Diagnostic performance between RT-PCR and chest CT in outpatients with clinically suspected COVID-19

Yıl 2024, , 18 - 22, 28.01.2024

Elif Tükenmez Tigen , Buket Erturk Sengel , Canan Cimsit , Hande Perk Gurun Çiğdem Apaydın Kaya , Volkan Korten

https://doi.org/10.5472/marumj.1379916

Öz

Objective: To investigate the diagnostic performance between chest computed tomography (CT) and reverse transcription-polymerase
chain reaction (RT-PCR) in outpatients with suspected coronavirus disease 2019 (COVID-19).
Patients and Methods: Between March and June 2020, a total of 812 patients with clinically suspected COVID-19 who underwent both
chest CT and initial-single RT-PCR on admission to outpatient units were retrospectively enrolled. CT severity-score (CT-SS) was
calculated and data were matched with PCR results.
Results: Of 812 patients, 54% (439/812) had positive RT-PCR results, and 47% (425/812) had a positive chest CT scan. With RT-PCR
results as reference, the sensitivity, specificity, accuracy of chest CT in defining COVID-19 infection were 60%, (95% CI 56-65%,
265/439 patients), 57% (95% CI 52-62%, 213/373), 59% (95% CI 55-62%, 478/812), respectively. Three hundred eighty-seven (47%)
patients had no CT findings, 380/812 (46.8%) had mild, 45/812 (5.5%) had moderate, and no patients in the severe group
Conclusion: Chest CT did not show high sensitivity for the diagnosis of COVID-19 for outpatients. We suggest RT-PCR should be
the primary diagnostic tool. Chest CT might be considered if there is a strong clinical suspicion with repeatedly negative RT-PCR test
results, ensuring infection prevention and control measures can be preserved.

Anahtar Kelimeler

Chest CT, RT-PCR, COVID-19, Outpatient, Diagnosis

Kaynakça

• Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; 382:727-33. doi: 10.1056/NEJMoa2001017.
• World Health Organization. Regional Office for the Western Pacific. Role of primary care in the COVID-19 response. https://apps.who.int/iris/handle/10665/331921 Accessed: 22 May 2023.
• Yang Y, Yang M, Shen C, et al. Laboratory Diagnosis and Monitoring the Viral Shedding of SARS-CoV-2 Infection. Innovation (Camb) 2020;1:100061. doi: 10.1016/j. xinn.2020.100061.
• 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:E41–E45. doi: 10.1148/radiol.202.020.0343.
• 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. doi: 10.1148/radiol.202.020.0330.
• Fang Y, Zhang H, Xie J, et al. Sensitivity of chest CT for COVID-19: comparison to RT-PCR. Radiology 2020; 296:E115–E117. doi: 10.1148/radiol.202.020.0432
• Chung M, Bernheim A, Mei X, et al. CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology 2020; 295:202-7. doi: 10.1148/radiol.202.020.0230.
• Fang Y, Zhang H, Xu Y, Xie J, Pang P, Ji W. CT Manifestations of Two cases of 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology 2020; 295:208-9. doi: 10.1148/ radiol.202.020.0280.
• Bernheim A, Mei X, Huang M, et al. Chest CT findings in coronavirus disease-19 (COVID-19): Relationship to duration of infection. Radiology 2020; 295:200463. doi: 10.1148/ radiol.202.020.0463.
• Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382:1708-20. doi: 10.1056/NEJMoa2002032.
• WHO Working Group on the Clinical Characterisation and Management of COVID-19 infection. A minimal common outcome measure set for COVID-19 clinical research. Lancet Infect Dis 2020; 20:e192–e197. doi: 10.1016/S1473- 3099(20)30483-7.
• Yang R, Li X, Liu H, et al. Chest CT Severity Score: An imaging tool for assessing severe COVID-19. Radiol: Cardiothorac Imaging 2020; 2:e200047. doi: 10.1148/ryct.202.020.0047.
• Li K, Fang Y, Li W, et al. CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19). Eur Radiol 2020; 30:4407-16. doi: 10.1007/ s00330.020.06817-6.
• Li Z, Zeng B, Lei P, et al. Differentiating pneumonia with and without COVID-19 using chest CT images: from qualitative to quantitative. J Xray Sci Technol 28:583-9. doi: 10.3233/XST- 200689.
• Paul NS, Roberts H, Butany J, et al. Radiologic pattern of disease in patients with severe acute respiratory syndrome: The Toronto experience. RadioGraphics 2004; 24:553-63. doi: 10.1148/rg.242035193.
• Ng M-Y, Lee EYP, Yang J, et al. Imaging profile of the COVID-19 infection: Radiologic findings and literature review. Radiol: Cardiothorac Imaging 2020; 2:e200034. doi: 10.1148/ryct.202.020.0034.
• Long C, Xu H, Shen Q, et al. Diagnosis of the coronavirus disease (COVID-19): rRT-PCR or CT? Eur J Radiol 2020; 126:108961. doi: 10.1016/j.ejrad.2020.108961.
• He J-L, Luo L, Luo Z-D, et al. Diagnostic performance between CT and initial real-time RT-PCR for clinically suspected 2019 coronavirus disease (COVID-19) patients outside Wuhan, China. Respir Med 2020; 168:105980. doi: 10.1016/j. rmed.2020.105980
• Waller JV, Allen IE, Lin KK, Diaz MJ, Henry TS, Hope MD. The limited sensitivity of chest computed tomography relative to reverse transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus-2 infection. Invest Radiol 2020;55:754-61. doi: 10.1097/RLI.000.000.0000000700.
• Pan F, Ye T, Sun P, et al. Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19). Radiology 2020; 295:715-21. doi: 10.1148/radiol.202.020.0370
• Li Y, Yao L, Li J, et al. Stability issues of RT-PCR testing of SARS-CoV-2 for hospitalized patients clinically diagnosed with COVID-19. J Med Virol 2020; 92:903-8. doi: 10.1002/ jmv.25786.
• Ai T, Yang Z, Hou H, et al. Correlation of chest CT and RTPCR testing for coronavirus disease 2019 (COVID-19) in China: A report of 1014 cases. Radiology 2020; 296:E32–E40. doi: 10.1148/radiol.202.020.0642