COVID-19 Hastalarında Erken Dönemde Çekilen Akciğer Bilgisayarlı Tomografi Bulguları ile PCR Testinin Uyumluluğu

Öz

Amaç: Bu çalışmanın amacı yakınmaları ve fizik muayene bulgularının değerlendirilmesi sonrasında koronavirüs hastalığı 2019 (coronavirus disease 2019, COVID-19) ön tanısı konulan hastaların erken dönemde çekilen akciğer bilgisayarlı tomografi (BT) bulguları ile polimeraz zincir reaksiyonu (polymerase chain reaction, PCR) testi sonuçları arasındaki uyumluluğun araştırılmasıdır. Gereç ve Yöntemler: Nisan ile Temmuz 2020 tarihleri arasında COVID-19 şüphesi olan, PCR testi ile şiddetli akut solunum yolu sendromu koronavirüsü 2 (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) varlığı açısından değerlendirilen ve ilk 48 saatte akciğer BT yapılan 114 hasta geriye dönük olarak bu çalışmaya alındı. PCR testi pozitif ve negatif olan hastaların demografik özellikleri, laboratuvar parametreleri ve akciğer BT bulguları karşılaştırıldı. PCR testi negatif saptanıp klinik şüphesi devam eden hastalarda 48 saatlik aralıklar ile yeni PCR örnekleri alındı. Bulgular: PCR pozitif hastalarda interlobüler septal kalınlaşma daha fazla bulundu (p=0,043). PCR pozitif olan 16 (%28,6) ve PCR negatif olan 14 (%24,1) hastada tomografide anlamlı bir bulgu saptanmadı. Her iki grupta da en sık bulgular; bilateral, periferal ve multilober yerleşimli buzlu cam görünümü, konsolidasyon ve interlobuler septal kalınlaşma idi. PCR pozitif olan grupta nötrofil (p<0,001) ve trombosit sayısı (p=0,038) anlamlı olarak daha düşük saptandı. Sonuç: PCR testi pozitif veya negatif saptanan hastaların interlobular septal kalınlaşma dışındaki akciğer BT bulguları oldukça benzer idi, dolayısıyla COVID-19 tanısında özellikle erken dönemlerde akciğer BT tek başına kullanılmamalıdır. Karar verme esnasında, hastaların semptom, laboratuvar ve BT bulguları ile PCR testi hep birlikte değerlendirilmelidir.

Anahtar Kelimeler

• COVID 19
• buzlu cam görünümü
• interlobüler septal kalınlaşma
• akciğer bilgisayarlı tomografi
• polimeraz zincir reaksiyonu

Concordance of PCR and Early Thorax Computed Tomography Findings in COVID-19 Patients

Abstract

Aim: The aim of this study was to investigate concordance between polymerase chain reaction (PCR) test results and early thorax computed tomography (CT) findings of the patients in whom coronavirus disease 2019 (COVID-19) was suspected after evaluation of their complaints and physical examination findings. Material and Methods: One hundred and fourteen patients with suspicion of COVID-19, evaluated for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) existence with PCR test and performed thorax CT in the first 48 hours, between April and July 2020, were enrolled in this study retrospectively. Demographic characteristics, laboratory parameters and thorax CT findings of PCR positive and negative patients were compared. If patients had negative PCR test results, but clinical suspicion for COVID-19 persisted, additional PCR samples were tested at 48-hour intervals. Results: Interlobular septal thickening was more frequent in PCR positive patients (p=0.043). There was no significant thorax CT finding in 16 (28.6%) PCR positive and 14 (24.1%) PCR negative patients. Bilateral, peripheral and multilobar ground glass opacifications, consolidation and interlobular septal thickening were the most frequent findings in both groups. Neutrophil (p<0.001) and platelet counts (p=0.038) were significantly lower in PCR positive group. Conclusion: The thorax CT findings of the patients whose PCR tests were positive or negative were greatly similar except for interlobular septal thickening, thus thorax CT should not be used alone in the diagnosis of COVID-19 especially in early stages. In decision making, symptoms, laboratory and CT findings and PCR tests of patients must be evaluated all together.

Keywords

• COVID 19
• ground glass opacity
• interlobular septal thickening
• thorax computed tomography
• polymerase chain reaction

References

1. Li B, Li X, Wang Y, Han Y, Wang Y, Wang C, et al. Diagnostic value and key features of computed tomography in Coronavirus Disease 2019. Emerg Microbes Infect. 2020;9(1):787-93.
2. Peiris JS, Chu CM, Cheng VC, Chan KS, Hung IF, Poon LL, et al. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet. 2003;361(9371):1767-72.
3. Wu J, Wu X, Zeng W, Guo D, Fang Z, Chen L, et al. Chest CT findings in patients with coronavirus disease 2019 and its relationship with clinical features. Invest Radiol. 2020;55(5):257-61.
4. Song F, Shi N, Shan F, Zhang Z, Shen J, Lu H, et al. Emerging 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology. 2020;295(1):210-7.
5. Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: A report of 1014 cases. Radiology 2020;296(2):E32-40.
6. Goyal P, Choi JJ, Pinheiro LC, Schenck EJ, Chen R, Jabri A, et al. Clinical characteristics of COVID-19 in New York City. N Engl J Med. 2020;382(24):2372-4.
7. Zhu J, Zhong Z, Ji P, Li H, Li B, Pang J, et al. Clinicopathological characteristics of 8697 patients with COVID-19 in China: A meta-analysis. Fam Med Community Health. 2020;8(2):e000406.
8. Heymann DL. Data sharing and outbreaks: best practice exemplified. Lancet. 2020;395(10223):469-70.

9. Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT findings in coronavirus disease-19 (COVID-19): Relationship to duration of infection. Radiology. 2020;295(3):200463.
10. Zhao W, Zhong Z, Xie X, Yu Q, Liu J. Relation between chest CT findings and clinical conditions of coronavirus disease (COVID-19) pneumonia: A multicenter study. AJR Am J Roentgenol. 2020;214(5):1072-7.
11. Oikonomou A, Müller NL, Nantel S. Radiographic and high-resolution CT findings of influenza virus pneumonia in patients with hematologic malignancies. AJR Am J Roentgenol. 2003;181(2):507-11.
12. Pinto PS. The CT halo sign. Radiology. 2004;230(1):109-10.
13. Liu T, Huang P, Liu H, Huang L, Lei M, Xu W, et al. Spectrum of chest CT findings in a familial cluster of COVID-19 infection. Radiology: Cardiothoracic Imaging. 2020;2(1):e200025.
14. Yin Z, Kang Z, Yang D, Ding S, Luo H, Xiao E. A comparison of clinical and chest CT findings in patients with influenza A (H1N1) virus infection and coronavirus disease (COVID-19). AJR Am J Roentgenol. 2020;215(5):1065-71.
15. Xu YH, Dong JH, An WM, Lv XY, Yin XP, Zhang JZ, et al. Clinical and computed tomographic imaging features of novel coronavirus pneumonia caused by SARS-CoV-2. J Infect. 2020;80(4):394-400.
16. Chinese Society of Radiology, Chinese Medical Association. Radiological diagnosis of COVID-19: expert recommendation from the Chinese Society of Radiology (First edition). Chin J Radiol. 2020;4(54):279-85.
17. Chen ZH, Li YJ, Wang XJ, Ye YF, Wu BL, Zhang Y, et al. Chest CT of COVID-19 in patients with a negative first RT-PCR test: Comparison with patients with a positive first RT-PCR test. Medicine (Baltimore). 2020;99(26):e20837.
18. Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J. Chest CT for typical coronavirus disease 2019 (COVID-19) pneumonia: Relationship to negative RT-PCR testing. Radiology. 2020;296(2):E41-5.
19. Gao JW, Rizzo S, Ma LH, Qiu XY, Warth A, Seki N, et al. Pulmonary ground-glass opacity: computed tomography features, histopathology and molecular pathology. Transl Lung Cancer Res. 2017;6(1):68-75.
20. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323(20):2052-9.
21. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9.