/10.1007/s00330-020-06865-y

11.

Chen X, Tang Y, Mo Y et al (2020) A diagnostic model for coronavirus disease 2019 (COVID-19) based on radiological semantic and clinical features: a multi-center study. Eur Radiol. https://doi.org/10.1007/s00330-020-06829-2

12.

Bernheim A, Mei X, Huang M et al (2020) Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology. 20:200463. https://doi.org/10.1148/radiol.2020200463CrossRef

13.

Bai HX, Hsieh B, Xiong Z et al (2020) Performance of radiologists in differentiating COVID-19 from viral pneumonia on chest CT. Radiology. 10:200823. https://doi.org/10.1148/radiol.2020200823CrossRef

14.

Li K, Fang Y, Li W et al (2020) CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19). Eur Radiol. https://doi.org/10.1007/s00330-020-06817-6

15.

Lee EYP, Ng MY, Khong PL (2020) COVID-19 pneumonia: what has CT taught us? Lancet Infect Dis 20(4):384–385CrossRefPubMedPubMedCentral

16.

American College of Radiology. ACR recommendations for the use of chest radiography and computed tomography (CT) for suspected COVID-19 infection. March 11, 2020. Available via https://www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/Recommendations-for-Chest-Radiography-and-CT-for-Suspected-COVID19-Infection (Accessed 15 Apr 2020)

17.

Rubin GD, Ryerson CJ, Haramati L et al (2020) The role of chest imaging in patient management during the COVID-19 pandemic: a multinational consensus statement from the Fleischner Society. Radiology. 7:201365. https://doi.org/10.1148/radiol.2020201365CrossRef

18.

Favaloro EJ, Lippi G (2020) Recommendations for minimal laboratory testing panels in patients with COVID-19: potential for prognostic monitoring. Semin Thromb Hemost. https://doi.org/10.1055/s-0040-1709498

19.

Zhou F, Yu T, Du R et al (2020) Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 395(10229):1054–1062. https://doi.org/10.1016/S0140-6736(20)30566-3CrossRefPubMedPubMedCentral

20.

Kim H, Hong H, Yoon SH (2020) Diagnostic performance of CT and reverse transcriptase-polymerase chain reaction for coronavirus disease 2019: a meta-analysis. Radiology. 201343. https://doi.org/10.1148/radiol.2020201343

21.

Caruso D, Zerunian M, Polici M et al (2020) Chest CT features of COVID-19 in Rome, Italy. Radiology 3:201237. https://doi.org/10.1148/radiol.2020201237CrossRef

22.

Ai T, Yang Z, Hou H et al (2020) Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology. 26:200642. https://doi.org/10.1148/radiol.2020200642CrossRef

23.

Fang Y, Zhang H, Xie J et al (2020) Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radiology. 19:200432. https://doi.org/10.1148/radiol.2020200432CrossRef

24.

Lippi G, Simundic AM, Plebani M (2020) Potential preanalytical and analytical vulnerabilities in the laboratory diagnosis of coronavirus disease 2019 (COVID-19). Clin Chem Lab Med. https://doi.org/10.1515/cclm-2020-0285

Title: Accuracy of CT in a cohort of symptomatic patients with suspected COVID-19 pneumonia during the outbreak peak in Italy
Authors: Giulia Besutti
Paolo Giorgi Rossi
Valentina Iotti
Lucia Spaggiari
Riccardo Bonacini
Andrea Nitrosi
Marta Ottone
Efrem Bonelli
Tommaso Fasano
Simone Canovi
Rossana Colla
Marco Massari
Ivana Maria Lattuada
Laura Trabucco
Pierpaolo Pattacini
the Reggio Emilia COVID-19 Working Group
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Computed Tomography
SARS-CoV-2
Pneumonia
COVID-19
Polymerase Chain Reaction
Published in: European Radiology / Issue 12/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-07050-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Accuracy of CT in a cohort of symptomatic patients with suspected COVID-19 pneumonia during the outbreak peak in Italy

Abstract

Objective

Methods

Results

Conclusions

Key Points

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Key Points

Please log in to get access to this content

Other articles of this Issue 12/2020

Use of dental MRI for radiation-free guided dental implant planning: a prospective, in vivo study of accuracy and reliability

Automated identification of chest radiographs with referable abnormality with deep learning: need for recalibration

Solitary solid pulmonary nodules: a CT-based deep learning nomogram helps differentiate tuberculosis granulomas from lung adenocarcinomas

Diffusion tensor imaging of the anterior cruciate ligament graft following reconstruction: a longitudinal study

Impact of coronavirus disease 2019 (COVID-19) emergency on Italian radiologists: a national survey

Does transient arterial-phase respiratory-motion-related artifact impact on diagnostic performance? An intra-patient comparison of extracellular gadolinium versus gadoxetic acid