Article ; Online: Accuracy and reproducibility of low-dose submillisievert chest CT for the diagnosis of COVID-19
Radiol Cardiothorac Imaging
Abstract: PURPOSE: To demonstrate the accuracy and reproducibility of low-dose submillisievert chest CT for the diagnosis of COVID-19 infection in emergency room (ER) patients. MATERIALS AND METHODS: This was a HIPAA-compliant, institutional review board-approved ... ...
| Abstract | PURPOSE: To demonstrate the accuracy and reproducibility of low-dose submillisievert chest CT for the diagnosis of COVID-19 infection in emergency room (ER) patients. MATERIALS AND METHODS: This was a HIPAA-compliant, institutional review board-approved retrospective study. From March 14(th) to March 24(th) 2020, 192 ER patients with symptoms suggestive of COVID-19 infection were studied with low-dose chest CT and real time polymerase chain reaction (RT-PCR). Image analysis included likelihood of COVID-19 infection and semi-quantitative extent of lung involvement. CT images were analyzed by 2 radiologists blinded to RT-PCR results. Reproducibility was assessed with McNemar test and intra-class correlation coefficient (ICC). Time between CT acquisition and report was measured. RESULTS: When compared to RT-PCR, low-dose submillisievert chest CT demonstrated excellent sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for diagnosis of COVID-19 (86.7%, 93.6%, 91.1%, 90.3%, and 90.2%, respectively), in particular in patients with clinical symptoms for >48h (95.6%, 93.2%, 91.5%, 96.5%, and 94.4%, respectively). In patients with a positive CT, likelihood of disease increased from 43.2% (pre-test probability) to 91.1% or 91.4% (post-test probability), while in patients with a negative CT, likelihood of disease decreased to 9.6% or 3.7% for all patients or those with clinical symptoms for >48h, respectively. The prevalence of alternative diagnoses based on chest CT in patients without COVID-19 infection was 17.6%. Mean effective radiation dose was 0.56±0.25 mSv (SD). Median time between CT acquisition and report was 25 minutes (IQR: 13-49 minutes). Intra- and interreader reproducibility of CT was excellent (all ICC□0.95) without significant bias in Bland-Altman analysis. CONCLUSION: Low-dose submillisievert chest CT allows for rapid, accurate and reproducible assessment of COVID-19 infection in ER patients, in particular in patients with symptoms lasting longer than 48 hours. Chest CT has the additional advantage of offering alternative diagnoses in a significant subset of patients. |
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| Keywords | covid19 |
| Publisher | PMC |
| Document type | Article ; Online |
| DOI | 10.1148/ryct.2020200196 |
| Database | COVID19 |
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