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

Öz

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

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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