From the Department of Scholarly Engagement, Harvard Medical School, 25 Shattuck St, Boston, MA 02115 (N.J.P., E.J.F.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S., N.D.M., J.D.C., E.J.F.); and Department of Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.P.L.).
Radiology. 2023 Mar;306(3):e220680. doi: 10.1148/radiol.220680. Epub 2022 Sep 6.
Background RSNA consensus guidelines for COVID-19-related chest CT are widely used but, to the knowledge of the authors, their rate of true-positive findings for COVID-19 pneumonia in vaccinated patients has not been assessed. Purpose To assess the rate of true-positive findings of typical appearance for COVID-19 at chest CT by using RSNA guidelines in fully vaccinated patients with polymerase chain reaction (PCR)-confirmed COVID-19 infection compared with unvaccinated patients. Materials and Methods Included were patients with COVID-19 who had typical appearance on chest CT images and one PCR test for COVID-19 with a positive result or two tests with negative results within 7 days of undergoing chest CT between January 2021 and January 2022 at a quaternary academic medical center. True-positive findings were defined as chest CT images interpreted as COVID-19 typical appearance and PCR-confirmed COVID-19 infection within 7 days. Logistic regression models were constructed to quantify the association between PCR results and vaccination status, vaccination status and COVID-19 variants, and vaccination status and number of months. Results Included were 652 patients (median age, 59 years; IQR, 48-72 years; 371 men [57%]) with CT scans classified as typical appearance. Of those patients, 483 (74%) were unvaccinated and 169 (26%) were fully vaccinated. The overall rate of true-positive findings on CT images rated as typical appearance was lower in vaccinated versus unvaccinated patients (70 of 169 [41%; 95% CI: 34, 49] vs 352 of 483 [73%; 95% CI: 69, 77]; odds ratio [OR], 3.8 [95% CI: 2.6, 5.5]; < .001). Unvaccinated patients were more likely to have true-positive findings on CT images compared with fully vaccinated patients during the peaks of COVID-19 variants Alpha (OR, 16; 95% CI: 6, 42; < .001) and Delta (OR, 8; 95% CI: 4, 16; < .001), but no statistical differences were found during the peak of the Omicron variant (OR, 1.7; 95% CI: 0.3, 11; = .56). Conclusion Fully vaccinated patients with confirmed COVID-19 breakthrough infections had lower rates of true-positive findings of COVID-19 typical appearance at chest CT. © RSNA, 2022 .
RSNA 关于 COVID-19 相关胸部 CT 的共识指南被广泛应用，但据作者所知，其在接种疫苗患者中 COVID-19 肺炎的真阳性发现率尚未得到评估。目的：在聚合酶链反应（PCR）确诊的 COVID-19 感染的完全接种疫苗患者中，使用 RSNA 指南评估 COVID-19 胸部 CT 上典型表现的真阳性发现率，并与未接种疫苗患者进行比较。材料与方法：纳入 2021 年 1 月至 2022 年 1 月在一家四级学术医疗中心接受胸部 CT 检查的 COVID-19 患者，这些患者的胸部 CT 图像有典型表现，且至少有一次 PCR 检测结果为 COVID-19 阳性，或两次检测结果为 COVID-19 阴性，但两次检测时间间隔在 7 天内。真阳性发现定义为在 7 天内 CT 图像被解读为 COVID-19 典型表现且 PCR 确诊 COVID-19 感染。构建逻辑回归模型来量化 PCR 结果与接种状态、接种状态与 COVID-19 变异体、以及接种状态与月数之间的关联。结果：共纳入 652 例（中位年龄 59 岁；IQR：48-72 岁；371 例男性[57%]）患者的 CT 扫描结果为典型表现。其中 483 例（74%）未接种疫苗，169 例（26%）完全接种疫苗。与未接种疫苗的患者相比，接种疫苗的患者 CT 图像上典型表现的真阳性发现率较低（70/169[41%]，95%CI：34，49，与 352/483[73%]，95%CI：69，77；比值比[OR]，3.8[95%CI：2.6，5.5]；<0.001）。在 COVID-19 Alpha（OR，16；95%CI：6，42；<0.001）和 Delta（OR，8；95%CI：4，16；<0.001）变异体高峰期，未接种疫苗的患者更有可能在 CT 图像上出现真阳性发现，但在 Omicron 变异体高峰期未发现统计学差异（OR，1.7；95%CI：0.3，11；=0.56）。结论：在确诊为 COVID-19 突破性感染的完全接种疫苗患者中，COVID-19 胸部 CT 上典型表现的真阳性发现率较低。©RSNA，2022。
