Xiao Nicholas, Abboud Samir, McCarthy Danielle M, Parekh Nishant
Department of Radiology, Division of Chest Imaging, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.
Department of Radiology, Division of Emergency Radiology, Northwestern University, Chicago, IL, USA.
Emerg Radiol. 2020 Dec;27(6):589-595. doi: 10.1007/s10140-020-01792-3. Epub 2020 May 25.
The COVID-19 pandemic has been responsible for thousands of deaths worldwide. Testing remains at a premium, and criteria for testing remains reserved for those with lower respiratory infection symptoms and/or a known high-risk exposure. The role of imaging in COVID-19 is rapidly evolving; however, few algorithms include imaging criteria, and it is unclear what should be done in low-suspicion patients with positive imaging findings.
From 03/01/2020-03/20/2020, a retrospective review of all patients with suspected COVID-19 on imaging was performed. Imaging was interpreted by a board-certified, fellowship-trained radiologist. Patients were excluded if COVID-19 infection was suspected at the time of presentation, was the reason for imaging, or if any lower respiratory symptoms were present.
Eight patients with suspected COVID-19 infection on imaging were encountered. Seven patients received testing due to suspicious imaging findings with subsequent lab-confirmed COVID-19. No patients endorsed prior exposure to COVID-19 or recent international travel. COVID-19 was suggested in six patients incidentally on abdominal CT and two on chest radiography. At the time of presentation, no patients were febrile, and seven endorsed gastrointestinal symptoms. Five COVID-19 patients eventually developed respiratory symptoms and required intubation. Two patients expired during the admission.
Patients with imaging findings suspicious for COVID-19 warrant prompt reverse transcription polymerase chain reaction (RT-PCR) testing even in low clinical suspicion cases. The prevalence of disease in the population may be underestimated by the current paradigm of RT-PCR testing with the current clinical criteria of lower respiratory symptoms and exposure risk.
新型冠状病毒肺炎（COVID-19）大流行已在全球造成数千人死亡。检测资源仍然稀缺，检测标准仍仅限于有下呼吸道感染症状和/或已知高风险暴露史的人群。影像学在COVID-19中的作用正在迅速演变；然而，很少有算法纳入影像学标准，对于影像学检查结果呈阳性但临床怀疑度低的患者应如何处理尚不清楚。
对2020年3月1日至20日所有影像学检查疑似COVID-19的患者进行回顾性研究。影像学检查由一名获得委员会认证、接受过专科培训的放射科医生解读。如果患者在就诊时被怀疑感染COVID-19、因COVID-19进行影像学检查或有任何下呼吸道症状，则将其排除。
共发现8例影像学检查疑似COVID-19感染的患者。7例患者因影像学检查结果可疑而接受检测，随后实验室确诊为COVID-19。所有患者均否认曾接触过COVID-19或近期有国际旅行史。6例患者在腹部CT检查时偶然发现疑似COVID-19，2例在胸部X线检查时发现。就诊时，所有患者均无发热，7例患者有胃肠道症状。5例COVID-19患者最终出现呼吸道症状并需要插管。2例患者在住院期间死亡。
即使临床怀疑度低，影像学检查结果可疑的COVID-19患者也应立即进行逆转录聚合酶链反应（RT-PCR）检测。按照目前下呼吸道症状和暴露风险的临床标准进行RT-PCR检测，可能会低估人群中的疾病患病率。
