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. 2021 Sep 9;58(3):2004188.
doi: 10.1183/13993003.04188-2020. Print 2021 Sep.

Chest radiography or computed tomography for COVID-19 pneumonia? Comparative study in a simulated triage setting

Nicola Sverzellati  1 , Christopher J Ryerson  2 , Gianluca Milanese  1 , Elisabetta A Renzoni  3 , Annalisa Volpi  4 , Paolo Spagnolo  5 , Francesco Bonella  6 , Ivan Comelli  7 , Paola Affanni  8 , Licia Veronesi  8 , Carmelinda Manna  1 , Andrea Ciuni  1 , Carlotta Sartorio  1 , Giulia Tringali  1 , Mario Silva  1 , Emanuele Michieletti  9 , Davide Colombi  9 , Athol U Wells  3
Affiliations

Chest radiography or computed tomography for COVID-19 pneumonia? Comparative study in a simulated triage setting

Nicola Sverzellati et al. Eur Respir J. .

Abstract

Introduction: For the management of patients referred to respiratory triage during the early stages of the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic, either chest radiography or computed tomography (CT) were used as first-line diagnostic tools. The aim of this study was to compare the impact on the triage, diagnosis and prognosis of patients with suspected COVID-19 when clinical decisions are derived from reconstructed chest radiography or from CT.

Methods: We reconstructed chest radiographs from high-resolution CT (HRCT) scans. Five clinical observers independently reviewed clinical charts of 300 subjects with suspected COVID-19 pneumonia, integrated with either a reconstructed chest radiography or HRCT report in two consecutive blinded and randomised sessions: clinical decisions were recorded for each session. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and prognostic value were compared between reconstructed chest radiography and HRCT. The best radiological integration was also examined to develop an optimised respiratory triage algorithm.

Results: Interobserver agreement was fair (Kendall's W=0.365, p<0.001) by the reconstructed chest radiography-based protocol and good (Kendall's W=0.654, p<0.001) by the CT-based protocol. NPV assisted by reconstructed chest radiography (31.4%) was lower than that of HRCT (77.9%). In case of indeterminate or typical radiological appearance for COVID-19 pneumonia, extent of disease on reconstructed chest radiography or HRCT were the only two imaging variables that were similarly linked to mortality by adjusted multivariable models CONCLUSIONS: The present findings suggest that clinical triage is safely assisted by chest radiography. An integrated algorithm using first-line chest radiography and contingent use of HRCT can help optimise management and prognostication of COVID-19.

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Conflict of interest statement

Conflict of interests: N. Sverzellati has nothing to disclose. Conflict of interests: C.J. Ryerson has nothing to disclose. Conflict of interests: G. Milanese has nothing to disclose. Conflict of interests: E.A. Renzoni has nothing to disclose. Conflict of interests: A. Volpi has nothing to disclose. Conflict of interests: P. Spagnolo reports grants, personal fees and nonfinancial support from Roche, PPM Services and Boehringer Ingelheim, personal fees from Red X Pharma, Galapagos and Chiesi, outside the submitted work; and the author's spouse is an employee of Novartis. Conflict of interests: F. Bonella reports personal fees and nonfinancial support from Boehringer Ingelheim, Roche, Galapagos, Savara Pharma and Bristol Myers Squibb, outside the submitted work. Conflict of interests: I. Comelli has nothing to disclose. Conflict of interests: P. Affanni has nothing to disclose. Conflict of interests: L. Veronesi has nothing to disclose. Conflict of interests: C. Manna has nothing to disclose. Conflict of interests: A. Ciuni has nothing to disclose. Conflict of interests: C. Sartorio has nothing to disclose. Conflict of interests: G. Tringali has nothing to disclose. Conflict of interests: M. Silva has nothing to disclose. Conflict of interests: E. Michieletti has nothing to disclose. Conflict of interests: D. Colombi has nothing to disclose. Conflict of interests: A.U. Wells reports personal fees and other from Roche, Boehringer Ingelheim and Bayer, outside the submitted work.

Figures

FIGURE 1
FIGURE 1
Diagram illustrating the selection of the derivation study cohort. CT: computed tomography.
FIGURE 2
FIGURE 2
a) Reconstructed chest radiography and b) coronal multiplanar reconstruction of high-resolution computed tomography (HRCT) of a 41-year-old male patient with unilateral COVID-19 pneumonia. The focal, ovoid area of ground-glass opacity in the left lower lobe was identified at both reconstructed chest radiography and HRCT by the study observers. The extent of disease at reconstructed chest radiography was scored as category 0 (<20%) by both of the study observers when using the prognostic scoring system.
FIGURE 3
FIGURE 3
a) Reconstructed chest radiography and b) coronal multiplanar reconstruction of high-resolution computed tomography (HRCT) of a 71-year-old male patient with bilateral COVID-19 pneumonia. Bilateral, peripheral ground-glass opacities were reported at both reconstructed chest radiography and HRCT. However, disease extent was scored as category 0 (<20%) on reconstructed chest radiography and category 1 (20–50%) on HRCT.
FIGURE 4
FIGURE 4
a) Reconstructed chest radiography and b) coronal multiplanar reconstruction of high-resolution computed tomography (HRCT) of a 41-year-old female patient with severe COVID-19 pneumonia. Bilateral, diffuse ground-glass opacities and consolidations occupy most of the lung parenchyma, and the disease extent was scored as category 2 (>50%) both on reconstructed chest radiography and HRCT.
FIGURE 5
FIGURE 5
Mortality in relation to the age/reconstructed chest radiography and age/high-resolution computed tomography (HRCT) scores. Age and extent of disease on imaging scores were summed to provide five-point scales (0–4) for both the age/reconstructed chest radiography and age/HRCT scoring systems (see main text for details).
See this image and copyright information in PMC

References

    1. Poston JT, Patel BK, Davis AM. Management of critically ill adults with COVID-19. JAMA 2020; 323: 1839–1841. - PubMed
    1. World Health Organization . Director-General's opening remarks at the media briefing on COVID-19 – 29 June 2020. 2020. www.who.int/director-general/speeches/detail/who-director-general-s-open... Date last accessed: 5 February 2020.
    1. Lancet Infectious Diseases . Challenges of coronavirus disease 2019. Lancet Infect Dis 2020; 20: 261. doi: 10.1016/S1473-3099(20)30072-4 - DOI - PMC - PubMed
    1. Blažić I, Brkljačić B, Frija G. The use of imaging in COVID-19 – results of a global survey by the International Society of Radiology. Eur Radiol 2021; 31: 1185–1193. doi: 10.1007/s00330-020-07252-3 - DOI - PMC - PubMed
    1. American College of Radiology . ACR Recommendations for the use of Chest Radiography and Computed Tomography (CT) for Suspected COVID-19 Infection. 2020. www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/Recommendatio... Date last accessed: 5 February 2020.