Effectiveness of COVID-19 diagnosis and management tools: A review

Abstract

Objective: To review the available literature concerning the effectiveness of the COVID-19 diagnostic tools.

Background: With the absence of specific treatment/vaccines for the coronavirus COVID-19, the most appropriate approach to control this infection is to quarantine people and isolate symptomatic people and suspected or infected cases. Although real-time reverse transcription-polymerase chain reaction (RT-PCR) assay is considered the first tool to make a definitive diagnosis of COVID-19 disease, the high false negative rate, low sensitivity, limited supplies and strict requirements for laboratory settings might delay accurate diagnosis. Computed tomography (CT) has been reported as an important tool to identify and investigate suspected patients with COVID-19 disease at early stage.

Key findings: RT-PCR shows low sensitivity (60-71%) in diagnosing patients with COVID-19 infection compared to the CT chest. Several studies reported that chest CT scans show typical imaging features in all patients with COVID-19. This high sensitivity and initial presentation in CT chest can be helpful in rectifying false negative results obtained from RT-PCR. As COVID-19 has similar manifestations to other pneumonia diseases, artificial intelligence (AI) might help radiologists to differentiate COVID-19 from other pneumonia diseases.

Conclusion: Although CT scan is a powerful tool in COVID-19 diagnosis, it is not sufficient to detect COVID-19 alone due to the low specificity (25%), and challenges that radiologists might face in differentiating COVID-19 from other viral pneumonia on chest CT scans. AI might help radiologists to differentiate COVID-19 from other pneumonia diseases.

Implication for practice: Both RT-PCR and CT tests together would increase sensitivity and improve quarantine efficacy, an impact neither could achieve alone.

Keywords: Artificial intelligence; CT scan; Consolidation; Crazy-paving; Ground-glass opacification; RT-PCR.

Graphical abstract

Figure 1

Lower bilateral peripheral consolidations and ground-glass opacities in keeping with the clinical diagnosis of clinical history provided of COVID-19.

Figure 2

Bilateral mainly basilar peripheral patchy consolidative opacities associated with bilateral basilar ill-defined ground-glass opacities.

Figure 3

Upper and lower lobe coalescent patchy perilobular ground-glass airspace opacities.

Figure 4

Multifocal bilateral airspace opacities that are more consolidation than ground glass and patchy peripheral distribution, which is related to patient's laboratory proven COVID-19.