TY - JOUR
T1 - Accuracy of CT in a cohort of symptomatic patients with suspected COVID-19 pneumonia during the outbreak peak in Italy
AU - Besutti, Giulia
AU - Giorgi Rossi, Paolo
AU - Iotti, Valentina
AU - Spaggiari, Lucia
AU - Bonacini, Riccardo
AU - Nitrosi, Andrea
AU - Ottone, Marta
AU - Bonelli, Efrem
AU - Fasano, Tommaso
AU - Canovi, Simone
AU - Colla, Rossana
AU - Massari, Marco
AU - Lattuada, Ivana Maria
AU - Trabucco, Laura
AU - Pattacini, Pierpaolo
N1 - Funding Information:
We thank Jacqueline Costa for the English language editing. The following are the members of the Reggio Emilia COVID-19 Working group: Massimo Costantini, Giulio Formoso, Manuela Bedeschi, Cinzia Perilli, Ivano Venturi, Eufemia Bisaccia, Elisabetta La Rosa, Cinzia Campari, Francesco Gioia, Serena Broccoli, Marta Ottone, Pierpaolo Pattacini, Giulia Besutti, Valentina Iotti, Lucia Spaggiari, Pamela Mancuso, Andrea Nitrosi, Marco Foracchia, Rossana Colla, Alessandro Zerbini, Marco Massari, Giovanni Dolci, Romina Corsini, Fabio Sampaolesi, Anna Maria Ferrari, Mirco Pinotti, Nicola Facciolongo, Ivana Lattuada, Laura Trabucco, Stefano De Pietri, Giorgio Francesco Danelli, Laura Albertazzi, Enrica Bellesia, Simone Canovi, Mattia Corradini, Tommaso Fasano, Elena Magnani, Annalisa Pilia, Alessandra Polese, Silvia Storchi Incerti, Piera Zaldini, Efrem Bonelli, Bonanno Orsola, Matteo Revelli, Carlo Salvarani, Francesco Venturelli.
Publisher Copyright:
© 2020, European Society of Radiology.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/12/1
Y1 - 2020/12/1
N2 - 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.
AB - 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.
KW - COVID-19
KW - Pneumonia
KW - Polymerase Chain Reaction
KW - Severe acute respiratory syndrome coronavirus 2
KW - Tomography, X-ray computed
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U2 - 10.1007/s00330-020-07050-x
DO - 10.1007/s00330-020-07050-x
M3 - Article
C2 - 32666316
AN - SCOPUS:85087920602
VL - 30
SP - 6818
EP - 6827
JO - European Radiology
JF - European Radiology
SN - 0938-7994
IS - 12
ER -