Does CT help in reducing RT-PCR false negative rate for COVID-19?

Abstract

Background: Early detection is the key to contain the ongoing pandemic. The current gold standard to detect SARS CoV2 is RT-PCR. However, it has a high false negative rate and long turnaround time. Purpose: In view of the high sensitivity of CT in detection of lower respiratory tract pathologies, a study of 2581 patients comparing RT-PCR status with CT findings was undertaken to see if it augments the diagnostic performance. Materials and Methods: A multi centre prospective study of consecutive cases was conducted. All CT studies suggestive of COVID 19 pneumonia were collated and evaluated independently by three Radiologists to confirm the imaging diagnosis of COVID-19 pneumonia. The RT-PCR values were retrospectively obtained, based on the RT-PCR values, CT studies were categorised into three subgroups, positive, negative and unknown. CT features from all three groups were compared to evaluate any communality or discordance. Results: Out of the 2581 patients with positive CT findings for COVID pneumonia, 825 were females and 1,756 were males in a wide age group of 28-90 years. Predominant CT features observed in all the subgroups were Ground glass densities 94.8%, in mixed distribution (peripheral and central) (59.12%), posterior segments in 92% and multilobar involvement in 70.9%. The CT features across the three subgroups were statistically significant with a P value <0.001. Conclusion: There was a communality of CT findings regardless of RT-PCR status. In a pandemic setting ground glass densities in a subpleural, posterior and basal distribution are indicative of COVID 19. Thus CT chest in conjunction to RT PCR augments the diagnosis of COVID 19 pneumonia; utilization of CT chest may just be the missing link in closing this pandemic.

Keywords

Coronavirus disease-2019 - ground glass opacity - reverse transcriptase polymerase chain reaction - severe acute respiratory syndrome

Publikationsverlauf

Eingereicht: 06. September 2020

Angenommen: 24. Dezember 2020

Artikel online veröffentlicht:
13. Juli 2021

• References

• 1 Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W. et al. Correlation of chest CT and RTPCR testing in coronavirus disease 2019 (COVID-19) in China: A report of 1014 cases. Radiology 2020; 296: E32-40
• 2 Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P. et al. Sensitivity of chest CT for COVID-19: Comparison to RT-PCR. Radiology 2020; 296: E115-7
• 3 SUMMARYCOVID-19 RT-PCR TEST – FDA. Available from: www.fda.gov/media/136151/download. [Last accessed on2020Apr 15].
• 4 Corman VM, Landt O, Kaiser M, Molenkamp R, Meijer A, Chu DK. et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill 2020; 25: 2000045
• 5 Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N. et al. Chest CT findings in coronavirus disease-19 (COVID-19): Relationship to duration of infection. Radiology 2020; 295: 200463
• 6 Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): A systematic review of imaging findings in 919 patients. AJR Am J Roentgenol 2020; 215: 87-93
• 7 Parry AH, Wani AH, Yaseen M, Jehangir M, Choh NA, Dar KA. Spectrum of chest computed tomographic (CT) findings in coronavirus disease-19 (COVID-19) patients in India. Eur J Radiol 2020; 129: 109147
• 8 Caruso D, Zerunian M, Polici M, Pucciarelli F, Polidori T, Rucci C. et al. Chest CT Features of COVID-19 in Rome, Italy. Radiology 2020; 296: E79-85
• 9 Kucirka LM, Lauer SA, Laeyendecker O, Boon D, Lessler J. Variation in false-negative rate of reverse transcriptase polymerase chain reaction-based SARS-CoV-2 tests by time since exposure. Ann Intern Med 2020; 173: 262-7
• 10 Carotti M, Salaffi F, Sarzi-Puttini P, Agostini A, Borgheresi A, Minorati D. et al. Chest CT features of coronavirus disease 2019 (COVID-19) pneumonia: Key points for radiologists. Radiol Med 2020; 125: 636-46
• 11 Han R, Huang L, Jiang H, Dong J, Peng H, Zhang D. Early clinical and CT manifestations of coronavirus disease 2019 (COVID-19) pneumonia. AJR Am J Roentgenol 2020; 215: 338-43
• 12 Parry AH, Wani AH, Yaseen M, Jehangir M. Chest CT features of coronavirus disease-19 (COVID-19) pneumonia: Which findings on initial CT can predict an adverse short-term outcome?. BJR Open 2020; 2: 20200016
• 13 Pan Y, Guan H, Zhou S, Wang Y, Li Q, Zhu T. et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): A study of 63 patients in Wuhan, China. Eur Radiol 2020; 30: 3306-9
• 14 Wang Y, Dong C, Hu Y, Li C, Ren Q, Zhang X. et al. Temporal changes of CT findings in 90 patients with COVID-19 pneumonia: A longitudinal study. Radiology 2020; 296: E55-64
• 15 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
• 16 Zhou S, Wang Y, Zhu T, Xia L. CT Features of coronavirus disease 2019 (COVID-19) pneumonia in 62 patients in Wuhan, China. AJR Am J Roentgenol 2020; 214: 1287-94
• 17 Zhang R, Ouyang H, Fu L, Wang S, Han J, Huang K. et al. CT features of SARS-CoV-2 pneumonia according to clinical presentation: A retrospective analysis of 120 consecutive patients from Wuhan city. Eur Radiol 2020; 30: 4417-26
• 18 Bai HX, Hsieh B, Xiong Z, Halsey K, Choi JW, Tran TM. et al. Performance of radiologists in differentiating COVID-19 from viral pneumonia on chest CT. Radiology 2020; 296: E46-54
• 19 Mason RJ. Pathogenesis of COVID-19 from a cell biology perspective. Eur Respir J 2020; 55: 2000607
• 20 Tahamtan A, Ardebili A. Real-time RT-PCR in COVID-19 detection: issues affecting the results. Expert Rev Mol Diagn 2020; May 20 (05) 453-454
• 21 Yu F, Yan L, Wang N, Yang S, Wang L, Tang Y. et al. Quantitative detection and viral load analysis of SARS-CoV-2 in infected patients. Clin Infect Dis 2020; 71: 793-8
• 22 Winichakoon P, Chaiwarith R, Liwsrisakun C, Salee P, Goonna A, Limsukon A. et al. Negative nasopharyngeal and oropharyngeal swabs do not rule out COVID-19. J Clin Microbiol 2020; 58: e00297-20
• 23 Wu J, Liu J, Zhao X, Liu C, Wang W, Wang D. et al. Clinical characteristics of imported cases of Coronavirus disease 2019 (COVID-19) in jiangsu province: A multicenter descriptive study. Clin Infect Dis 2020; 71: 706-12
• 24 Ooi EE, Low JG. Asymptomatic SARS-CoV-2 infection. Lancet Infect Dis. 2020; 20 (09) 996-998
• 25 Mizumoto K, Kagaya K, Zarebski A, Chowell G. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Euro Surveill 2020; 25: 2000180
• 26 Chang MC, Lee W, Hur J, Park D. Chest computed tomography findings in asymptomatic patients with COVID-19. Respiration 2020; 99: 748-54
• 27 Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C. et al. Pathological findings of COVID19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020; 84: 420-2
• 28 Fehr AR, Perlman S. Coronaviruses: An overview of their replication and pathogenesis. Methods Mol Biol 2015; 1282: 1-23
• 29 Wang Y, Sun J, Zhu A, Zhao J, Zhao J. Current understanding of middle east respiratory syndrome coronavirus infection in human and animal models. J Thorac Dis 2018; 10: S2260-71
• 30 Du L, Yang Y, Zhou Y, Lu L, Li F, Jiang S. MERS-CoV spike protein: A key target for antivirals. Expert Opin Ther Targets 2017; 21: 131-43
• 31 Du L, He Y, Zhou Y, Liu S, Zheng B, Jiang S. The spike protein of SARS-CoV—A target for vaccine and therapeutic development. Nat Rev Microbiol 2009; 7: 226-36
• 32 Wu J, Wu X, Zeng W, Guo D, Fang Z, Chen L. et al. Chest CT findings in patients with Corona virus disease 2019 and its relationship with clinical features. Invest Radiol 2020; 55: 257-61
• 33 Hani C, Trieu NH, Saab I, Dangeard S, Bennani S, Chassagnon G. et al. COVID-19 pneumonia: A review of typical CT findings and differential diagnosis. Diagn Interv Imaging 2020; 101: 263-8
• 34 Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX. et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708-20
• 35 Lan L, Xu D, Ye G, Xia C, Wang S, Li Y. et al. Positive RT-PCR test results in patients recovered from COVID-19. JAMA 2020; 323: 1502-3
• 36 Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J. Chest CT for typical 2019-nCoV pneumonia: Relationship to negative RTPCR testing. Radiology 2020; 296: E41-5
• 37 Rubin GD, Ryerson CJ, Haramati LB, Sverzellati N, Kanne JP, Raoof S. et al. The role of chest imaging in patient management during the COVID-19 pandemic: A multinational consensus statement from the Fleischner Society. Radiology 2020; 296: 172-80
• 38 WHO/2019-nCoV/Clinical/Radiology_imaging/2020.1.
• 39 ACR Recommendations for the use of Chest Radiography and Computed Tomography (CT) for Suspected COVID-19 Infection.
• 40 Kalra MK, Homayounieh F, Arru C, Holmberg O, Vassileva J. Chest CT practice and protocols for COVID-19 from radiation dose management perspective. Eur Radiol 2020; 30: 6554-60
• 41 Elicker BM, Jones KD, Henry TS, Collard HR. Multidisciplinary approach to hypersensitivity pneumonitis. J Thorac Imaging 2016; 31: 92-103
• 42 Parekh M, Donuru A, Balasubramanya R, Kapur S. Review of the Chest CT differential diagnosis of ground-glass opacities in the COVID Era. Radiology 2020; 297: E289-302
• 43 Li K, Wu J, Wu F, Guo D, Chen L, Fang Z. et al. The clinical and chest CT features associated with severe and critical COVID-19 pneumonia. Invest Radiol 2020; 55: 327-31
• 44 Zu ZY, Jiang MD, Xu PP, Chen W, Ni QQ, Lu GM. et al. Coronavirus disease 2019 (COVID-19): A perspective from China. Radiology 2020; 296: E15-25
• 45 Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X. et al. CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology 2020; 295: 202-7
• 46 Song F, Shi N, Shan F, Zhang Z, Shen J, Lu H. et al. Emerging 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology 2020; 295: 210-7
• 47 Tanaka N, Emoto T, Suda H, Kunihiro Y, Matsunaga N, Hasegawa S. et al. High-resolution computed tomography findings of influenza virus pneumonia: A comparative study between seasonal and novel (H1N1) influenza virus pneumonia. Jpn J Radiol 2012; 30: 154-61
• 48 Deng J, Zheng Y, Li C, Ma Z, Wang H, Rubin BK. Plastic bronchitis in three children associated with 2009 influenza A (H1N1) virus infection. Chest 2010; 138: 1486-8
• 49 Kim YN, Cho HJ, Cho YK, Ma JS. Clinical significance of pleural effusion in the new influenza A (H1N1) viral pneumonia in children and adolescent. Pediatr Pulmonol 2012; 47: 505-9
• 50 Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497-506
• 51 Altmayer S, Zanon M, Pacini GS, Watte G, Barros MC, Mohammed TL. et al. Comparison of the computed tomography findings in COVID-19 and other viral pneumonia in immunocompetent adults: A systematic review and meta-analysis. Eur Radiol 2020; 30: 6485-96
• 52 Vagal A, Mahoney M, Allen B, Kapur S, Udstuen G, Wang L. et al. Rescheduling nonurgent care in radiology: Implementation during the coronavirus disease 2019 (COVID-19) pandemic. J Am Coll Radiol 2020; 17: 882-9
• 53 Aguiar de Sousa D, Sandset EC, Elkind MSV. The curious case of the missing strokes during the COVID-19 pandemic. Stroke 2020; 51: 1921-3
• 54 Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Imaging Case Volumes. doi.org/10.1016/j.jacr.2020.05.004.
• 55 Nakajima K, Kato H, Yamashiro T, Izumi T, Takeuchi I, Nakajima H. et al. COVID-19 pneumonia: Infection control protocol inside computed tomography suites. Jpn J Radiol 2020; 38: 391-3
• 56 Mossa-Basha M, Azadi J, Ko J, Klein J, Meltzer C. COVID-19 Task Force. RSNA COVID-19 task force.
• 57 Singh S, Kalra MK, Ali Khawaja RD, Padole A, Pourjabbar S, Lira D. et al. Radiation dose optimization and thoracic computed tomography. Radiol Clin N Am 2014; 52: 1-15
• 58 Fan L, Liu S. CT and COVID-19: Chinese experience and recommendations concerning detection, staging and follow-up. Eur Radiol 2020; 30: 5214-6
• 59 Yang Q, Liu Q, Xu H, Lu H, Liu S, Li H. Imaging of coronavirus disease 2019: A Chinese expert consensus statement. Eur J Radiol 2020; 127: 109008
• 60 worldometers.info/world-population/population-by-country.
• 61 worldometers.info/coronavirus/country/china.
• 62 Lai CC, Wang CY, Hsueh PR. Co-infections among patients with COVID-19: The need for combination therapy with non-anti-SARS-CoV-2 agents?. J Microbiol Immunol Infect 2020; 53: 505-12