tetano
Editor, Senior Moderator
Respir Investig
. 2022 May 8;S2212-5345(22)00051-X.
doi: 10.1016/j.resinv.2022.04.007. Online ahead of print.
Clinical significance of chest CT for the exclusion of COVID-19 in pre-admission screening: Is it worthwhile using chest CT with reverse-transcription polymerase chain reaction test?
Kazuhiko Morikawa[SUP] 1 [/SUP], Shigeki Misumi[SUP] 2 [/SUP], Takao Igarashi[SUP] 2 [/SUP], Ayako Fujimori[SUP] 2 [/SUP], Akira Ogihara[SUP] 2 [/SUP], Ryo Akao[SUP] 2 [/SUP], Jun Hasumi[SUP] 2 [/SUP], Takashi Watanabe[SUP] 2 [/SUP], Yuriko Fujii[SUP] 2 [/SUP], Hiroya Ojiri[SUP] 2 [/SUP], Shohei Mori[SUP] 3 [/SUP]
Affiliations
Abstract
Background: A single reverse-transcription polymerase chain reaction (RT-PCR) test is not sufficient to exclude COVID-19 in hospital pre-admission screening. However, repeated RT-PCR tests are time-consuming. This study investigates the utility of chest computed tomography (CT) for COVID-19 screening in asymptomatic patients.
Methods: Between April 2020 and March 2021, RT-PCR testing and chest CT were performed to screen COVID-19 in 10 823 asymptomatic patients prior to admission. Chest CT findings were retrospectively evaluated using the reporting system of the Radiological Society of North America. Using RT-PCR results as a reference, we assessed the diagnostic efficacy of chest CT during both the low- and high-prevalence periods of the COVID-19 pandemic.
Results: Following a positive RT-PCR test, 20 asymptomatic patients (0.18%) were diagnosed with COVID-19; in the low-prevalence period, 5 of 6556 patients (0.076%) were positive; and in the high-prevalence period, 15 of 4267 patients (0.35%) were positive. Of the 20 asymptomatic COVID-19 positive patients, chest CT results were positive for COVID-19 pneumonia in 8 patients. Chest CT results were false-positive in 185 patients (1.7% false-positive rate, and 60% false-negative rate). Pneumonia that was classified as a "typical appearance" of COVID-19 reported as false-positives in 36 of 39 patients (92.3%). Across the study period, the diagnostic efficacy of "typical appearance" on chest CT were characterized by a sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of 15%, 99.7%, 99.7%, 7.7%, and 99.8%; 20%, 99.6%, 99.6%, 4%, and 99.9%; and 13.3%, 99.7%, 99.7%, 14.3%, and 99.7%, in the entire study, low-, and high-prevalence periods, respectively.
Conclusions: Addition of chest CT to RT-PCR testing provides no benefit to the detection of COVID-19 in asymptomatic patients.
Keywords: Asymptomatic patient; COVID-19; Chest computed tomography screening; Severe acute respiratory syndrome coronavirus-2.
. 2022 May 8;S2212-5345(22)00051-X.
doi: 10.1016/j.resinv.2022.04.007. Online ahead of print.
Clinical significance of chest CT for the exclusion of COVID-19 in pre-admission screening: Is it worthwhile using chest CT with reverse-transcription polymerase chain reaction test?
Kazuhiko Morikawa[SUP] 1 [/SUP], Shigeki Misumi[SUP] 2 [/SUP], Takao Igarashi[SUP] 2 [/SUP], Ayako Fujimori[SUP] 2 [/SUP], Akira Ogihara[SUP] 2 [/SUP], Ryo Akao[SUP] 2 [/SUP], Jun Hasumi[SUP] 2 [/SUP], Takashi Watanabe[SUP] 2 [/SUP], Yuriko Fujii[SUP] 2 [/SUP], Hiroya Ojiri[SUP] 2 [/SUP], Shohei Mori[SUP] 3 [/SUP]
Affiliations
- PMID: 35581125
- DOI: 10.1016/j.resinv.2022.04.007
Abstract
Background: A single reverse-transcription polymerase chain reaction (RT-PCR) test is not sufficient to exclude COVID-19 in hospital pre-admission screening. However, repeated RT-PCR tests are time-consuming. This study investigates the utility of chest computed tomography (CT) for COVID-19 screening in asymptomatic patients.
Methods: Between April 2020 and March 2021, RT-PCR testing and chest CT were performed to screen COVID-19 in 10 823 asymptomatic patients prior to admission. Chest CT findings were retrospectively evaluated using the reporting system of the Radiological Society of North America. Using RT-PCR results as a reference, we assessed the diagnostic efficacy of chest CT during both the low- and high-prevalence periods of the COVID-19 pandemic.
Results: Following a positive RT-PCR test, 20 asymptomatic patients (0.18%) were diagnosed with COVID-19; in the low-prevalence period, 5 of 6556 patients (0.076%) were positive; and in the high-prevalence period, 15 of 4267 patients (0.35%) were positive. Of the 20 asymptomatic COVID-19 positive patients, chest CT results were positive for COVID-19 pneumonia in 8 patients. Chest CT results were false-positive in 185 patients (1.7% false-positive rate, and 60% false-negative rate). Pneumonia that was classified as a "typical appearance" of COVID-19 reported as false-positives in 36 of 39 patients (92.3%). Across the study period, the diagnostic efficacy of "typical appearance" on chest CT were characterized by a sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of 15%, 99.7%, 99.7%, 7.7%, and 99.8%; 20%, 99.6%, 99.6%, 4%, and 99.9%; and 13.3%, 99.7%, 99.7%, 14.3%, and 99.7%, in the entire study, low-, and high-prevalence periods, respectively.
Conclusions: Addition of chest CT to RT-PCR testing provides no benefit to the detection of COVID-19 in asymptomatic patients.
Keywords: Asymptomatic patient; COVID-19; Chest computed tomography screening; Severe acute respiratory syndrome coronavirus-2.