COVID-19: Investigation of Diagnostic Value of the Thorax Computed Tomography Imaging with CO-RADS Categorical Assessment Scheme

Abstract

Aim: The definitive diagnosis of new coronavirus disease (COVID-19) caused by ‘severe acute respiratory syndrome corona-virus 2’ (SARS-CoV-2), is possible with the reverse transcriptasepolymerase chain reaction (RT-PCR) test. At the beginning of the pandemic, since it may take time for the RT-PCR test to result, there has been difficulty in deciding whether to quarantine or treat suspected Bioekpatients. Chest computed tomography (CT) not being a screening method, has been widely applied for rapid filiation and treatment. In this study, the diagnostic value of CT for COVID-19 in the first peak of the pandemic was investigated. Material and Methods: All consecutive adult patients who underwent chest CT in the Radiology clinic with suspected COVID-19 between 16 March-April 30 2020 were retrospectively screened. All the images were evaluated in terms of the likelihood of COVID-19 suspicion according to the COVID-19 Reporting and Data System (CO-RADS). Pulmonary involvement findings, age, gender, and comorbid diseases of the patients were recorded. Results: Total of 504 patients consisted of 262 (52%) men, 242 (48%) women with mean age of 53.3±19.4 years-old were included. RT-PCR positivity was detected in 29/291 (9.96%) of CO-RADS 1; 4/65 (26%) of the CO-RADS 2; 15/63 (23.8%) of CO-RADS 3; 19/28 (67.9%) of the CO-RADS 4; 36/57 (63.2%) of the CO-RADS 5 patients. 356 patients were CO-RADS (1-3), 85 patients were CO-RADS (4,5). Accordingly sensitivity, specificity, positive and negative likelihood ratios, prevalence, positive and negative predictive values and accuracy rates, were 53.4%, 92.52%, 7.14, 0.5, 20.44%, 64.71%, 88.54% and 84.52% respectively. Conclusion: CO-RADS categorization improves the diagnostic value in COVID-19 pneumonia. Thorax CT has high specificity, positive and negative predictive value but low sensitivity for COVID-19 in. It is not suitable to use CT for diagnostic or screening purposes

Keywords

• COVID-19
• CT
• RT-PCR
• CO-RADS
• Chest
• İnfection

COVID-19: CO-RADS Kategorik Değerlendirme Sistemi ile Toraks Bilgisayarlı Tomografi Görüntülemenin Tanısal Değerinin Araştırılması

Abstract

Amaç: ‘Severe Acute Respiratory Syndrome Corona Virus 2 (SARS CoV-2)’ nin etken olduğu COVID-19 hastalığının kesin tanısı reverse transcriptase-polymerase chain reaction (RT-PCR) testi ile mümkündür. Toraks bilgisayarlı tomografisi (BT) tarama yöntemi olmamakla beraber hızlı filyasyon ve tedavi için yaygın kullanılmıştır. Bu çalışmada salgının ilk pikinde BT’nin COVID-19 için tanısal değeri araştırılmıştır. Gereç ve Yöntemler: 16 Mart-30 Nisan 2020 arasında COVID-19 şüphesi ile Radyoloji kliniğinde toraks BT yapılmış ardışık tüm yetişkin hastalar retrospektif tarandı. Görüntüler COVID-19 Reporting and Data System (CO-RADS)’e göre COVID-19 şüphe olasılığı bakımından değerlendirildi. Akciğerdeki tutulum bulguları ile hastaların yaş, cinsiyet ve komorbid hastalıkları kaydedildi. Bulgular: Yaş ortalama ± SD, 53.3±19.4; 262’si (%52) erkek ve 242’si (%48) kadın, toplam 504 olgu dahil edildi. 103 (%20.4) hastada RT-PCR pozitifliği vardı. CO-RADS 1 olguların 29/291 (%9.96)’i; CO-RADS 2’nin 4/65 (%26)’ü; CO-RADS 3’ün 15/63 (%23.8)’ü; CO-RADS 4’ün 19/28 (%67.9)’ünde; CO-RADS 5’in 36/57 (%63.2)’inde RT-PCR pozitifliği saptanmıştır. 356 hasta CO-RADS (1-3); 85 hasta CO-RADS (4.5)’ti. Duyarlılık, özgüllük, pozitif ve negatif olabilirlik oranları, prevalans, pozitif ve negatif prediktif değerler ve doğruluk oranları sırasıyla; %53.4, %92.52, 7.14, 0.5, %20.44, %64.71, %88.54 ve %84.52 saptandı. Sonuç: CO-RADS kategorizasyonu, COVID-19 pnömonisinde tanı değerini arttırmaktadır. Toraks BT’nin COVID-19 için özgüllüğü, pozitif ve negatif prediktif değeri yüksek ancak duyarlılığı düşüktür. Bilgisayarlı tomografinin tanısal veya tarama amaçlı kullanılaması uygun değildir.

Keywords

• COVID-19
• BT
• RT-PCR
• CO-RADS
• Göğüs
• Enfeksion

Thanks

Bu zor zamanlarda başta hocalarım olmak üzere emeği geçen tüm arkadaşlarıma ve sağlık çalışanlarına teşekkür ederim.

References

1. 1. Altmayer S, Matheus Zanon et al., Comparison of the computed tomography findings in COVID-19 and other viral pneumonia in immunocompetent adults: a systematic review and meta-analysis. European Radiology, 27 haziran 2020; 30:6485–6496. https://doi.org/10.1007/s00330-020-07018-x
2. 2. Li Y, Xia L., Coronavirus Disease 2019 (COVID-19): Role of Chest CT in Diagnosis and Management. AJR, haziran 2020; 2020;214: 1280-1286. 10.2214/AJR.20.22954
3. 3. Shohei Inui,MD, AkiraFujikawa,MD,PhD et al., Chest CT Findings in Cases from the Cruise Ship Diamond Princess with Coronavirus Disease (COVID-19). Radiology: Cardiothoracic Imaging, 17 mart 2020; 2(2):e200110 . https://doi.org/10.1148/ryct.2020200110
4. 4. Tao Ai, MD, PhD, Zhenlu Yang, MD et al., Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology, 26 şubat 2020; 296:E32–E40 https://doi.org/10.1148/radiol.2020200642
5. 5. W. Guan, Z. Ni, et al., Clinical Characteristics of Coronavirus Disease 2019 in China, N Engl J Med, 6 mart 2020;382:1708-20. DOI: 10.1056/NEJMoa2002032
6. 6. Adam Bernheim, MD, Xueyan Mei, MS et al., Chest CT Findings in Coronavirus Disease 2019 (COVID-19): Relationship to Duration of Infection, Radiology, 20 şubat 2020; 295:685–691 https://doi.org/10.1148/radiol.2020200463
7. 7. Wei Zhao, Zheng Zhong, Xingzhi Xie, Qizhi Yu., Relation Between Chest CT Findings and Clinical Conditions of Coronavirus Disease (COVID-19) Pneumonia: A Multicenter Study, American Journal of Roentgenology, Mayıs 2020;214: 1072-1077. 10.2214/AJR.20.22976
8. 8. Na Zhu, PhD, Dingyu Zhang, MD et al. for the China Novel Coronavirus Investigating and Research Team, A Novel Coronavirus from Patients with Pneumonia in China, 2019. The new england journal o f medicine, 24 ocak 2020; doı: 10.1056/NEJMoa2001017

9. 9. American College of Radiology. ACR recommendations for the use of chest radiography and computed tomography (CT) for suspected COVID-19 infection. American College of Radiology, 11 mart 2020; https://www.acr.org/Advocacy-and-Economics/ACR-Position- Statements/Recommendations-for-Chest-Radiography-and-CT-for-Suspected-COVID19-Infection. Updated March 22, 2020
10. 11. Geoffrey D Rubin, Christopher J Ryerson et al., The Role of Chest Imaging in Patient Management during the COVID-19 Pandemic: A Multinational Consensus Statement from the Fleischner Society.. Radiology, 7 nisan 2020; 296(1):172-180. doi: 10.1148/radiol.2020201365
11. 12. Scott Simpson, Fernando U Kay et al., Radiological Society of North America Expert Consensus Document on Reporting Chest CT Findings Related to COVID-19: Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. Radiol Cardiothorac Imaging, 25 mart 2020; 2(2):e200152. doi: 10.1148/ryct.2020200152.
12. 13. Mathias Prokop , Wouter van Everdingen et al., COVID-19 Standardized Reporting Working Group of the Dutch Radiological Society. CO-RADS: A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19-Definition and Evaluation. Radiology, 27 nisan 2020;296(2):E97-E104. doi: 10.1148/radiol.2020201473.
13. 14. Yicheng Fang, Huangqi Zhang, Jicheng Xie, Minjie Lin, Lingjun Ying, Peipei Pang, Wenbin Ji, Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radiology, 19 şubat 2020; https://doi.org/10.1148/radiol.2020200432
14. 15. Rui Han, Lu Huang, Hong Jiang, Jin Dong, Hongfen Peng and Dongyou Zhang. Early Clinical and CT Manifestations of Coronavirus Disease 2019 (COVID-19) Pneumonia, American Journal of Roentgenology. Ağustos 2020;215(2):338-343. doi: 10.2214/AJR.20.22961
15. 16. Zu ZY, Meng Di Jiang, et al., Coronavirus Disease 2019 (COVID-19): A Perspective from China. Radiology, 21 şubat 2020; 296(2):E15-E25. doi: 10.1148/radiol.2020200490
16. 17. Hyungjin Kim , Hyunsook Hong, Soon Ho Yoon. Diagnostic Performance of CT and Reverse Transcriptase-Polymerase Chain Reaction for Coronavirus Disease 2019: A Meta-Analysis. Radiology, 17 nisan 2020; 296(3):E145-E155. doi: 10.1148/radiol.2020201343.
17. 18. Robert M Kwee, Hugo J A Adams, Thomas C Kwee. Diagnostic Performance of CO-RADS and the RSNA Classification System in Evaluating COVID-19 at Chest CT: A Meta-Analysis. Radiol Cardiothorac Imaging, 14ocak 2021 3(1):e200510. doi: 10.1148/ryct.2021200510.
18. 19. Daniël A Korevaar, Ruud S Kootte et al., Amsterdam UMC location AMC COVID-19 group. Added value of chest computed tomography in suspected COVID-19: an analysis of 239 patients. Eur Respir J ., 20 ağustos 2020; 2001377. doi: 10.1183/13993003.01377-2020.
19. 20. Kristof De Smet, Dieter De Smet et al., Diagnostic Performance of Chest CT for SARS-CoV-2 Infection in Individuals with or without COVID-19 Symptoms. Radiology. 10 ağustos 2021; 298(1):E30-E37. doi: 10.1148/radiol.2020202708.
20. 21. Joep J. R. Hermans, Joost Groen et al., Chest CT for triage during COVID-19 on the emergency department: myth or truth?, American Society of Emergency Radiology, 9 Temmuz 2020, doi: 10.1007/s10140-020-01821-1
21. 22. Fujioka F, Takahashi M, Mori M, Tsuchiya J et al., Evaluation of the Usefulness of CO-RADS for Chest CT in Patients Suspected of Having COVID-19. Diagnostics (Basel), 16 temmuz 2020; 10(9): 608. doi: 10.3390/diagnostics10090608.
22. 23. Brecht Van Berkel, Jan Vandevenne et al., Chest CT Diagnosis of COVID-19: Accuracy using CO-RADS and CT-Involvement Scoring. Journal of the Belgian Society of Radiology, 5 nisan 2021; 105(1):17. doi: 10.5334/jbsr.2342.
23. 24. Mohamed Abdel-Tawab, Mohammad Abd Alkhalik Basha et al., Comparison of the CO-RADS and the RSNA chest CT classification system concerning sensitivity and reliability for the diagnosis of COVID-19 pneumonia. Insights Imaging 28 nisan 2021; 55. doi: 10.1186/s13244-021-00998-4.
24. 25. COVID-19 Use of Chest Imaging in COVID-19. A rapid advice guide. 11.6.2020. World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/332336/WHO-2019-nCoV-Clinical-Radiology_imaging-2020.1-eng.pdf
25. 26. Harrison X Bai, Ben Hsieh, Zeng Xiong et al., Performance of Radiologists in Differentiating COVID-19 from Non-COVID-19 Viral Pneumonia at Chest CT. Radiology,10 mart 2020; 296(2):E46-E54. doi: 10.1148/radiol.2020200823.
26. 27. Buyun Xu, Yangbo Xing et al., Chest CT for detecting COVID‐19: a systematic review and meta‐analysis of diagnostic accuracy. Eur Radiol, 15 mayıs 2020; 30(10):5720-5727. doi: 10.1007/s00330-020-06934-2.
27. 28. Damiano Caruso, Marta Zerunian, Michela Polici et al., Chest CT Features of COVID-19 in Rome, Italy. Radiology, 3 nisan 2020; 296:E79–E85 • https://doi.org/10.1148/radiol.2020201237.
28. 29. Wei-cai Dai, Han-wen Zhang, Juan Yu et al., CT Imaging and Differential Diagnosis of COVID-19. Canadian Association of Radiologists, 4 mart 2020; 71(2) 195-200 doi:10.1177/0846537120913033.