Shah Jay Vikram, Shah Chirag, Shah Sambhav, Gandhi Nila, Dikshit Nitin Arun, Patel Palak, Parghi Devam, Pankhania Mayur
Medimax Advance Radio Imaging Centre, Ellisbridge, India.
Department of Radiodiagnosis, Dr. N.D. Desai Faculty of Medical Science and Research, Nadiad, India.
Indian J Radiol Imaging. 2021 Jan;31(Suppl 1):S182-S186. doi: 10.4103/ijri.IJRI_405_20. Epub 2021 Jan 23.
The COVID-19 pandemic began in late December in 2019 and has now reached to 216 countries with 1,08,42,028 confirmed cases and 5,21,277 deaths according to the WHO reports and 6,49,666 confirmed cases in india alone with 18,679 deaths (as on 04 july 2020). RT-PCR has been considered the standard test for diagnosis of COVID 19. However, there has been reported a high false negative rate. This high false negative rate increases the risk of further transmission as well as delays the timely management of suspected cases. We have conducted HRCT chest of various (200 patient case study) proven and suspected cases of COVID-19 infection in the months of April, May and June 2020. Out of 200 scanned patients with clinical complains and suspicion, positive HRCT chest findings were seen in 196 patients, showing clinical-radiological correlation and an accuracy of 98%. The sensitivity of chest CT in suggesting COVID-19 was 98.6% (146/148patients) based on positive RT-PCR results. In patients with negative RT-PCR results and high clinical suspicion, 90% (18/20) had positive chest CT findings. HRCT chest is very sensitive and accurate in picking up lung parenchymal abnormalities in laboratory negative RT-PCR cases with high clinical suspicion of COVID-19 infection and also in all symptomatic patients where RT-PCR was not done. HRCT can also be very sensitive, cost effective and time effective in screening patients with high clinical suspicion. HRCT scores over RT-PCR in giving immediate results, assessing severity of disease and prediction of prognosis. We suggest HRCT chest for detection of early parenchymal abnormalities, assessing severity of disease in all patients with clinical symptoms and suspicion of COVID infection irrespective of laboratory RT-PCR status.
新冠疫情于2019年12月下旬开始，根据世界卫生组织的报告，目前已蔓延至216个国家，确诊病例达10842028例，死亡521277例；仅印度就有649666例确诊病例，18679例死亡（截至2020年7月4日）。逆转录聚合酶链反应（RT-PCR）被认为是诊断新冠病毒的标准检测方法。然而，据报道其假阴性率很高。这种高假阴性率增加了进一步传播的风险，也延误了疑似病例的及时治疗。我们在2020年4月、5月和6月对各类（200例患者病例研究）已确诊和疑似新冠病毒感染病例进行了胸部高分辨率计算机断层扫描（HRCT）。在200例有临床症状和疑似感染的扫描患者中，196例患者胸部HRCT检查结果呈阳性，显示出临床与影像学的相关性，准确率为98%。根据RT-PCR阳性结果，胸部CT提示新冠病毒感染的敏感性为98.6%（146/148例患者）。在RT-PCR结果为阴性但临床高度怀疑的患者中，90%（18/20）胸部CT检查结果呈阳性。对于临床高度怀疑感染新冠病毒但实验室RT-PCR检测为阴性的病例，以及所有未进行RT-PCR检测的有症状患者，胸部HRCT在发现肺实质异常方面非常敏感和准确。在筛查临床高度怀疑的患者时，HRCT也非常敏感、具有成本效益且节省时间。在提供即时结果、评估疾病严重程度和预测预后方面，HRCT比RT-PCR更具优势。我们建议对所有有临床症状且疑似感染新冠病毒的患者，无论其实验室RT-PCR检测结果如何，均进行胸部HRCT检查，以检测早期实质异常并评估疾病严重程度。
