Scienze Radiologiche, Dipartimento di Medicina e Chirurgia, University Hospital of Parma, Parma, Italy.
Dept of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada.
Eur Respir J. 2021 Sep 9;58(3). doi: 10.1183/13993003.04188-2020. Print 2021 Sep.
For the management of patients referred to respiratory triage during the early stages of the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic, either chest radiography or computed tomography (CT) were used as first-line diagnostic tools. The aim of this study was to compare the impact on the triage, diagnosis and prognosis of patients with suspected COVID-19 when clinical decisions are derived from reconstructed chest radiography or from CT.
We reconstructed chest radiographs from high-resolution CT (HRCT) scans. Five clinical observers independently reviewed clinical charts of 300 subjects with suspected COVID-19 pneumonia, integrated with either a reconstructed chest radiography or HRCT report in two consecutive blinded and randomised sessions: clinical decisions were recorded for each session. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and prognostic value were compared between reconstructed chest radiography and HRCT. The best radiological integration was also examined to develop an optimised respiratory triage algorithm.
Interobserver agreement was fair (Kendall's =0.365, p<0.001) by the reconstructed chest radiography-based protocol and good (Kendall's =0.654, p<0.001) by the CT-based protocol. NPV assisted by reconstructed chest radiography (31.4%) was lower than that of HRCT (77.9%). In case of indeterminate or typical radiological appearance for COVID-19 pneumonia, extent of disease on reconstructed chest radiography or HRCT were the only two imaging variables that were similarly linked to mortality by adjusted multivariable models CONCLUSIONS: The present findings suggest that clinical triage is safely assisted by chest radiography. An integrated algorithm using first-line chest radiography and contingent use of HRCT can help optimise management and prognostication of COVID-19.
在严重急性呼吸综合征冠状病毒 2 型（SARS-CoV-2）大流行的早期，对于转诊至呼吸分诊的患者，胸部 X 线摄影或计算机断层扫描（CT）都被用作一线诊断工具。本研究旨在比较在临床决策源自重建的胸部 X 射线摄影或 CT 时，对疑似 COVID-19 患者分诊、诊断和预后的影响。
我们从高分辨率 CT（HRCT）扫描重建了胸部 X 射线照片。五名临床观察者独立回顾了 300 名疑似 COVID-19 肺炎患者的临床图表，将重建的胸部 X 射线照片或 HRCT 报告整合到两个连续的盲法和随机会议中：为每个会议记录临床决策。比较了重建的胸部 X 射线摄影和 HRCT 之间的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和预后价值。还检查了最佳的影像学整合，以开发优化的呼吸分诊算法。
基于重建的胸部 X 射线摄影的协议，观察者间的一致性为一般（Kendall's =0.365，p<0.001），而基于 CT 的协议为良好（Kendall's =0.654，p<0.001）。重建的胸部 X 射线摄影辅助的 NPV（31.4%）低于 HRCT（77.9%）。对于 COVID-19 肺炎的不确定或典型放射表现，疾病程度是重建的胸部 X 射线摄影或 HRCT 唯一与调整后的多变量模型相关的两个影像学变量。
本研究结果表明，胸部 X 射线摄影可安全地协助临床分诊。使用一线胸部 X 射线摄影和补充使用 HRCT 的综合算法可以帮助优化 COVID-19 的管理和预后。
