Accuracy of CT in a cohort of symptomatic patients with suspected COVID-19 pneumonia during the outbreak peak in Italy
- PDF / 1,251,580 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 72 Downloads / 182 Views
CHEST
Accuracy of CT in a cohort of symptomatic patients with suspected COVID-19 pneumonia during the outbreak peak in Italy Giulia Besutti 1,2 & Paolo Giorgi Rossi 3 & Valentina Iotti 2 & Lucia Spaggiari 2 & Riccardo Bonacini 2 & Andrea Nitrosi 4 & Marta Ottone 3 & Efrem Bonelli 2,5 & Tommaso Fasano 5 & Simone Canovi 5 & Rossana Colla 5 & Marco Massari 6 & Ivana Maria Lattuada 7 & Laura Trabucco 7 & Pierpaolo Pattacini 2 & the Reggio Emilia COVID-19 Working Group Received: 21 April 2020 / Revised: 3 June 2020 / Accepted: 29 June 2020 # European Society of Radiology 2020
Abstract Objective To assess sensitivity/specificity of CT vs RT-PCR for the diagnosis of COVID-19 pneumonia in a prospective Italian cohort of symptomatic patients during the outbreak peak. Methods In this cross-sectional study, we included all consecutive patients who presented to the ER between March 13 and 23 for suspected COVID-19 and underwent CT and RT-PCR within 3 days. Using a structured report, radiologists prospectively classified CTs in highly suggestive, suggestive, and non-suggestive of COVID-19 pneumonia. Ground-glass, consolidation, and visual extension of parenchymal changes were collected. Three different RT-PCR-based reference standard definitions were used. Oxygen saturation level, CRP, LDH, and blood cell counts were collected and compared between CT/RT-PCR classes. Results The study included 696 patients (41.4% women; age 59 ± 15.8 years): 423/454 (93%) patients with highly suggestive CT, 97/ 127 (76%) with suggestive CT, and 31/115 (27%) with non-suggestive CT had positive RT-PCR. CT sensitivity ranged from 73 to 77% and from 90 to 94% for high and low positivity threshold, respectively. Specificity ranged from 79 to 84% for high positivity threshold and was about 58% for low positivity threshold. PPV remained ≥ 90% in all cases. Ground-glass was more frequent in patients with positive RT-PCR in all CT classes. Blood tests were significantly associated with RT-PCR and CT classes. Leukocytes, lymphocytes, neutrophils, and platelets decreased, CRP and LDH increased from non-suggestive to suggestive CT classes. Conclusions During the outbreak peak (in a high-prevalence setting), CT presented high PPV and may be considered a good reference to recognize COVID-19 patients while waiting for RT-PCR confirmation. Key Points • During the epidemic peak, CT showed high positive predictive value and sensitivity for COVID-19 pneumonia when compared with RT-PCR. • Blood tests were significantly associated with RT-PCR and CT classes. Keywords COVID-19 . Severe acute respiratory syndrome coronavirus 2 . Pneumonia . Polymerase Chain Reaction . Tomography, X-ray computed Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00330-020-07050-x) contains supplementary material, which is available to authorized users. * Giulia Besutti [email protected] 1
Clinical and Experimental Medicine PhD program, University of Modena and Reggio Emilia, Modena, Italy
2
Radiology Unit, Department of Diagnosti
Data Loading...
