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. 2020 May 7;20(1):129.
doi: 10.1186/s12890-020-1170-6.

CT differential diagnosis of COVID-19 and non-COVID-19 in symptomatic suspects: a practical scoring method

Lin Luo  1 , Zhendong Luo  1 , Yizhen Jia  2 , Cuiping Zhou  1 , Jianlong He  1 , Jianxun Lyu  1 , Xinping Shen  3
Affiliations

CT differential diagnosis of COVID-19 and non-COVID-19 in symptomatic suspects: a practical scoring method

Lin Luo et al. BMC Pulm Med. .

Abstract

Background: Although typical and atypical CT image findings of COVID-19 are reported in current studies, the CT image features of COVID-19 overlap with those of viral pneumonia and other respiratory diseases. Hence, it is difficult to make an exclusive diagnosis.

Methods: Thirty confirmed cases of COVID-19 and forty-three cases of other aetiology or clinically confirmed non-COVID-19 in a general hospital were included. The clinical data including age, sex, exposure history, laboratory parameters and aetiological diagnosis of all patients were collected. Seven positive signs (posterior part/lower lobe predilection, bilateral involvement, rounded GGO, subpleural bandlike GGO, crazy-paving pattern, peripheral distribution, and GGO +/- consolidation) from significant COVID-19 CT image features and four negative signs (only one lobe involvement, only central distribution, tree-in-bud sign, and bronchial wall thickening) from other non-COVID-19 pneumonia were used. The scoring analysis of CT features was compared between the two groups (COVID-19 and non-COVID-19).

Results: Older age, symptoms of diarrhoea, exposure history related to Wuhan, and a lower white blood cell and lymphocyte count were significantly suggestive of COVID-19 rather than non-COVID-19 (p < 0.05). The receiver operating characteristic (ROC) curve of the combined CT image features analysis revealed that the area under the curve (AUC) of the scoring system was 0.854. These cut-off values yielded a sensitivity of 56.67% and a specificity of 95.35% for a score > 4, a sensitivity of 100% and a specificity of 23.26% for a score > 0, and a sensitivity of 86.67% and a specificity of 67.44% for a score > 2.

Conclusions: With a simple and practical scoring system based on CT imaging features, we can make a hierarchical diagnosis of COVID-19 and non-COVID-19 with different management suggestions.

Keywords: Coronavirus infections; Lung diseases; Pneumonia; Tomography, x-ray computed.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a-d are the images of COVID-19. a Pure GGO and Rounded GGO (circle). b Mix GGO and consolidation. c Crazy-paving pattern. d Subpleural bandlike areas of GGO. e-f are the images of non-COVID-19. e Central (peribronchovascular) distribution (circle). f Tree-in-bud sign (circle)
Fig. 2
Fig. 2
ROC curve for COVID-19 prediction
See this image and copyright information in PMC

References

    1. Authority MAaH. Guidlines for the diagnosis and treatment of coronavirus 2019 (COVID-19) infection by the national health commission (trial version 7). National Health Commision of the People’s Republic of China website. 2020. http://en.nhc.gov.cn/2020-03/29/c_78469.htm. Accessed 3 Mar 2020.
    1. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC et al. Clinical characteristics of Coronavirus disease 2019 in China. N Engl J Med. 2020. 10.1056/NEJMc2005203. - PMC - PubMed
    1. Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J. Chest CT for Typical 2019-nCoV Pneumonia. Relationship to Negative RT-PCR Testing. Radiology. 2020. 10.1148/radiol.2020200343. - PMC - PubMed
    1. Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, Ji W. Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radiology. 2020. 10.1148/radiol.2020200432. - PMC - PubMed
    1. Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, Tao Q, Sun Z, Xia L. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: a Report of 1014 Cases. Radiology. 2020. 10.1148/radiol.2020200642. - PMC - PubMed

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