From the Department of Radiology, Affiliated Taizhou Hospital of Wenzhou Medical University, 150 Ximen St, Linhai, Taizhou, 317000, Zhejiang Province, China (Y.F., H.Z., J.X., M.L., W.J.); Taizhou Enze Medical Center (Group) Enze Hospital, Taizhou, China (L.Y.); and Advanced Application Team, GE Healthcare, Shanghai, China (P.P.).
In December 2019, an outbreak of unexplained pneumonia in Wuhan, China (1), was caused by a new coronavirus infection named coronavirus disease 2019 (COVID-19). Unenhanced chest CT may be considered for early diagnosis of viral disease, although viral nucleic acid detection with real-time polymerase chain reaction (RT-PCR) remains the standard of reference. Chung et al (2) reported that chest CT may be negative for viral pneumonia of COVID-19 at initial presentation (three of 21 patients). Recently, Xie et al (3) reported that five of 167 patients (3%) had negative RT-PCR findings for COVID-19 at initial presentation despite chest CT findings typical of viral pneumonia. The purpose of our study was to compare the sensitivity of chest CT with that of viral nucleic acid assay at initial patient presentation.
Materials and Methods
This retrospective analysis was approved by institutional review board. The requirement to obtain patient consent was waived. Patients at Taizhou Enze Medical Center (Group) Enze Hospital were evaluated from January 19, 2020, to February 4, 2020. During this period, chest CT and RT-PCR (Shanghai ZJ Bio-Tech, Shanghai, China) were performed for consecutive patients who presented with (a) a travel history to or residential history in Wuhan or local endemic areas or contact with individuals from these areas with fever or respiratory symptoms within 14 days and (b) fever or acute respiratory symptoms of unknown cause. In the case of an initial negative RT-PCR test, repeat testing was performed at intervals of 1 day or more. We included all patients who underwent both unenhanced chest CT (slice thickness, 5 mm) and RT-PCR testing within an interval of 3 days or less and in whom COVID-19 infection was eventually diagnosed by means of RT-PCR testing (Fig 1). Typical and atypical chest CT findings were recorded according to CT features previously described for COVID-19 (4,5). The detection rate of COVID-19 infection based on the initial chest CT and RT-PCR findings was compared. Statistical analysis was performed by using the McNemar χ2 test, with P < .05 indicative of a statistically significant difference.
Results
Fifty-one patients (29 men, 22 women) were included. The median patient age was 45 years (interquartile range, 39–55 years). Throat swab (45 patients) or sputum (six patients) samples were obtained in all patients, followed by at least one RT-PCR assay. The average time from initial symptom onset to CT was 3 days ± 3 (standard deviation); the average time from initial symptom onset to RT-PCR testing was 3 days ± 3. Of the 51 patients, 36 had initial positive RT-PCR findings for COVID-19. COVID-19 was confirmed in 12 of the 51 patients with two RT-PCR nucleic acid tests (1–2 days), in two patients with three tests (2–5 days), and in one patient with four tests (7 days) after initial onset.
Fifty of the 51 patients (98%) had evidence of abnormal CT findings compatible with viral pneumonia at baseline; one patient had a normal CT scan. Of the 50 patients with abnormal CT scans, 36 (72%) had typical CT manifestations (eg, peripheral and subpleural ground-glass opacities, often in the lower lobes) (Fig 2), and 14 (28%) had atypical CT manifestations (Fig 3) (2). In this patient sample, the detection rate for initial CT (50 of 51 patients [98%]; 95% confidence interval: 90%, 100%) was greater than that for first RT-PCR (36 of 51 patients [71%]; 95% confidence interval: 56%, 83%) (P < .001).
Discussion
In our series, the sensitivity of chest CT was greater than that of RT-PCR (98% vs 71%, respectively; P < .001). The reasons for the low efficiency of viral nucleic acid detection may include (a) immature development of nucleic acid detection technology, (b) variation in detection rate from different manufacturers, (c) low patient viral load, or (d) improper clinical sampling. The reasons for the relatively lower detection rate with RT-PCR in our sample compared with a prior report are unknown (3). Our results support the use of chest CT to screen for COVID-19 in patients with clinical and epidemiologic features compatible with COVID-19 infection, particularly when results of RT-PCR tests are negative.
Disclosures of Conflicts of Interest: Y.F. disclosed no relevant relationships. H.Z. disclosed no relevant relationships. J.X. disclosed no relevant relationships. M.L. disclosed no relevant relationships. L.Y. disclosed no relevant relationships. P.P. disclosed no relevant relationships. W.J. disclosed no relevant relationships.
Acknowledgments
The authors thank Jian Wang, MD, Rongzhen Zhou, MD, and Xunyu Xu, MD, Department of Radiology, Taizhou Hospital of Wenzhou Medical University, and Hai Yang, MD, Department of Radiology, Taizhou Enze Medical Center Enze Hospital, for assisting with CT imaging data collection. The authors also thank Shaofeng Duan, PhD, GE Healthcare, for assisting with data analysis.
Author Contributions
Author contributions: Guarantors of integrity of entire study, all authors; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; agrees to ensure any questions related to the work are appropriately resolved, all authors; literature research, Y.F., H.Z., J.X., M.L., L.Y., W.J.; clinical studies, Y.F., H.Z., J.X., M.L., L.Y., W.J.; experimental studies, all authors; statistical analysis, Y.F., H.Z., P.P.; and manuscript editing, Y.F., H.Z., P.P
References
1. Chen N, Zhou M, Dong X, et al.Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet2020;395(10223):507–513.
3. 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. Radiology2020 Feb 12:200343 [Epub ahead of print].
5. Pan F, Ye T, Sun P, et al.Time Course of Lung Changes On Chest CT During Recovery From 2019 Novel Coronavirus (COVID-19) Pneumonia. Radiology2020 Feb 13:200370 [Epub ahead of print].
Received: Feb 12 2020 Revision requested: Feb 13 2020 Revision received: Feb 14 2020 Accepted: Feb 17 2020 Published online: Feb 19 2020 Published in print: Aug 2020
Andres F.Escobar-Ortiz, Maria A.Amezquita-Dussan, Juan S.Galindo-Sanchez, JoshPardo-Cabrera, JuliánHurtado-López, David F.Ramirez-Moreno, Luz F.Sua-Villegas, LilianaFernandez-Trujillo
2024Jul1 | Biomedical Signal Processing and Control, Vol. 93
Didier NdyanaboNdabahweje, OlivierMukuku, Charles KangitsiKahindo, Michel LeloTshikwela, Gertrude LuyeyeMvila, Antoine MoluaAundu, Jean TshibolaMukaya, Stanislas OkitotshoWembonyama, Zacharie KibendelwaTsongo
16 April 2024 | Journal of the Pan African Thoracic Society, Vol. 0
Didier NdyanaboNdabahweje, OlivierMukuku, Charles KangitsiKahindo, Michel LeloTshikwela, Gertrude LuyeyeMvila, Antoine MoluaAundu, Jean TshibolaMukaya, Stanis OkitotshoWembonyama, Zacharie KibendelwaTsongo
22 February 2024 | Advances in General Practice of Medicine, Vol. 5, No. 1
MohammedHazem, Sayed IbrahimAli, Qasem M.AlAlwan, Ibrahim KhalidAl Jabr, Sarah Abdulrahman F.Alshehri, Mohammed Q.AlAlwan, Mohammed IbrahimAlsaeed, MohammedAldawood, Jamela A.Turkistani, Yasser AbdelkarimAmin
2023 | Journal of Clinical Medicine, Vol. 12, No. 16
P. SureshBabu, C. ManojKrishna, M.Pradeep, M. UdayKiran, P.Bharghav, V. KiranKumar, M. PradeepKumar, B.Rajesh, S.Himaja, Aishwarya PLakshmi, A.Y.Lakshmi, R.Ram
2022Jun1 | Journal of Clinical and Scientific Research, Vol. 11, No. Suppl 1
Sergey G.Shcherbak, Anton I.Changalidi, Yury A.Barbitoff, Anna Yu.Anisenkova, Sergei V.Mosenko, Zakhar P.Asaulenko, Victoria V.Tsay, Dmitrii E.Polev, Roman S.Kalinin, Yuri A.Eismont, Andrey S.Glotov, Evgeny Y.Garbuzov, Alexander N.Chernov, Olga A.Klitsenko, Mikhail O.Ushakov, Anton E.Shikov, Stanislav P.Urazov, Vladislav S.Baranov, Oleg S.Glotov
Michael D.Kuo, Keith W. H.Chiu, David S.Wang, Anna RitaLarici, DmytroPoplavskiy, AdeleValentini, AlessandroNapoli, AndreaBorghesi, GuidoLigabue, Xin Hao B.Fang, Hing Ki C.Wong, SailongZhang, John R.Hunter, AbeerMousa, AmatoInfante, LorenzoElia, SalvatoreGolemi, Leung Ho P.Yu, Christopher K. M.Hui, Bradley J.Erickson
Anas M.Tahir, YazanQiblawey, AmithKhandakar, TawsifurRahman, UzairKhurshid, FarayiMusharavati, M. T.Islam, SerkanKiranyaz, SomayaAl-Maadeed, Muhammad E. H.Chowdhury
SimonBernatz, SaifAfat, Ahmed E.Othman, KonstantinNikolaou, MalteSieren, Marwin-JonathanSähn, DanielPinto dos Santos, TobiasPenzkofer, Andreas MichaelBucher, BerndHamm, Thomas J.Vogl, BorisBodelle
2022 | RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, Vol. 194, No. 01
Karem D.Marcomini, Diego A. C.Cardenas, Agma J. M.Traina, José E.Krieger, Marco A.Gutierrez, Khan M.Iftekharuddin, KarenDrukker, Maciej A.Mazurowski, HongbingLu, ChisakoMuramatsu, Ravi K.Samala
Firoozeh AbolhasaniZadeh, Mohammadreza VazifehArdalani, Ali RezaeiSalehi, RozaJalali Farahani, MandanaHashemi, Adil HusseinMohammed, Mohammed A. A.Al qaness
2022 | Computational Intelligence and Neuroscience, Vol. 2022
Cristina GamilaWakfie-Corieh, FedericoFerrando-Castagnetto, Alba María BlanesGarcía, Marta GarcíaGarcía-Esquinas, Aída OrtegaCandil, Cristina RodríguezRey, María NievesCabrera-Martín, Ana DelgadoCano, José Luis CarrerasDelgado
2022 | Journal of Nuclear Medicine, Vol. 63, No. 2
V. S.Ermakov, V. N.Kravchuk, O. Ya.Porembskaya, K. V.Kuznetsov, E. A.Knyazev, A. V.Belikov, T. V.Garpinchenko, I. B.Kazakova, K. E.Lobzhanidze, R. V.Deev, S. A.Sayganov
Luis DanielGoyzueta-Mamani, Miguel AngelChávez-Fumagalli, KarlaAlvarez-Fernandez, Jorge A.Aguilar-Pineda, RitaNieto-Montesinos, GonzaloDavila Del-Carpio, Karin J.Vera-Lopez, Christian L.Lino Cardenas
2022 | Recent Patents on Biotechnology, Vol. 16, No. 4
Ali AbbasianArdakani, Robert M.Kwee, MohammadMirza-Aghazadeh-Attari, Horacio MatíasCastro, Taha YusufKuzan, Kübra MurzoğluAltintoprak, GiuliaBesutti, FilippoMonelli, FariborzFaeghi, U RajendraAcharya, AfshinMohammadi
ÁlvaroTamayo-Velasco, María JesúsPeñarrubia-Ponce, Francisco JavierÁlvarez, HugoGonzalo-Benito, Ignaciode la Fuente, MartaMartín-Fernández, José MaríaEiros, PedroMartínez-Paz, José PabloMiramontes-González, AidaFiz-López, ElisaArribas-Rodríguez, PalomaCal-Sabater, RocíoAller, CarlosDueñas, MaríaHeredia-Rodríguez, EduardoTamayo, DavidBernardo, EstherGómez-Sánchez
20 July 2021 | Journal of Personalized Medicine, Vol. 11, No. 7
Alex Sandro RollandSouza, Melania Maria RamosAmorim, Adriana Suely de OliveiraMelo, Alexandre MagnoDelgado, Anna Catharina Magliano Carneiro da CunhaFlorêncio, Thaise Villarim deOliveira, Lara Caline SantosLira, Lucas Martins dos SantosSales, Gabriela AlbuquerqueSouza, Brena Carvalho Pinto deMelo, ÍtaloMorais, LeilaKatz
1 February 2021 | Revista Brasileira de Saúde Materno Infantil, Vol. 21, No. suppl 1
MaríaMateos González, GonzaloGarcía de Casasola Sánchez, Francisco Javier TeigellMuñoz, KevinProud, DavideLourdo, Julia-VerenaSander, Gabriel E. OrtizJaimes, MichaelMader, JesúsCanora Lebrato, Marcos I.Restrepo, Nilam J.Soni
DanielleByrne, Siobhan B. O’Neill, Nestor L.Müller, C. Isabela SilvaMüller, John P.Walsh, SabeenaJalal, WilliamParker, Ana-MariaBilawich, SavvasNicolaou
2 July 2020 | Canadian Association of Radiologists Journal, Vol. 72, No. 1
Cristina GamilaWakfie-Corieh, Alba MaríaBlanes García, FedericoFerrando-Castagnetto, RaquelValhondo-Rama, AidaOrtega Candil, CristinaRodríguez Rey, María NievesCabrera Martín, Marta GarcíaGarcía-Esquinas, Rosa MaríaCouto Caro, MaríaPedrera Canal, José LuisCarreras Delgado
2021 | European Journal of Nuclear Medicine and Molecular Imaging, Vol. 48, No. 3
José RanieryFerreira Junior, Diego ArmandoCardona Cardenas, Ramon AlfredoMoreno, Marina de Fátimade Sá Rebelo, José EduardoKrieger, Marco AntonioGutierrez
DennisYang, Yaseen B.Perbtani, JuliaLoeb, NanlongLiu, Peter V.Draganov, David E.Estores, MichaelLauzardo, AnthonyMaurelli, John A.Lednicky, J. GlennMorris
2021 | Endoscopy International Open, Vol. 09, No. 08
Dustin RLong, SaurabhGombar, Catherine AHogan, Alexander LGreninger, VikasO’Reilly-Shah, ChloeBryson-Cahn, BryanStevens, ArjunRustagi, Keith RJerome, Christina SKong, JamesZehnder, Nigam HShah, Noel SWeiss, Benjamin APinsky, Jacob ESunshine
Caitlin MDugdale, Melis NAnahtar, John JChiosi, Jacob ELazarus, Suzanne MMcCluskey, Andrea LCiaranello, TasosGogakos, Brent PLittle, John ABranda, Erica SShenoy, Rochelle PWalensky, Kimon CZachary, David CHooper, Sarah ETurbett, Emily PHyle
2021 | Open Forum Infectious Diseases, Vol. 8, No. 1
Maarten COttenhoff, Lucas ARamos, WouterPotters, Marcus L FJanssen, DeborahHubers, ShiHu, Egill AFridgeirsson, DanPiña-Fuentes, RajatThomas, Iwan C Cvan der Horst, ChristianHerff, PieterKubben, Paul W GElbers, Henk AMarquering, MaxWelling, SuatSimsek, Martijn Dde Kruif, TomDormans, Lucas MFleuren, MichielSchinkel, Peter GNoordzij, Joop Pvan den Bergh, Caroline EWyers, David T BBuis, W JoostWiersinga, Ella H Cvan den Hout, Auke CReidinga, DaisyRusch, Kim C ESigaloff, Renee ADouma, Liannede Haan, Niels CGritters van den Oever, Roger J M WRennenberg, Guido Avan Wingen, Marcel J HAries, MartijnBeudel
Kartika A.Madurani, SupraptoSuprapto, Muhammad YudhaSyahputra, IkaPuspita, AhmadMasudi, Hamdan DwiRizqi, Agus MuhamadHatta, JuniastutiJuniastuti, Maria IngeLusida, FredyKurniawan
2021 | Journal of The Electrochemical Society, Vol. 168, No. 3
RobertoMogami, Agnaldo JoseLopes, Ronaldo CarvalhoAraújo Filho, Fernando Carlos Santos deAlmeida, Alexandre Malta da CostaMesseder, Ana Celia BaptistaKoifman, Amanda BarbosaGuimarães, AlexandraMonteiro
V. B.Grinevich, Yu. A.Kravchuk, V. I.Ped, E. I.Sas, S. P.Salikova, I. V.Gubonina, E. I.Tkachenko, S. I.Sitkin, L. B.Lazebnik, E. V.Golovanova, E. A.Belousova, P. A.Makarchuk, E. Yu.Eremina, A. S.Sarsenbaeva, D. I.Abdulganieva, L. V.Tarasova, O. A.Gromova, V. A.Ratnikov, K. V.Kozlov, A. K.Ratnikova
2021 | Experimental and Clinical Gastroenterology, No. 3
Eduardo Kaiser Ururahy NunesFonseca, Lorena CarneiroFerreira, Bruna Melo CoelhoLoureiro, Daniel GiunchettiStrabelli, Lucas de Pádua Gomes deFarias, Gabriel Abrantes deQueiroz, José Vitor RassiGarcia, Renato de FreitasTeixeira, Victor Arcanjo AlmeidaGama, Rodrigo CarusoChate, Antonildes NascimentoAssunção, Márcio Valente YamadaSawamura, Cesar HigaNomura
Sergey G.Shcherbak, Anna YuAnisenkova, Sergei V.Mosenko, Oleg S.Glotov, Alexander N.Chernov, Svetlana V.Apalko, Stanislav P.Urazov, Evgeny Y.Garbuzov, Dmitry N.Khobotnikov, Olga A.Klitsenko, Evdokia M.Minina, Zakhar P.Asaulenko
HéctorMurrieta-González, JorgeRamírez-Landero, Hugo AlbertoCervantes-Flores, ArturoCadena-Fernández, Karina IlianaHolguin-Andrade, Ana PatriciaChischistz-Condey, EstefaníaMurrieta-Peralta
2021 | NCT Neumología y Cirugía de Tórax, Vol. 80, No. 1
Eduardo Kaiser Ururahy NunesFonseca, Antonildes NascimentoAssunção, Jose de Arimateia BatistaAraujo-Filho, Lorena CarneiroFerreira, Bruna Melo CoelhoLoureiro, Daniel GiunchettiStrabelli, Lucas de Pádua Gomes deFarias, Rodrigo CarusoChate, Giovanni GuidoCerri, Marcio Valente YamadaSawamura, Cesar HigaNomura