Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases
Tao Ai, Zhenlu Yang, Hongyan Hou, Chenao Zhan, Chong Chen, Wenzhi Lv, Qian Tao, Ziyong Sun, Liming Xia, Tao Ai, Zhenlu Yang, Hongyan Hou, Chenao Zhan, Chong Chen, Wenzhi Lv, Qian Tao, Ziyong Sun, Liming Xia
Abstract
Background Chest CT is used in the diagnosis of coronavirus disease 2019 (COVID-19) and is an important complement to reverse-transcription polymerase chain reaction (RT-PCR) tests. Purpose To investigate the diagnostic value and consistency of chest CT as compared with RT-PCR assay in COVID-19. Materials and Methods This study included 1014 patients in Wuhan, China, who underwent both chest CT and RT-PCR tests between January 6 and February 6, 2020. With use of RT-PCR as the reference standard, the performance of chest CT in the diagnosis of COVID-19 was assessed. In addition, for patients with multiple RT-PCR assays, the dynamic conversion of RT-PCR results (negative to positive, positive to negative) was analyzed as compared with serial chest CT scans for those with a time interval between RT-PCR tests of 4 days or more. Results Of the 1014 patients, 601 of 1014 (59%) had positive RT-PCR results and 888 of 1014 (88%) had positive chest CT scans. The sensitivity of chest CT in suggesting COVID-19 was 97% (95% confidence interval: 95%, 98%; 580 of 601 patients) based on positive RT-PCR results. In the 413 patients with negative RT-PCR results, 308 of 413 (75%) had positive chest CT findings. Of those 308 patients, 48% (103 of 308) were considered as highly likely cases and 33% (103 of 308) as probable cases. At analysis of serial RT-PCR assays and CT scans, the mean interval between the initial negative to positive RT-PCR results was 5.1 days ± 1.5; the mean interval between initial positive to subsequent negative RT-PCR results was 6.9 days ± 2.3. Of the 1014 patients, 60% (34 of 57) to 93% (14 of 15) had initial positive CT scans consistent with COVID-19 before (or parallel to) the initial positive RT-PCR results. Twenty-four of 57 patients (42%) showed improvement on follow-up chest CT scans before the RT-PCR results turned negative. Conclusion Chest CT has a high sensitivity for diagnosis of coronavirus disease 2019 (COVID-19). Chest CT may be considered as a primary tool for the current COVID-19 detection in epidemic areas. © RSNA, 2020 Online supplemental material is available for this article. A translation of this abstract in Farsi is available in the supplement. ترجمه چکیده این مقاله به فارسی، در ضمیمه موجود است.
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References
- Huang C, Wang Y, Li X, et al. . Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020. 395(10223):497-506.
- WHO. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected: interim guidance. Jan 11, 2020.
- National Health Commission of the People’s Republic of China . (Assessed on February 25th, 2020).
- The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team, Chinese Center of Disease Control and Prevention . The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Chinese journal of epidemiology. 2020. 41(2):145-151. DOI:10.3760/cma.j.issn.0254-6450.2020.02.003. (In Chinese with English Abstract).
- General Office of National Health Committee . Notice on the issuance of a program for the diagnosis and treatment of novel coronavirus (2019-nCoV) infected pneumonia (trial sixth edition) (2020-02-18). (accessed Feb 24, 2020).
- Yang Y, Yang M, Shen C, et al. . Evaluating the accuracy of different respiratory specimens in the laboratory diagnosis and monitoring the viral shedding of 2019-nCoV infections. 2020. 10.1101/2020.02.11.20021493.
- Chung M, Bernheim A, Mei X, et al. . CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology 2020. DOI: 10.1148/radiol.2020200230.
- Huang P, Liu T, Huang L, et al. . Use of chest CT in combination with negative RT-PCR assay for the 2019 novel coronavirus but high clinical suspicion. Radiology 2020. DOI: 10.1148/radiol.2020200330.
- Xie X, Zhong Z, Zhao W, et al. . Chest CT for typical 2019-nCoV pneumonia: relationship to negative RT-PCR testing. Radiology 2020. DOI: 10.1148/radiol.2020200343.
- Lei J, Li J, Li X, et al. . CT imaging of the 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology 2020. DOI: 10.1148/radiol.2020200236.
- Shi H, Han X, Zheng C. Evolution of CT manifestations in a patient recovered from 2019 novel coronavirus (2019-nCoV) pneumonia in Wuhan, China. Radiology 2020. DOI: 10.1148/radiol.2020200269.
- Pan F, Ye T, Sun P, et al. . Time course of lung changes on chest CT during recovery from 2019 novel coronavirus (COVID-19) pneumonia. Radiology 2020. DOI: 10.1148/radiol.2020200370.
- Pan Y, Guan H, Zhou S, 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. DOI: 10.1007/s00330-020-06731-x.
- Guan W, Ni Z, Hu Y, et al. . Clinical characteristics of 2019 novel coronavirus infection in China. 202010.1101/2020.02.06.20020974.
- General Office of National Health Committee . Notice on the issuance of a program for the diagnosis and treatment of novel coronavirus (2019-nCoV) infected pneumonia (trial revised fifth edition) (2020-02-8). (accessed Feb 24, 2020).
Source: PubMed