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Meta-Analysis
. 2022 May 16;5(5):CD013639.
doi: 10.1002/14651858.CD013639.pub5.

Thoracic imaging tests for the diagnosis of COVID-19

Sanam Ebrahimzadeh #  1 , Nayaar Islam #  1   2 , Haben Dawit  1   2 , Jean-Paul Salameh  2 , Sakib Kazi  2 , Nicholas Fabiano  2 , Lee Treanor  2 , Marissa Absi  2 , Faraz Ahmad  2 , Paul Rooprai  2 , Ahmed Al Khalil  2 , Kelly Harper  2 , Neil Kamra  2 , Mariska Mg Leeflang  3 , Lotty Hooft  4 , Christian B van der Pol  5 , Ross Prager  6 , Samanjit S Hare  7 , Carole Dennie  2   8 , René Spijker  4   9 , Jonathan J Deeks  10   11 , Jacqueline Dinnes  10   11 , Kevin Jenniskens  12 , Daniël A Korevaar  13 , Jérémie F Cohen  14 , Ann Van den Bruel  15 , Yemisi Takwoingi  10   11 , Janneke van de Wijgert  12   16 , Junfeng Wang  17 , Elena Pena  2   8 , Sandra Sabongui  18 , Matthew Df McInnes  1   2 ; Cochrane COVID-19 Diagnostic Test Accuracy Group  11
Affiliations
Meta-Analysis

Thoracic imaging tests for the diagnosis of COVID-19

Sanam Ebrahimzadeh et al. Cochrane Database Syst Rev. .

Abstract

Background: Our March 2021 edition of this review showed thoracic imaging computed tomography (CT) to be sensitive and moderately specific in diagnosing COVID-19 pneumonia. This new edition is an update of the review.

Objectives: Our objectives were to evaluate the diagnostic accuracy of thoracic imaging in people with suspected COVID-19; assess the rate of positive imaging in people who had an initial reverse transcriptase polymerase chain reaction (RT-PCR) negative result and a positive RT-PCR result on follow-up; and evaluate the accuracy of thoracic imaging for screening COVID-19 in asymptomatic individuals. The secondary objective was to assess threshold effects of index test positivity on accuracy.

Search methods: We searched the COVID-19 Living Evidence Database from the University of Bern, the Cochrane COVID-19 Study Register, The Stephen B. Thacker CDC Library, and repositories of COVID-19 publications through to 17 February 2021. We did not apply any language restrictions.

Selection criteria: We included diagnostic accuracy studies of all designs, except for case-control, that recruited participants of any age group suspected to have COVID-19. Studies had to assess chest CT, chest X-ray, or ultrasound of the lungs for the diagnosis of COVID-19, use a reference standard that included RT-PCR, and report estimates of test accuracy or provide data from which we could compute estimates. We excluded studies that used imaging as part of the reference standard and studies that excluded participants with normal index test results.

Data collection and analysis: The review authors independently and in duplicate screened articles, extracted data and assessed risk of bias and applicability concerns using QUADAS-2. We presented sensitivity and specificity per study on paired forest plots, and summarized pooled estimates in tables. We used a bivariate meta-analysis model where appropriate.

Main results: We included 98 studies in this review. Of these, 94 were included for evaluating the diagnostic accuracy of thoracic imaging in the evaluation of people with suspected COVID-19. Eight studies were included for assessing the rate of positive imaging in individuals with initial RT-PCR negative results and positive RT-PCR results on follow-up, and 10 studies were included for evaluating the accuracy of thoracic imaging for imagining asymptomatic individuals. For all 98 included studies, risk of bias was high or unclear in 52 (53%) studies with respect to participant selection, in 64 (65%) studies with respect to reference standard, in 46 (47%) studies with respect to index test, and in 48 (49%) studies with respect to flow and timing. Concerns about the applicability of the evidence to: participants were high or unclear in eight (8%) studies; index test were high or unclear in seven (7%) studies; and reference standard were high or unclear in seven (7%) studies. Imaging in people with suspected COVID-19 We included 94 studies. Eighty-seven studies evaluated one imaging modality, and seven studies evaluated two imaging modalities. All studies used RT-PCR alone or in combination with other criteria (for example, clinical signs and symptoms, positive contacts) as the reference standard for the diagnosis of COVID-19. For chest CT (69 studies, 28285 participants, 14,342 (51%) cases), sensitivities ranged from 45% to 100%, and specificities from 10% to 99%. The pooled sensitivity of chest CT was 86.9% (95% confidence interval (CI) 83.6 to 89.6), and pooled specificity was 78.3% (95% CI 73.7 to 82.3). Definition for index test positivity was a source of heterogeneity for sensitivity, but not specificity. Reference standard was not a source of heterogeneity. For chest X-ray (17 studies, 8529 participants, 5303 (62%) cases), the sensitivity ranged from 44% to 94% and specificity from 24 to 93%. The pooled sensitivity of chest X-ray was 73.1% (95% CI 64. to -80.5), and pooled specificity was 73.3% (95% CI 61.9 to 82.2). Definition for index test positivity was not found to be a source of heterogeneity. Definition for index test positivity and reference standard were not found to be sources of heterogeneity. For ultrasound of the lungs (15 studies, 2410 participants, 1158 (48%) cases), the sensitivity ranged from 73% to 94% and the specificity ranged from 21% to 98%. The pooled sensitivity of ultrasound was 88.9% (95% CI 84.9 to 92.0), and the pooled specificity was 72.2% (95% CI 58.8 to 82.5). Definition for index test positivity and reference standard were not found to be sources of heterogeneity. Indirect comparisons of modalities evaluated across all 94 studies indicated that chest CT and ultrasound gave higher sensitivity estimates than X-ray (P = 0.0003 and P = 0.001, respectively). Chest CT and ultrasound gave similar sensitivities (P=0.42). All modalities had similar specificities (CT versus X-ray P = 0.36; CT versus ultrasound P = 0.32; X-ray versus ultrasound P = 0.89). Imaging in PCR-negative people who subsequently became positive For rate of positive imaging in individuals with initial RT-PCR negative results, we included 8 studies (7 CT, 1 ultrasound) with a total of 198 participants suspected of having COVID-19, all of whom had a final diagnosis of COVID-19. Most studies (7/8) evaluated CT. Of 177 participants with initially negative RT-PCR who had positive RT-PCR results on follow-up testing, 75.8% (95% CI 45.3 to 92.2) had positive CT findings. Imaging in asymptomatic PCR-positive people For imaging asymptomatic individuals, we included 10 studies (7 CT, 1 X-ray, 2 ultrasound) with a total of 3548 asymptomatic participants, of whom 364 (10%) had a final diagnosis of COVID-19. For chest CT (7 studies, 3134 participants, 315 (10%) cases), the pooled sensitivity was 55.7% (95% CI 35.4 to 74.3) and the pooled specificity was 91.1% (95% CI 82.6 to 95.7).

Authors' conclusions: Chest CT and ultrasound of the lungs are sensitive and moderately specific in diagnosing COVID-19. Chest X-ray is moderately sensitive and moderately specific in diagnosing COVID-19. Thus, chest CT and ultrasound may have more utility for ruling out COVID-19 than for differentiating SARS-CoV-2 infection from other causes of respiratory illness. The uncertainty resulting from high or unclear risk of bias and the heterogeneity of included studies limit our ability to confidently draw conclusions based on our results.

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Conflict of interest statement

Sanam Ebrahimzadeh has no known conflicts of interest.

Nayaar Islam has no known conflicts of interest.

Haben Dawit has no known conflicts of interest.

Jean‐Paul Salameh has no known conflicts of interest.

Sakib Kazi has no known conflicts of interest.

Nicholas Fabiano has no known conflicts of interest.

Lee Treanor has no known conflicts of interest.

Marissa Absi has no known conflicts of interest.

Faraz Ahmad has no known conflicts of interest.

Paul Rooprai has no known conflicts of interest.

Ahmed Al Khalil has no known conflicts of interest.

Kelly Harper has no known conflicts of interest.

Neil Kamra has no known conflicts of interest.

Mariska MG Leeflang has no known conflicts of interest.

Lotty Hooft has no known conflicts of interest.

Christian B van der Pol has no known conflicts of interest.

Ross Prager has no known conflicts of interest.

Samanjit S Hare has no known conflicts of interest.

Carole Dennie has no known conflicts of interest.

René Spijker: the Dutch Cochrane Centre (DCC) has received grants for performing commissioned systematic reviews. In no situation did the commissioner have any influence on the results of the work.

Jonathan J Deeks has no known conflicts of interest.

Jacqueline Dinnes has no known conflicts of interest.

Kevin Jenniskens has no known conflicts of interest.

Daniel Korevaar has no known conflicts of interest.

Jérémie F Cohen has no known conflicts of interest.

Ann Van den Bruel has no known conflicts of interest.

Yemisi Takwoingi has no known conflicts of interest.

Janneke van de Wijgert has no known conflicts of interest.

Junfeng Wang received a consultancy fee from Biomind, an Artificial Intelligence (AI) company providing machine intelligence solutions in medical imaging. The consultancy service was about design of clinical studies, not related to this review. The company had no influence on the results of the work.

Elena Pena has no known conflicts of interest.

Sandra Sabongui has no known conflicts of interest.

Matthew McInnes has no known conflicts of interest.

Figures

1
1
Study flow diagram
2
2
Risk of bias and applicability concerns graph: review authors' judgements about each domain presented as percentages across included studies (n = 98).
3
3
Risk of bias and applicability concerns summary: review authors' judgements about each domain for each included study.
4
4
Forest plot of chest CT in suspected cases.
5
5
Summary ROC plot of chest CT in suspected cases.The summary point is indicated by the solid black circle, individual studies are indicated by outlined circles (scale=study sample size). The dotted border and the dashed border represent 95% confidence regions and 95% prediction regions, respectively.
6
6
7
7
Summary ROC plot of chest X‐ray in suspected cases.The summary point is indicated by the solid black circle, individual studies are indicated by outlined circles (scale=study sample size). The dotted border and the dashed border represent 95% confidence regions and 95% prediction regions, respectively.
8
8
Summary ROC plot of ultrasound of the lungs in suspected cases.The summary point is indicated by the solid black circle, individual studies are indicated by outlined circles (scale=study sample size). The dotted border and the dashed border represent 95% confidence regions and 95% prediction regions, respectively.
9
9
Forest plot of chest CT studies in suspected cases that used the CO‐RADS scoring system at varying thresholds: A) CO‐RADS 5, B) CO‐RADS 4, C) CO‐RADS 3, and D) CO‐RADS 2.
10
10
Pooled sensitivity and specificity estimate and 95% confidence intervals at varying CO‐RADS thresholds: CO‐ RADS 2 (n = 9), CO‐RADS 3 (n = 11), CO‐RADS 4 (n = 9), and CO‐RADS 5 (n = 9).
11
11
Forest plot of chest CT studies in suspected cases that used the RSNA scoring system at varying thresholds: A) RSNA 4, B) RSNA 3, and C) RSNA 2.
12
12
Pooled sensitivity and specificity estimate and 95% confidence intervals at varying RSNA thresholds: RSNA 3 (n = 4), and RSNA 4 (n = 4).
13
13
Forest plot of positive chest CT imaging in participants with repeat RT‐PCR positive results where initial RT‐PCR was negative. N positive = number of participants with an initial negative RT‐PCR test and a positive result on repeat RT‐PCR testing, who had chest CT imaging positive for COVID‐19. N negative = number of participants with an initial negative RT‐PCR test result and a positive result on repeat RT‐PCR testing, who had chest CT imaging negative for COVID‐19. Rate = N positive / (N positive + N negative).
14
14
Forest plot of positive chest CT imaging in asymptomatic participants.
15
15
Summary ROC plot of chest CT in asymptomatic cases.The summary point is indicated by the solid black circle, individual studies are indicated by outlined circles (scale=study sample size). The dotted border and the dashed border represent 95% confidence regions and 95% prediction regions, respectively.
16
16
Pooled sensitivity and specificity estimate and 95% confidence intervals across all review versions (Salameh 2020a (Version 1); Islam 2020 (Version 2); Islam 2021 (Version 3); and this review update version (Version 4)) for chest CT, chest X‐ray and ultrasound of the lungs.
1
1. Test
Chest CT in suspected cases
2
2. Test
Chest X‐ray in suspected cases
3
3. Test
Ultrasound of the lungs in suspected cases
4
4. Test
CT CO‐RADS 2
5
5. Test
CT CO‐RADS 3
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6. Test
CT CO‐RADS 4
7
7. Test
CT CO‐RADS 5
8
8. Test
RT‐PCR (Chest CT)
9
9. Test
RT‐PCR (US of the lungs)
10
10. Test
Asymptmotic (Chest CT)
11
11. Test
Asymptomatic (X‐ray)
12
12. Test
Asymptomatic (US of the lungs)
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13. Test
CT‐RSNA 2
14
14. Test
CT‐RSNA 3
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15. Test
CT RSNA 4
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Gietema 2020 {published data only}
    1. Gietema HA, Zelis N, Nobel JM, Lambriks LJ, Van Alphen LB, Oude Lashof AM, et al.CT in relation to RT-PCR in diagnosing COVID-19 in The Netherlands: a prospective study. PLOS One 2020;15(7):e0235844. [DOI: 10.1371/journal.pone.0235844] - DOI - PMC - PubMed
Gil‐Rodrigo 2020 {published data only}
    1. Gil-Rodrigo A, Llorens P, Martínez-Buendía C, Luque-Hernández M-J, Espinosa B, Ramos-Rincón JM.Diagnostic yield of point-of-care ultrasound imaging of the lung in patients with COVID-19. Emergencias 2020 Sep;32(5):340-4. - PubMed
Grando 2020 {published data only}
    1. Grando RD, Brentano VB, Zanardo AP, Hertz FT, Júnior LC, Prietto dos Santos JF, et al.Clinical usefulness of tomographic standards for COVID-19 pneumonia diagnosis: Experience from a Brazilian reference center. Brazilian Journal of Infectious Diseases 2020 Nov;24(6):524-33. [DOI: 10.1016/j.bjid.2020.10.002] - DOI - PMC - PubMed
Gross 2021 {published data only}
    1. Gross A, Heine G, Schwarz M, Thiemig D, Gläser S, Albrecht T.Structured reporting of chest CT provides high sensitivity and specificity for early diagnosis of COVID-19 in a clinical routine setting. British Journal of Radiology 2021 Jan 1;94(1117):20200574. [DOI: 10.1259/bjr.20200574] - DOI - PMC - PubMed
Guillo 2020 {published data only}
    1. Guillo E, Bedmar Gomez I, Dangeard S, Bennani S, Saab I, Tordjman M, et al.COVID-19 pneumonia: diagnostic and prognostic role of CT based on a retrospective analysis of 214 consecutive patients from Paris, France. European Journal of Radiology 2020;131:109209. [DOI: 10.1016/j.ejrad.2020.109209] - DOI - PMC - PubMed
Gumus 2020 {published data only}
    1. Gümüs T, Kabaoglu ZU, Coskan B, Kartal F, Artukoglu F, Atasoy KC.Preoperative computerized tomography screening for COVID‑19 pneumonia in asymptomatic patients: experiences from two centers. Japanese Journal of Radiology 2021 Mar;39(3):240-5. [DOI: 10.1007/s11604-020-01061-w] - DOI - PMC - PubMed
Haak 2021 {published data only}
    1. Haak SL, Renken IJ, Jager LC, Lameijer H, Kolk BY.Diagnostic accuracy of point-of-care lung ultrasound in COVID-19. Emergency Medicine Journal 2021 Feb 1;38(2):94-9. [DOI: 10.1136/emermed-2020-210125] - DOI - PubMed
Hanif 2021 {published data only}
    1. Hanif N, Rubi G, Irshad N, Ameer S, Habib U, Zaidi SRH.Comparison of HRCT Chest and RT-PCR in Diagnosis of COVID-19. Journal of the College of Physicians and Surgeons Pakistan 2021 Jan;30(1):S1-6. [DOI: 10.29271/jcpsp.2021.01.S1] - DOI - PubMed
He 2020 {published data only}
    1. He J-L, Luo L, Luo Z-D, Lyu J-X, Ng M-Y, Shen X-P, et al.Diagnostic performance between CT and initial real-time RT-PCR for clinically suspected 2019 coronavirus disease (COVID-19) patients outside Wuhan, China. Respiratory Medicine 2020 Jul;168:105980. [DOI: 10.1016/j.rmed.2020.105980] - DOI - PMC - PubMed
Hermans 2020 {published data only}
    1. Hermans JJ, Groen J, Zwets E, Boxma-De Klerk BM, Van Werkhoven JM, Ong DS, et al.Chest CT for triage during COVID-19 on the emergency department: myth or truth? Emergency Radiology 2020;27(6):641-51. [DOI: 10.1007/s10140-020-01821-1] - DOI - PMC - PubMed
Hernigou 2020 {published data only}
    1. Hernigou J, Cornil F, Poignard A, El Bouchaibi S, Mani J, Naouri JF, et al.Thoracic computerised tomography scans in one hundred eighteen orthopaedic patients during the COVID-19 pandemic: identification of chest lesions; added values; help in managing patients; burden on the computerised tomography scan department. International Orthopaedics (SICOT) 2020 Aug;44(8):1571–80. [DOI: 10.1007/s00264-020-04651-5] - DOI - PMC - PubMed
Herpe 2020 {published data only}
    1. Herpe G, Lederlin M, Naudin M, Ohana M, Chaumoitre K, Gregory J, et al.Efficacy of chest CT for COVID-19 pneumonia in France. Radiology 2020 Sep 1;298(2):E81-E87. [DOI: 10.1148/radiol.2020202568] - DOI - PMC - PubMed
Hwang 2020 {published data only}
    1. Hwang EJ, Kim H, Yoon SH, Goo JM, Park CM.Implementation of a deep learning-based computer-aided detection system for the interpretation of chest radiographs in patients suspected for COVID-19. Korean Journal of Radiology 2020 Oct;21(10):1150-60. [DOI: 10.3348/kjr.2020.0536] - DOI - PMC - PubMed
Ippolito 2020 {published data only}
    1. Ippolito D, Pecorelli A, Maino C, Capodaglio C, Mariani I, Giandola T, et al.Diagnostic impact of bedside chest X-ray features of 2019 novel coronavirus in the routine admission at the emergency department: case series from Lombardy region. European Journal of Radiology 2020;129:109092. [DOI: 10.1016/j.ejrad.2020.109092] - DOI - PMC - PubMed
Jalil 2020 {published data only}
    1. Jalil BA, Khan A, Kugasia IR, Ijaz M.Lung ultrasound in early SARS-CoV-2 pneumonia and the LUS-CoV criteria. Baylor University Medical Center Proceedings 2020 Oct 26;34(1):1-4. [DOI: 10.1080/08998280.2020.1834658] - DOI - PMC - PubMed
Krdzalic 2020 {published data only}
    1. Krdzalic J, De Jaegere TM, Kwee RM.Diagnostic performance of chest CT in screening patients with suspected COVID-19 infection in a Western population. Brtish Jounal of Radiology 2020 Sep 1;93(1113):20200643. [DOI: 10.1259/bjr.20200643] - DOI - PMC - PubMed
Kuzan 2020 {published data only}
    1. Kuzan TY, Murzoğlu Altıntoprak K, Çiftçi HÖ, Ergül U, Ünal Özdemir NB, Bulut M, et al.A comparison of clinical, laboratory and chest CT findings of laboratory-confirmed and clinically diagnosed COVID-19 patients at first admission. Diagnostic and Interventional Radiology 2020 May;27(3):336-43. [DOI: 10.5152/dir.2020.20270] - DOI - PMC - PubMed
Lieveld 2021a {published data only}
    1. Lieveld AW, Azijli K, Teunissen BP, Haaften RM, Kootte RS, van den Berk IA, et al.Chest CT in COVID-19 at the ED: validation of the COVID-19 Reporting and Data System (CO-RADS) and CT Severity Score: a prospective, multicenter, observational study. Chest 2021 Mar 1;159(3):1126-35. [DOI: 10.1016/j.chest.2020.11.026] - DOI - PMC - PubMed
Lieveld 2021b {published data only}
    1. Lieveld AW, Kok B, Schuit FH, Azijli K, Heijmans J, Laarhoven A, et al.Diagnosing COVID-19 pneumonia in a pandemic setting: Lung Ultrasound versus CT (LUVCT) – a multicentre, prospective, observational study. ERJ Open Research 2020 Oct;6(4):00539-2020. [DOI: 10.1183/23120541.00539-2020] - DOI - PMC - PubMed
Luo 2020a {published data only}
    1. Luo L, Luo Z, Jia Y, Zhou C, He J, Lyu J, et al.CT differential diagnosis of COVID-19 and non-COVID-19 in symptomatic suspects: a practical scoring method. BMC Pulmonary Medicine 2020 May 07;20(1):129. [DOI: 10.1186/s12890-020-1170-6] - DOI - PMC - PubMed
Majeed 2020 {published data only}
    1. Majeed T, Ali RS, Solomon J, Mesri M, Sharma S, Shamim S, et al.The role of the computed tomography (CT) thorax in the diagnosis of COVID-19 for patients presenting with acute surgical emergencies. a single institute experience. Indian Journal of Surgery 2020 Oct 20;82(6):1005-10. [DOI: 10.1007/s12262-020-02626-9] - DOI - PMC - PubMed
Mei 2020 {published data only}
    1. Mei X, Lee H-C, Diao K, Huang M, Lin B, Liu C, et al.Artificial intelligence-enabled rapid diagnosis of COVID-19 patients. Nature Medicine 2020 Aug;26(8):1224-8. [DOI: 10.1038/s41591-020-0931-3] - DOI - PMC - PubMed
Miranda Magalhaes Santos 2020 {published data only}
    1. Miranda Magalhães Santos JM, Paula Alves Fonseca A, Pinheiro Zarattini Anastacio E, Formagio Minenelli F, Furtado de Albuquerque Cavalcanti C, Borges da Silva Teles G.Initial results of the use of a standardized diagnostic criteria for chest computed tomography findings in coronavirus disease 2019. Journal of Computer Assisted Tomography 2020;44(5):647-51. [DOI: 10.1097/RCT.0000000000001054] - DOI - PubMed
Moroni 2021 {published data only}
    1. Moroni C, Cozzi D, Albanesi M, Cavigli E, Bindi A, Luvarà S, et al.Chest X-ray in the emergency department during COVID-19 pandemic descending phase in Italy: correlation with patients' outcome. Radiologia Medica 2021 May;126(5):661-8. [DOI: 10.1007/s11547-020-01327-3] - DOI - PMC - PubMed
Murphy 2020 {published data only}
    1. Murphy K, Smits H, Knoops AJ, Korst MB, Samson T, Scholten ET, et al.COVID-19 on chest radiographs: a multireader evaluation of an artificial intelligence system. Radiology 2020;296(3):E166-72. [DOI: 10.1148/radiol.202020187] - DOI - PMC - PubMed
Narinx 2020 {published data only}
    1. Narinx N, Smismans A, Symons R, Frans J, Demeyere A, Gillis M.Feasibility of using point-of-care lung ultrasound for early triage of COVID-19 patients in the emergency room. Emergency Radiology 2020;27(6):663-70. [DOI: 10.1007/s10140-020-01849-3] - DOI - PMC - PubMed
Nivet 2021 {published data only}
    1. Nivet H, Crombé A, Schuster P, Ayoub T, Pourriol L, Favard N, et al.The accuracy of teleradiologists in diagnosing COVID-19 based on a French multicentric emergency cohort. European Radiology 2021 May 1;31(5):2833-44. [DOI: 10.1007/s00330-020-07345-z] - DOI - PMC - PubMed
O'Neill 2020 {published data only}
    1. O'Neill SB, Byrne D, Müller NL, Jalal S, Parker W, Nicolaou S, et al.Radiological Society of North America (RSNA) Expert consensussStatement related to chest CT findings in COVID-19 versus CO-RADS: comparison of reportingsSystem performance among chest radiologists and end-user preference. Canadian Association of Radiologists' Journal 2020;0846537120968919:Epub 2020 Nov 3. PMID: 33138634. [DOI: 10.1177/0846537120968919] - DOI - PubMed
Ohana 2021 {published data only}
    1. Ohana M, Muller J, Severac F, Bilbault P, Behr M, Oberlin M, et al.Temporal variations in the diagnostic performance of chest CT for Covid-19 depending on disease prevalence: Experience from North-Eastern France. European Journal of Radiology 2021 Jan;134:109425. [DOI: 10.1016/j.ejrad.2020.109425] - DOI - PMC - PubMed
Ooi 2021 {published data only}
    1. Ooi MW, Liong SY, Baguley N, Sharman A, Tuck J.Role of complementary Ct chest in patients presenting with acute abdominal symptoms during covid-19 pandemic: a UK experience. Clinical Imaging 2021 Jan;69:289-92. [DOI: 10.1016/j.clinimag.2020.09.00] - DOI - PMC - PubMed
Pagano 2021 {published data only}
    1. Pagano A, Finkelstein M, Overbey J, Steinberger S, Ellison T, Manna S, et al.Portable chest radiography as an exclusionary test for adverse clinical outcomes during the COVID-19 pandemic. Chest 2021 Jul;160(1):238-48. [DOI: 10.1016/j.chest.2021.01.053] - DOI - PMC - PubMed
Palmisano 2021 {published data only}
    1. Palmisano A, Scotti GM, Ippolito D, Morelli MJ, Vignale D, Gandola D, et al.Chest CT in the emergency department for suspected COVID-19 pneumonia. Radiologia Medica 2021 Mar 1;126(3):498-502. [DOI: 10.1007/s11547-020-01302-y] - DOI - PMC - PubMed
Pare 2020 {published data only}
    1. Pare J, Camelo I, Mayo K, Leo M, Dugas J, Nelson K, et al.Point-of-care lung ultrasound is more sensitive than chest radiograph for evaluation of COVID-19. Western Journal of Emergency Medicine 2020 Jun 19;21(4):771-8. [DOI: 10.5811/westjem.2020.5.47743] - DOI - PMC - PubMed
Patel 2020 {published data only}
    1. Patel M, Chowdhury J, Zheng M, Abramian O, Verga S, Zhao H, et al.High Resolution CHEST CT(HRCT) evaluation in patients hospitalized with COVID-19 infection. medRxiv [Preprint] 2020;203(4). [DOI: 10.1101/2020.05.26.20114082] - DOI
Patrucco 2021 {published data only}
    1. Patrucco F, Carriero A, Falaschi Z, Paschè A, Gavelli F, Airoldi C, et al.COVID-19 diagnosis in case of two negative nasopharyngeal swabs: association between chest CT and bronchoalveolar lavage results. Radiology 2021 Jan 5;298(3):E152-5. [DOI: 10.1148/radiol.2020203776] - DOI - PMC - PubMed
Peng 2020a {published data only}
    1. Peng D, Zhang J, Xu Y, Liu Z, Wu P.Clinical analysis and early differential diagnosis of suspected pediatric patients with 2019 novel coronavirus infection. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.04.07.20057315] - DOI
Pivetta 2021 {published data only}
    1. Pivetta E, Goffi A, Tizzani M, Locatelli SM, Porrino G, Losano I, et al.Lung ultrasonography for the diagnosis of SARS-CoV-2 pneumonia in the emergency department. Annals of Emergency Medicine 2021 Apr 1;77(4):385-94. [DOI: 10.1016/j.annemergmed.2020.10.008] - DOI - PMC - PubMed
Puylaert 2020 {published data only}
    1. Puylaert CA Scheijmans JC, Borgstein AB, Andeweg CS, Bartels-Rutten A, Beets GL, et al.Yield of Screening for COVID-19 in asymptomatic patients prior to elective or emergency surgery using chest CT and RT-PCR (SCOUT): multicenter study. Annals of Surgery 2020 Dec;272(6):919-24. [DOI: 10.1097/SLA.0000000000004218] - DOI - PMC - PubMed
Ravikanth 2021 {published data only}
    1. Ravikanth R.Diagnostic accuracy and false-positive rate of chest CT as compared to RT-PCR in coronavirus disease 2019 (COVID-19) pneumonia: a prospective cohort of 612 cases from India and review of literature. Indian Journal of Radiology & Imaging 2021 Jan;31(Suppl 1):S161-9. [DOI: 10.4103/ijri.IJRI_377_20] - DOI - PMC - PubMed
Reginelli 2021 {published data only}
    1. Reginelli A, Grassi R, Feragalli B, Belfiore MP, Montanelli A, Patelli G, et al.Coronavirus disease 2019 (COVID-19) in Italy: double reading of Ccest CT examination. Biology (Basel) 2021 Jan 25;10(2):89. [DOI: 10.3390/biology10020089] - DOI - PMC - PubMed
Rona 2021 {published data only}
    1. Rona G, Voyvoda N, Arifoğlu M, Karaaslan A, Çetin C.The efficacy of chest computed tomography in pediatric patients with suspected COVID-19. Journal of Computer Assisted Tomography 2021 Mar 1;45(2):337-41. [DOI: 10.1097/RCT.0000000000001127] - DOI - PubMed
Roy Choudhury 2020 {published data only}
    1. Choudhury RS, Shahi PK, Sharma S, Dhar R.Utility of chest radiography on admission for initial triaging of COVID-19 in symptomatic patients. ERJ Open Research 2020 Jul;6(3):00357-2020. [DOI: 10.1183/23120541.00357-2020] - DOI - PMC - PubMed
Saeed 2020 {published data only}
    1. Saeed GA, Helali AA, Almazrouei S, Shah A, Ahmed LA.Chest CT features of COVID-19 in the region of Abu Dhabi, UAE: a single institute study. Chinese Journal of Academic Radiology 2021;4:248–56. [DOI: 10.1007/s42058-021-00075-1] - DOI - PMC - PubMed
Salehi‐Pourmehr 2020 {published data only}
    1. Salehi-Pourmehr H, Pourfathi H, Tarzamni MK, Ghojazadeh M, Naghili B, Zarrintan A, et al.Diagnostic value of chest CT in Iranian patients with suspected COVID-19. Caspian Journal of Internal Medicine 2020;11(Suppl 1):527-30. [DOI: 10.22088/cjim.11.0.527] - DOI - PMC - PubMed
Schalekamp 2020 {published data only}
    1. Schalekamp S, Bleeker-Rovers CP, Beenen LF, Quarles van Ufford HM, Gietema HA, Stöger JL, et al.Chest CT in the emergency department for diagnosis of COVID-19 pneumonia: Dutch experience. Radiology 2020 Nov 17;298(2):E98-106. [DOI: 10.1148/radiol.2020203465] - DOI - PMC - PubMed
Schmid 2020 {published data only}
    1. Schmid B, Feuerstein D, Lang CN, Fink K, Steger R, Rieder M, et al.Lung ultrasound in the emergency department - a valuable tool in the management of patients presenting with respiratory symptoms during the SARS-CoV-2 pandemic. BMC Emergency Medicine 2020 Dec 7;20(1):96. [DOI: 10.1186/s12873-020-00389-w] - DOI - PMC - PubMed
Schulze‐hagen 2020 {published data only}
    1. Schulze-Hagen M, Hübel C, Meier-Schroers M, Yüksel C, Sander A, Sähn M, et al.Low-dose chest CT for the diagnosis of COVID-19—a systematic, prospective comparison with PCR. Deutsches Aerzteblatt Online 2020;117(22-23):389-95. [DOI: 10.3238/arztebl.2020.0389] - DOI - PMC - PubMed
Shah 2021 {published data only}
    1. Shah JV, Shah C, Shah S, Gandhi N, Dikshit NA, Patel P, et al.HRCT chest in COVID-19 patients: An initial experience from a private imaging center in western India. Indian Journal of Radiology & Imaging 2021 Jan;31(Suppl 1):S182-6. [DOI: 10.4103/ijri.IJRI_405_20] - DOI - PMC - PubMed
Skalidis 2020 {published data only}
    1. Skalidis I, Nguyen VK, Bothorel H, Poli L, Da Costa RR, Younossian AB, et al.Unenhanced computed tomography (CT) utility for triage at the emergency department during COVID-19 pandemic. American Journal of Emergency Medicine 2021 Aug;46:260-5. [DOI: 10.1016/j.ajem.2020.07.058] - DOI - PMC - PubMed
Song 2020a {published data only}
    1. Song S, Wu F, Liu Y, Jiang H, Xiong F, Guo X, et al.Correlation between chest CT findings and clinical features of 211 COVID-19 suspected patients in Wuhan, China. Open Forum Infectious Diseases 2020 Jun;7(6):ofaa171. [DOI: 10.1093/ofid/ofaa171] - DOI - PMC - PubMed
Sorlini 2021 {published data only}
    1. Sorlini C, Femia M, Nattino G, Bellone P, Gesu E, Francione P, et al.The role of lung ultrasound as a frontline diagnostic tool in the era of COVID-19 outbreak. Internal and Emergency Medicine 2021 Apr;16(3):749-56. [DOI: 10.1007/s11739-020-02524-] - DOI - PMC - PubMed
Speidel 2021 {published data only}
    1. Speidel V, Conen A, Gisler V, Fux CA, Haubitz S.Lung assessment with point-of-care ultrasound in respiratory coronavirus disease (COVID-19): a prospective cohort study. Ultrasound in Medicine & Biology 2021 Apr 1;47(4):896-901. [DOI: 10.1016/j.ultrasmedbio.2020.12.021] - DOI - PMC - PubMed
Steuwe 2020 {published data only}
    1. Steuwe A, Rademacher C, Valentin B, Köhler M-H, Appel E, Keitel V, et al.Dose-optimised chest computed tomography for diagnosis of coronavirus disease 2019 (COVID-19) - evaluation of image quality and diagnostic impact. Journal of Radiological Protection 2020;40(3):877-91. [10.1088/1361-6498/aba16a] - PubMed
Stevens 2020 {published data only}
    1. Stevens BJ.Reporting radiographers' interpretation and use of the British Society of Thoracic Imaging's coding system when reporting COVID-19 chest X-rays. Radiography 2020 Feb;27(1):90-4. [DOI: 10.1016/j.radi.2020.06.010] - DOI - PMC - PubMed
Sukhija 2021 {published data only}
    1. Sukhija A, Mahajan M, Joshi PC, Dsouza J, Seth ND, Patil KH.Radiographic findings in COVID-19: Comparison between AI and radiologist. Indian Journal of Radiology and Imaging 2021 Jan;31(Suppl 1):S87-93. [10.4103/ijri.IJRI_777_20] - PMC - PubMed
Sverzellati Nicola 2021 {published data only}
    1. Sverzellati N, Ryerson CJ, Milanese G, Renzoni EA, Volpi A, Spagnolo P, et al.Chest x-ray or CT for COVID-19 pneumonia? Comparative study in a simulated triage setting. European Respiratory Journal 2021 Sep 9;58(3):2004188. [DOI: 10.1183/13993003.04188-2020] - DOI - PMC - PubMed
Teichgraber 2021 {published data only}
    1. Teichgräber U, Malouhi A, Ingwersen M, Neumann R, Reljic M, Deinhardt-Emmer S, et al.Ruling out COVID-19 by chest CT at emergency admission when prevalence is low: the prospective, observational SCOUT study. Respiratory Research 2021 Jan 12;22(1):13. [10.1186/s12931-020-01611-w] - PMC - PubMed
Tsakok 2020 {published data only}
    1. Tsakok M, Shaw R, Murchison A, Ather S, Xie C, Watson R, et al.Diagnostic accuracy of initial chest radiograph compared to SARS-CoV-2 PCR in patients with suspected COVID-19. BJR Open 2020 Aug 5;2(1):20200034. [DOI: 10.1259/bjro.20200034] - DOI - PMC - PubMed
Wang 2020a {published data only}
    1. Wang T, Xiong Z, Zhou H, Luo W, Tang H, Liu J.Design, validation, and clinical practice of standardized imaging diagnostic report for COVID-19. Zhong Nan da Xue Xue Bao Yi Xue Ban [Journal of Central South University Medical Sciences] 2020 Mar 28;45(3):229-35. [DOI: 10.11817/j.issn.1672-7347.2020.200152] - DOI - PubMed
Wehbe 2021 {published data only}
    1. Wehbe RM, Sheng J, Dutta S, Chai S, Dravid A, Barutcu S, et al.DeepCOVID-XR: an artificialiIntelligence algorithm to detect COVID-19 on chest radiographs trained and tested on a large U.S. clinical data set. Radiology 2021 Apr;299(1):E167-76. [DOI: 10.1148/radiol.2020203511] - DOI - PMC - PubMed
Xiaocheng 2020 {published data only}
    1. Xiaocheng X, Haiyan J, Xiaoping C, Yi Z, Huiyuan S.Preliminary analysis of visits to fever clinics during the epidemic of new coronavirus pneumonia. Academic Journal of Second Military Medical University 2020;41(8):828-31. [DOI: 10.16781/j.0258‑879x.2020.08.0828] - DOI
Xiong 2020 {published data only}
    1. Xiong Z, Fu L, Zhou H, Liu JK, Wang AM, Huang Y, et al.Construction and evaluation of a novel diagnosis pathway for 2019-Corona virus disease. Zhonghua Yi Xue za Zhi 2020 Apr 28;100(16):1223-9. [DOI: 10.3760/cma.j.cn112137-20200228-00499] - DOI - PubMed
Yassa 2020 {published data only}
    1. Yassa M, Yirmibes C, Cavusoglu G, Eksi H, Dogu C, Usta C, et al.Outcomes of universal SARS-CoV-2 testing program in pregnant women admitted to hospital and the adjuvant role of lung ultrasound in screening: a prospective cohort study. Journal of Maternal-Fetal & Neonatal Medicine 2020 Nov;33(22):3820-6. [DOI: 10.1080/14767058.2020.1798398] - DOI - PubMed
Yates 2021 {published data only}
    1. Yates A, Dempsey PJ, Vencken S, MacMahon PJ, Hutchinson BD.Structured reporting in portable chest radiographs: An essential tool in the diagnosis of COVID-19. European Journal of Radiology 2021 Jan;134:109414. [DOI: 10.1016/j.ejrad.2020.109414] - DOI - PMC - PubMed

References to studies excluded from this review

Ai 2020b {published data only}
    1. Ai J, Gong J, Xing L, He R, Tian F, Wang J, et al.Analysis of factors associated early diagnosis in coronavirus disease 2019 (COVID-19). medRxiv [Preprint] 2020. [DOI: 10.1101/2020.04.09.20059352] - DOI
Ai 2020c {published data only}
    1. Ai J, Chen J, Wang Y, Liu X, Fan W, Qu G, et al.The cross-sectional study of hospitalized coronavirus disease 2019 patients in Xiangyang, Hubei province. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.02.19.20025023] - DOI
Arentz 2020 {published data only}
    1. Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, et al.Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. JAMA 2020;323(16):1612-4. - PMC - PubMed
Bai 2020a {published data only}
    1. Bai HX, Hsieh B, Xiong Z, Halsey K, Choi JW, Tran TM, et al.Performance of radiologists in differentiating COVID-19 from viral pneumonia on chest CT. Radiology 2020;296(2):E46-E54. - PMC - PubMed
Bai 2020b {published data only}
    1. Bai HX, Wang R, Xiong Z, Hsieh B, Chang K, Halsey K, et al.Artificial intelligence augmentation of radiologist performance in distinguishing COVID-19 from pneumonia of other origin at chest CT. Radiology 2020;296(3):E156-65. - PMC - PubMed
Chang 2020 {published data only}
    1. Chang D, Lin M, Wei L, Xie L, Zhu G, Dela Cruz CS, et al.Epidemiologic and clinical characteristics of novel coronavirus infections involving 13 patients outside Wuhan, China. JAMA 2020;323(11):1092-3. [DOI: 10.1001/jama.2020.1623 10.1001/jama.2020.1623.] - PMC - PubMed
Chen 2020a {published data only}
    1. Chen S, Wu JJ, Li MZ, Xu DZ, Zhu YZ, Wang HC, et al.Clinical features of 109 cases of novel coronavirus pneumonia. Chinese Journal of Infectious Diseases 2020;38(12):E015. [DOI: 10.3760 / cma.j.issn.1000-6680.2020.0015]
Chen 2020b {published data only}
    1. Chen X, Tang Y, Mo Y, Li S, Lin D, Yang Z, et al.A diagnostic model for coronavirus disease 2019 (COVID-19) based on radiological semantic and clinical features: a multi-center study. European Radioliology 2020;30(9):4893-902. [DOI: 10.1007/s00330-020-06829-2] - DOI - PMC - PubMed
Chen 2020c {published data only}
    1. Chen Z, Fan H, Cai J, Li Y, Wu B, Hou Y, et al.High-resolution computed tomography manifestations of COVID-19 infections in patients of different ages. European Journal of Radiology 2020;126:108972. - PMC - PubMed
Cheng 2020 {published data only}
    1. Cheng Z, Lu Y, Cao Q, Qin L, Pan Z, Yan F, et al.Clinical features and chest CT manifestations of coronavirus disease 2019 (COVID-19) in a single-center study in Shanghai, China. American Journal of Roentgenology 2020;215(1):121-6. [DOI: 10.2214/ajr.20.22959 10.2214/AJR.20.22959.] - PubMed
Çinkooğlu 2020 {published data only}
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References to other published versions of this review

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