Department of Radiology, Giresun University, Faculty of Medicine, Giresun, Turkey.
Department of Radiology, Emergency Medicine, Giresun University, Faculty of Medicine, Giresun, Turkey.
Diagn Interv Radiol. 2021 Mar;27(2):181-187. doi: 10.5152/dir.2020.20350.
We aimed to evaluate the diagnostic performance of low-dose chest computed tomography (CT) in patients under investigation for coronavirus disease 2019 (COVID-19).
This retrospective study included 330 patients suspected of having COVID-19 from March 15 to April 16, 2020. We examined 306 patients upon initial presentation using both CT and real-time reverse-transcriptase polymerase-chain-reaction (rRT-PCR). The diagnostic performance of CT was calculated using rRT-PCR as a reference. Clinical and laboratory data, CT characteristics, and lesion distribution were assessed for patients with a confirmed diagnosis via rRT-PCR.
A total of 250 patients were finally diagnosed with COVID-19. Clinical and laboratory findings included myalgia or fatigue (76%), fever (64.8%), dry cough (60.8%), elevated levels of C-reactive protein (86.4%), procalcitonin (62%), and D-dimer (58.2%), increased neutrophil-lymphocyte ratio (NLR) (54.8%), and lymphopenia (34%). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the initial CT scan were 90.4% (95% IC, 86%-93%), 64.2% (95% IC, 50%-76%), 91.8% (95% IC, 88%-94%), and 60% (95% IC, 49%-69%), respectively. The percentage of patients diagnosed on the initial rRT-PCR test was 51.6% (n=129). Most frequent CT characteristics of COVID-19 in the subgroup of rRT-PCR-positive patients were multiple lesion (97.4%, n=220), followed by bilateral involvement (88.5%, n=200), peripheral distribution (74.3%, n=168), ground-glass opacity (GGO) (69.2%, n=157), subpleural curvilinear opacity (41.6%, n=104), and mixed GGOs (27.6%, n=67).
rRT-PCR may produce initial false negative results. For this reason, typical CT findings for COVID-19 should be known especially by radiologists. We suggest that patients with typical CT findings but negative rRT-PCR results should be isolated, and rRT-PCR should be repeated to avoid misdiagnosis.
评估低剂量胸部计算机断层扫描（CT）在疑似 2019 年冠状病毒病（COVID-19）患者中的诊断性能。
本回顾性研究纳入 2020 年 3 月 15 日至 4 月 16 日期间 330 例疑似 COVID-19 的患者。我们对 306 例初诊患者同时进行 CT 和实时逆转录聚合酶链反应（rRT-PCR）检查。以 rRT-PCR 为参照计算 CT 的诊断性能。对 rRT-PCR 确诊的患者评估临床和实验室数据、CT 特征和病变分布。
共有 250 例患者最终被诊断为 COVID-19。临床和实验室发现包括肌痛或疲劳（76%）、发热（64.8%）、干咳（60.8%）、C 反应蛋白升高（86.4%）、降钙素原（62%）和 D-二聚体（58.2%）、中性粒细胞/淋巴细胞比值升高（54.8%）和淋巴细胞减少（34%）。初始 CT 扫描的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 90.4%（95%CI，86%-93%）、64.2%（95%CI，50%-76%）、91.8%（95%CI，88%-94%）和 60%（95%CI，49%-69%）。最初 rRT-PCR 检测诊断为 COVID-19 的患者百分比为 51.6%（n=129）。rRT-PCR 阳性患者亚组中 COVID-19 最常见的 CT 特征是多发病灶（97.4%，n=220），其次是双侧受累（88.5%，n=200）、外周分布（74.3%，n=168）、磨玻璃影（GGO）（69.2%，n=157）、胸膜下线状影（41.6%，n=104）和混合 GGOs（27.6%，n=67）。
rRT-PCR 可能产生初始假阴性结果。因此，放射科医生尤其应该了解 COVID-19 的典型 CT 表现。我们建议对具有典型 CT 表现但 rRT-PCR 结果阴性的患者进行隔离，并重复 rRT-PCR 以避免误诊。
