The role of chest tomography in the diagnosis of COVID-19

Abstract

Aim: We aimed to examine the diagnostic power of chest computerized tomography (CT) comparing with ‘Clinical Decision’ and RT-PCR results among the patients admitted to the hospital with COVID-19 disease suspicion. Material and Method: This study included 162 patients who applied to the pandemic outpatient clinic between March 11 and April 11, 2020, suspected of new coronavirus infection, and had chest CT and RT-PCR tests at the same time. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy and positive odds ratio of RT-PCR and chest CT imaging are investigated for the diagnosis of COVID-19. Results: It was found that 56.8% (92 patients) of chest CT scans taken at admission were compatible with viral pneumonia. With the ‘Clinical Decision’, which we accept as the gold standard diagnostic method, 61.1% of the patients (99 patients) were evaluated as COVID-19 positive and treatment was started. According to clinical decision, sensitivity of chest CT was 92.9%. Conclusion: COVID-19 pneumonia is a serious life-threatening condition. Rapid diagnosis and early treatment are very important in terms of reducing mortality and morbidity. The chest CT might create an early diagnosis and treatment opportunity.

Keywords

• COVID-19
• Coronavirus
• pneumonia
• chest
• computerized tomography

COVID-19 tanısında göğüs tomografisinin rolü

Abstract

Amaç: COVID-19 hastalığı şüphesiyle hastaneye başvuran hastalarda göğüs bilgisayarlı tomografi (BT)’sinin ‘Klinik Karar’ ve RT-PCR sonuçları ile karşılaştırmalı olarak tanısal gücünü incelemeyi amaçladık. Gereç ve Yöntem: Bu çalışmaya 11 Mart - 11 Nisan 2020 tarihleri ​​arasında pandemi polikliniğine başvuran, yeni koronavirüs enfeksiyonu şüphesi olan ve aynı anda göğüs BT ve RT-PCR tetkikleri yapılan 162 hasta dahil edildi. COVID-19 tanısı için RT-PCR ve göğüs BT görüntülemenin duyarlılığı, özgüllüğü, pozitif öngörü değeri (PPV), negatif öngörü değeri (NPV), doğruluğu ve pozitif olasılık oranı araştırılmaktadır. Bulgular: Başvuru sırasında çekilen akciğer tomografilerinin %56,8’inin (92 hasta) viral pnömoni ile uyumlu olduğu bulundu. Altın standart tanı yöntemi olarak kabul ettiğimiz ‘Klinik Karar’ ile hastaların %61,1’i (99 hasta) COVID-19 pozitif olarak değerlendirildi ve tedaviye başlandı. Klinik karara göre göğüs BT’nin duyarlılığı %92,9 idi. Sonuç: COVID-19 pnömonisi hayatı tehdit eden ciddi bir durumdur. Hızlı tanı ve erken tedavi, mortalite ve morbiditeyi azaltmak açısından çok önemlidir. Göğüs BT erken tanı ve tedavi fırsatı yaratabilir.

Keywords

• COVID-19
• Coronavirüs
• pnomoni
• göğüs
• Bilgisayarlı tomografi

References

1. Öztürk Durmaz Ş, Sümer Coşkun A, Yalçın AN. Clinical and prognostic evaluation of patients admitted to the COVID-19 pandemic unit of the emergency department. J Health Sci Med 2021; 4: 835-9.
2. Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet 2020; 395: 470-3.
3. Wang,W, Tang J, Wei F. Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China. J Med Virol 2020; 92: 441–7.
4. Sreepadmanabh M, Sahu AK, Chande A. COVID-19: Advances in diagnostic tools, treatment strategies, and vaccine development. J Biosci 2020; 45: 148.
5. Akçay Ş, Özlü T, Yılmaz A. Radiological approaches to COVID-19 pneumonia. Turk J Med Sci 2020; 50: 604-10.
6. Ye Z, Zhang Y, Wang Y, Huang Z, Song B. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol 2020; 30: 4381-9.
7. Kesmez Can F, Alay H, Yılmaz S, et al. The thorax tomography correlation in COVID-19 RT-PCR positive patients. Anatolian Curr Med J 2021; 3: 145-50.
8. Chung M, Bernheim A, Mei X, et al. CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology 2020; 295: 202-7.

9. Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, Ji W. Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radiology 2020; 296: 115-7.
10. Huang P, Liu T, Huang L, et al. Use of chest CT in combination with negative RT-PCR assay for the 2019 novel coronavirus but high clinical suspicion. Radiology 2020; 295: 22-3.
11. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507-13.
12. Ai T, Yang Z, Hou H, 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: 32-40.
13. Guan W, Ni Z, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020; 382: 1708-20.
14. Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J. Chest CT for typical 2019-nCoV pneumonia: relationship to negative RT-PCR testing. Radiology 2020; 296: 41-5.
15. Xiao AT, Tong YX, Zhang S. False negative of RT-PCR and prolonged nucleic acid conversion in COVID-19: Rather than recurrence. J Med Virol October 2020; 92: 1755-6.
16. Long C, Xu H, Shen Q, Zhang X, Fan B, Wang C, Zeng B, Li Z, Li X, Li H. Diagnosis of the Coronavirus disease (COVID-19): rRT-PCR or CT? Eur J Radiol 2020 May; 126: 108961.
17. Feng H, Liu Y, Lv M, Zhong J. A case report of COVID-19 with false negative RT-PCR test: necessity of chest CT. Jpn J Radiol 2020; 38: 409-10.
18. Waller JV, Kaur P, Tucker A, et al. Diagnostic tools for coronavirus disease (COVID-19): comparing CT and RT-PCR viral nucleic acid testing. AJR Am J Roentgenol 2020; 215: 834-8.
19. Tenda ED, Yulianti M, Asaf MM, et al. The Importance of Chest CT Scan in COVID-19. Acta Med Indones 2020; 52: 68-73.
20. Li Y, Xia L. Coronavirus disease 2019 (COVID-19): role of chest CT in diagnosis and management. Am J Roentgenol 2020; 1-7.