Department of Infectious Diseases, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Department of Infectious Diseases, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Department of Laboratory Medicine, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
J Infect Chemother. 2021 Feb;27(2):232-236. doi: 10.1016/j.jiac.2020.09.025. Epub 2020 Sep 29.
In the novel coronavirus disease (COVID-19) pandemic era, it is essential to rule out COVID-19 effectively to prevent transmission in both communities and medical facilities. According to previous reports in high prevalence areas, CT screening may be useful in the diagnosis of COVID-19. However, the value of CT screening in low prevalence areas has scarcely been reported.
This report examines the diagnostic efficacy of CT screening before admission to a hospital in Tokyo. We conducted a retrospective analysis at Keio University Hospital from April 6, 2020, through May 29, 2020. We set up an outpatient screening clinic on April 6 for COVID-19, administering both PCR with nasopharyngeal swabs and chest CT for all patients scheduled for surgery under general anesthesia.
A total of 292 asymptomatic patients were included in this study. There were three PCR-positive patients, and they all had negative CT findings, which revealed that both the sensitivity and positive predictive value of CT (PPV) were 0%. There were nine CT-positive patients; the specificity and the negative predictive value (NPV) were 96.9% and 98.9%, respectively.
CT screening was not useful in low prevalence areas at this time in Tokyo, even with the inclusion of the most prevalent phase. Given that the utility of CT screening depends on disease prevalence, the criteria for performing CT screening based on the prevalence of COVID-19 should be established.
在新型冠状病毒病（COVID-19）大流行时期，有效地排除 COVID-19 以防止在社区和医疗机构中传播至关重要。根据以往高发地区的报告，CT 筛查可能有助于 COVID-19 的诊断。然而，CT 筛查在低流行地区的价值鲜有报道。
本报告检查了东京某医院入院前 CT 筛查的诊断效果。我们对庆应义塾大学医院进行了回顾性分析，时间为 2020 年 4 月 6 日至 5 月 29 日。我们于 4 月 6 日为 COVID-19 设立了一个门诊筛查诊所，对所有接受全身麻醉手术的患者进行鼻咽拭子聚合酶链反应（PCR）和胸部 CT 检查。
本研究共纳入 292 例无症状患者。有 3 例 PCR 阳性患者，且均有阴性 CT 结果，这表明 CT 的敏感性和阳性预测值（PPV）均为 0%。有 9 例 CT 阳性患者，特异性和阴性预测值（NPV）分别为 96.9%和 98.9%。
即使包括最流行的阶段，CT 筛查在此时的东京低流行地区也没有用处。鉴于 CT 筛查的效用取决于疾病流行程度，应根据 COVID-19 的流行情况制定进行 CT 筛查的标准。
