Department of Surgery Pietro Valdoni, Sapienza University of Rome, Rome, Italy.
Department of Radiology, Oncology, and Pathology, Sapienza University of Rome, Rome, Italy.
J Ultrasound Med. 2021 Jun;40(6):1113-1123. doi: 10.1002/jum.15487. Epub 2020 Sep 7.
We compared 2 imaging modalities in patients suspected of having coronavirus disease 2019 (COVID-19) pneumonia. Blinded to the results of real-time reverse transcriptase polymerase chain reaction (rRT-PCR) testing, lung ultrasound (LUS) examinations and chest computed tomography (CT) were performed, and the specific characteristics of these imaging studies were assessed.
From March 15, 2020, to April 15, 2020, 63 consecutive patients were enrolled in this prospective pilot study. All patients underwent hematochemical tests, LUS examinations, chest CT, and confirmatory rRT-PCR. The diagnostic performance of LUS and chest CT was calculated with rRT-PCR as a reference. The interobserver agreement of radiologists and ultrasound examiners was calculated. Ultrasound and CT features were compared to assess the sensitivity, specificity, positive predictive value, and negative predictive value. Positive and negative likelihood ratios measured the diagnostic accuracy.
Nineteen (30%) patients were COVID-19 negative, and 44 (70%) were positive. No differences in demographics and clinical data at presentation were observed among positive and negative patients. Interobserver agreement for CT had a κ value of 0.877, whereas for LUS, it was 0.714. The sensitivity, specificity, positive predictive value, and negative predictive value of chest CT for COVID-19 pneumonia were 93%, 90%, 85%, and 95%, respectively; whereas for LUS, they were 68%, 79%, 88%, and 52%. On receiver operating characteristic curves, area under the curve values were 0.834 (95% confidence interval, 0.711-0.958) and 0.745 (95% confidence interval, 0.606-0.884) for chest CT and LUS.
Lung ultrasound had good reliability compared to chest CT. Therefore, our results indicate that LUS may be used to assess patients suspected of having COVID-19 pneumonia.
我们比较了两种影像学检查方法在疑似 2019 冠状病毒病（COVID-19）肺炎患者中的应用。在对实时逆转录聚合酶链反应（rRT-PCR）检测结果不知情的情况下，对患者进行肺部超声（LUS）检查和胸部计算机断层扫描（CT），评估这些影像学研究的具体特征。
2020 年 3 月 15 日至 2020 年 4 月 15 日，前瞻性纳入 63 例连续患者。所有患者均进行了血液化学检查、LUS 检查、胸部 CT 和确认性 rRT-PCR。以 rRT-PCR 为参考，计算 LUS 和胸部 CT 的诊断性能。计算放射科医生和超声检查医生的观察者间一致性。比较超声和 CT 特征，以评估敏感度、特异度、阳性预测值和阴性预测值。阳性和阴性似然比衡量诊断准确性。
19 例（30%）患者 COVID-19 检测结果为阴性，44 例（70%）为阳性。阳性和阴性患者在人口统计学和临床表现方面无差异。CT 的观察者间一致性κ 值为 0.877，而 LUS 的为 0.714。胸部 CT 对 COVID-19 肺炎的敏感度、特异度、阳性预测值和阴性预测值分别为 93%、90%、85%和 95%，而 LUS 的分别为 68%、79%、88%和 52%。在受试者工作特征曲线中，CT 和 LUS 的曲线下面积分别为 0.834（95%置信区间，0.711-0.958）和 0.745（95%置信区间，0.606-0.884）。
与胸部 CT 相比，肺部超声具有良好的可靠性。因此，我们的结果表明，LUS 可用于评估疑似 COVID-19 肺炎的患者。
