Stephanie Stephanie, Shum Thomas, Cleveland Heather, Challa Suryanarayana R, Herring Allison, Jacobson Francine L, Hatabu Hiroto, Byrne Suzanne C, Shashi Kumar, Araki Tetsuro, Hernandez Jose A, White Charles S, Hossain Rydhwana, Hunsaker Andetta R, Hammer Mark M
Department of Internal Medicine, University of Maryland School of Medicine, Midtown Campus, 827 Linden Avenue, Baltimore, MD 21201 (S.S., T.S., S.R.C.); Department of Physician Assistant Studies, Massachusetts General Hospital Institute of Health Professions, 55 Fruit St, Boston, MA 02114 (H.C.); Department of Radiology, University of Maryland School of Medicine, Downtown Campus, 22 S Greene St, Baltimore, MD 21201 (A.H., C.S.W., R.H.); Department of Pediatric Radiology, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030 (J.A.H.); and Department of Radiology, The Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02114 (F.L.J., H.H., S.C.B., K.S., T.A., A.R.H., M.M.H.).
Radiol Cardiothorac Imaging. 2020 Sep 24;2(5):e200337. doi: 10.1148/ryct.2020200337. eCollection 2020 Oct.
To evaluate the sensitivity, specificity, and severity of chest x-rays (CXR) and chest CTs over time in confirmed COVID-19+ and COVID-19- patients and to evaluate determinants of false negatives.
In a retrospective multi-institutional study, 254 RT-PCR verified COVID-19+ patients with at least one CXR or chest CT were compared with 254 age- and gender-matched COVID-19- controls. CXR severity, sensitivity, and specificity were determined with respect to time after onset of symptoms; sensitivity and specificity for chest CTs without time stratification. Performance of serial CXRs against CTs was determined by comparing area under the receiver operating characteristic curves (AUC). A multivariable logistic regression analysis was performed to assess factors related to false negative CXR.
COVID-19+ CXR severity and sensitivity increased with time (from sensitivity of 55% at ≤2 days to 79% at >11 days; p<0.001 for trends of both severity and sensitivity) whereas CXR specificity decreased over time (from 83% to 70%, p=0.02). Serial CXR demonstrated increase in AUC (first CXR AUC=0.79, second CXR=0.87, p=0.02), and second CXR approached the accuracy of CT (AUC=0.92, p=0.11). COVID-19 sensitivity of first CXR, second CXR, and CT was 73%, 83%, and 88%, whereas specificity was 80%, 73%, and 77%, respectively. Normal and mild severity CXR findings were the largest factor behind false-negative CXRs (40% normal and 87% combined normal/mild). Young age and African-American ethnicity increased false negative rates.
CXR sensitivity in COVID-19 detection increases with time, and serial CXRs of COVID-19+ patients has accuracy approaching that of chest CT.
评估确诊的新冠病毒阳性（COVID-19+）和阴性（COVID-19-）患者胸部X线（CXR）和胸部CT随时间推移的敏感性、特异性及严重程度，并评估假阴性的决定因素。
在一项回顾性多机构研究中，将254例经逆转录聚合酶链反应（RT-PCR）验证的COVID-19+患者（至少有一次CXR或胸部CT检查）与254例年龄和性别匹配的COVID-19-对照进行比较。根据症状出现后的时间确定CXR的严重程度、敏感性和特异性；胸部CT的敏感性和特异性无时间分层。通过比较受试者操作特征曲线（AUC）下的面积来确定系列CXR相对于CT的性能。进行多变量逻辑回归分析以评估与CXR假阴性相关的因素。
COVID-19+患者的CXR严重程度和敏感性随时间增加（≤2天时敏感性为55%，>11天时为79%；严重程度和敏感性趋势的p均<0.001），而CXR特异性随时间降低（从83%降至70%，p=0.02）。系列CXR显示AUC增加（首次CXR的AUC=0.79，第二次CXR=0.87，p=0.02），第二次CXR接近CT的准确性（AUC=0.92，p=0.11）。首次CXR、第二次CXR和CT的COVID-19敏感性分别为73%、83%和88%，而特异性分别为80%、73%和77%。正常和轻度严重程度的CXR表现是CXR假阴性的最大因素（40%为正常，87%为正常/轻度合并）。年轻和非裔美国人种族增加了假阴性率。
COVID-19检测中CXR的敏感性随时间增加，COVID-19+患者的系列CXR准确性接近胸部CT。
