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?

Overview

Journal Respir Investig

Publisher Elsevier

Date 2022 May 17

PMID 35581125

Authors

Kazuhiko Morikawa

Shigeki Misumi

Takao Igarashi

Ayako Fujimori

Akira Ogihara

Ryo Akao

Jun Hasumi

Takashi Watanabe

Yuriko Fujii

Hiroya Ojiri

Shohei Mori

Affiliations

Soon will be listed here.

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.

Citing Articles

Neck CT angiography in acute stroke: An open window for fast detection of COVID-19 lung involvement? Applicability in telemedicine.

Ucles J, Cuesta E, Rigual R, Rodriguez-Pardo J, Ruiz-Ares G, Navia P PLoS One. 2023; 18(2):e0281955.

PMID: 36827270 PMC: 9955938. DOI: 10.1371/journal.pone.0281955.

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