Early chest computed tomography to diagnose COVID-19 from suspected patients: A multicenter retrospective study

Abstract

Objective: The purpose of this study was to distinguish the imaging features of COVID-19 from those of other infectious pulmonary diseases and evaluate the diagnostic value of chest CT for suspected COVID-19 patients.

Methods: Adult patients suspected of COVID-19 aged >18 years who underwent chest CT scans and reverse-transcription polymerase chain reaction (RT-PCR) tests within 14 days of symptom onset were enrolled. The enrolled patients were confirmed and grouped according to the results of the RT-PCR tests. The basic demographics, single chest CT features, and combined chest CT features were analyzed for the confirmed and nonconfirmed groups.

Results: A total of 130 patients were enrolled, with 54 testing positive and 76 testing negative. The typical CT imaging features of the positive group were ground glass opacities (GGOs), the crazy-paving pattern and air bronchogram. The lesions were mostly distributed bilaterally and close to the lower lungs or the pleura. When features were combined, GGOs with bilateral pulmonary distribution and GGOs with pleural distribution were more common among the positive patients, found in 31 (57.4%) and 30 patients (55.6%), respectively. The combinations were almost all statistically significant (P < .05), except for the combination of GGOs with consolidation. Most combinations presented relatively low sensitivity but extremely high specificity. The average specificity of these combinations was approximately 90%.

Conclusions: The combinations with GGOs could be useful in the identification and differential diagnosis of COVID-19, alerting clinicians to isolate patients for prompt treatment and repeat RT-PCR tests until the end of incubation.

Keywords: 2019-nCoV, 2019 novel coronavirus; BALF, Bronchoalveolar lavage fluid; COVID-19, Coronavirus Disease 2019; Computed tomography; Coronavirus infections; GGO, ground glass opacity; HRCT, High-resolution computed tomography; MERS, Middle East respiratory syndrome; RT-PCR, reverse-transcription polymerase chain reaction; Reverse-transcription polymerase chain reaction; SARS, Severe acute respiratory syndrome; Sensitivity and specificity; Viral pneumonia.

Fig. 1

Flow chart of the study.

Fig. 2

Various combinations of GGO on early CT imaging GGO, ground glass opacity Various combinations of GGO on early CT imaging were shown as above. A, B, C: GGO with bilateral and subpleural distribution; D: GGO with air bronchogram and bilateral lower pulmonary distribution; E: GGO with air bronchogram; F: GGO with crazy-paving pattern and bilateral lower pulmonary distribution.