胸部高分辨率 CT（HRCT）CO RADS 分级和 RT-PCR 检测在 2019 年冠状病毒病（COVID-19）诊断中的应用：一项针对无症状拟行手术病例的基于医院的描述性研究。
CO RADS grade of HRCT Thorax and RT PCR testing for the diagnosis of coronavirus disease 2019 (COVID 19): A descriptive hospital based study of asymptomatic planned surgery cases.
机构信息
Department of Medicine, Murshidabad Medical College, Murshidabad, India.
Department of Anesthesiology, Murshidabad Medical College, Murshidabad, India.
出版信息
Ann Afr Med. 2023 Jan-Mar;22(1):40-44. doi: 10.4103/aam.aam_205_21.
BACKGROUND
The coronavirus disease 2019 (COVID-19) reporting and data system (CO-RADS) grade of high-resolution computed tomography (HRCT)-thorax scan investigation is an innovative tool for the diagnosis of COVID-19 patients. By this tool, majority of moderate-to-severe COVID-19 patients are screened to detect lung pathologies. Hardly any study has explored its use vis-a-vis reverse transcriptase-polymerase chain reaction (RT-PCR) in asymptomatic patients.
OBJECTIVES
(1) The objective of the study is to assess the frequency COVID-19 patients among asymptomatic subjects who were admitted in the hospital for planned surgery, (2) estimate the sensitivity and specificity of CO-RADS grade of HRCT-thorax investigation for the diagnosis of COVID-19 patients where RT-PCR test was considered as "Gold Standard" test.
METHODOLOGY
A descriptive retrospective study was conducted by studying the records in the case files of 150 patients who were admitted in the Department of General Surgery, Man Mohini Health Clinic, Murshidabad, West Bengal for minor surgical procedures between September 1 and December 31, 2020. Data were collected from hospital records. The CO-RADS grade of HRCT-thorax investigation and RT-PCR test were performed for the diagnosis of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) virus. The MS-excel application was applied for data analysis.
RESULTS
The mean age of the participants was 42.58 ± 14.29 years. A total of 17 (11%) and 39 (26%) of the patients were diagnosed with COVID-19 by HRCT-thorax and RT-PCR test, respectively. The sensitivity and specificity of CO-RADS grade of HRCT-thorax investigation for diagnosis of COVID-19 patients were 43.58% and 100%, respectively. The positive and negative predictive values of CO-RADS grade of HRCT-thorax investigation were 100% and 83.45%, respectively.
CONCLUSIONS
The frequency of asymptomatic patients with COVID-19 that was missed by HRCT thorax was high, compared to the gold standard RT-PCR, reflecting its low sensitivity and low negative predictive value in the diagnosis of SARS-CoV-2 virus infection. Hence, it is difficult to conclude in favor of HRCT thorax as first-line screening modality in all individuals.
背景
2019 年冠状病毒病（COVID-19）报告和数据系统（CO-RADS）高分辨率计算机断层扫描（HRCT）-胸部扫描调查的等级是 COVID-19 患者诊断的创新工具。通过该工具，对大多数中重度 COVID-19 患者进行筛查，以检测肺部病变。几乎没有任何研究探讨过其在无症状患者中与逆转录酶-聚合酶链反应（RT-PCR）的用途。
目的
（1）本研究的目的是评估无症状患者中 COVID-19 患者的频率，这些患者因计划手术而住院，（2）估计 HRCT-胸部调查的 CO-RADS 等级对 COVID-19 患者的诊断的敏感性和特异性，其中 RT-PCR 测试被视为“金标准”测试。
方法
通过研究 2020 年 9 月 1 日至 12 月 31 日期间在西孟加拉邦默什里德巴德的 Man Mohini 健康诊所普外科住院的 150 名接受小手术的患者的病历记录，进行了描述性回顾性研究。数据来自医院记录。对 HRCT-胸部调查和 RT-PCR 测试进行 SARS-CoV-2 病毒严重急性呼吸综合征相关冠状病毒 2（SARS-CoV-2）病毒的诊断。应用 MS-excel 应用程序进行数据分析。
结果
参与者的平均年龄为 42.58 ± 14.29 岁。通过 HRCT-胸部和 RT-PCR 测试，分别有 17（11%）和 39（26%）名患者被诊断为 COVID-19。CO-RADS 等级 HRCT-胸部调查对 COVID-19 患者的诊断的敏感性和特异性分别为 43.58%和 100%。CO-RADS 等级 HRCT-胸部调查的阳性和阴性预测值分别为 100%和 83.45%。
结论
与金标准 RT-PCR 相比，通过 HRCT 胸部漏诊的无症状 COVID-19 患者的频率较高，反映了其在 SARS-CoV-2 病毒感染诊断中的低敏感性和低阴性预测值。因此，很难得出有利于 HRCT 胸部作为所有个体一线筛查方式的结论。
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