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Chest CT Imaging Signature of Coronavirus Disease 2019 Infection: In Pursuit of the Scientific Evidence.
Chest. 2020 11; 158(5):1885-1895.Chest

Abstract

BACKGROUND

Chest CT may be used for the diagnosis of coronavirus disease 2019 (COVID-19), but clear scientific evidence is lacking. Therefore, we systematically reviewed and meta-analyzed the chest CT imaging signature of COVID-19.

RESEARCH QUESTION

What is the chest CT imaging signature of COVID-19 infection?

STUDY DESIGN AND METHODS

A systematic literature search was performed for original studies on chest CT imaging findings in patients with COVID-19. Methodologic quality of studies was evaluated. Pooled prevalence of chest CT imaging findings were calculated with the use of a random effects model in case of between-study heterogeneity (predefined as I2 ≥50); otherwise, a fixed effects model was used.

RESULTS

Twenty-eight studies were included. The median number of patients with COVID-19 per study was 124 (range, 50-476), comprising a total of 3,466 patients. Median prevalence of symptomatic patients was 99% (range, >76.3%-100%). Twenty-seven of the studies (96%) had a retrospective design. Methodologic quality concerns were present with either risk of or actual referral bias (13 studies), patient spectrum bias (eight studies), disease progression bias (26 studies), observer variability bias (27 studies), and test review bias (14 studies). Pooled prevalence was 10.6% for normal chest CT imaging findings. Pooled prevalences were 90.0% for posterior predilection, 81.0% for ground-glass opacity, 75.8% for bilateral abnormalities, 73.1% for left lower lobe involvement, 72.9% for vascular thickening, and 72.2% for right lower lobe involvement. Pooled prevalences were 5.2% for pleural effusion, 5.1% for lymphadenopathy, 4.1% for airway secretions/tree-in-bud sign, 3.6% for central lesion distribution, 2.7% for pericardial effusion, and 0.7% for cavitation/cystic changes. Pooled prevalences of other CT imaging findings ranged between 10.5% and 63.2%.

INTERPRETATION

Studies on chest CT imaging findings in COVID-19 suffer from methodologic quality concerns. More high-quality research is necessary to establish diagnostic CT criteria for COVID-19. Based on the available evidence that requires cautious interpretation, several chest CT imaging findings appear to be suggestive of COVID-19, but normal chest CT imaging findings do not exclude COVID-19, not even in symptomatic patients.

Authors+Show Affiliations

Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: thomaskwee@gmail.com.Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA; Radiology Service, Veterans Affairs Medical Center, San Francisco, CA.Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

32592709

Citation

Adams, Hugo J A., et al. "Chest CT Imaging Signature of Coronavirus Disease 2019 Infection: in Pursuit of the Scientific Evidence." Chest, vol. 158, no. 5, 2020, pp. 1885-1895.
Adams HJA, Kwee TC, Yakar D, et al. Chest CT Imaging Signature of Coronavirus Disease 2019 Infection: In Pursuit of the Scientific Evidence. Chest. 2020;158(5):1885-1895.
Adams, H. J. A., Kwee, T. C., Yakar, D., Hope, M. D., & Kwee, R. M. (2020). Chest CT Imaging Signature of Coronavirus Disease 2019 Infection: In Pursuit of the Scientific Evidence. Chest, 158(5), 1885-1895. https://doi.org/10.1016/j.chest.2020.06.025
Adams HJA, et al. Chest CT Imaging Signature of Coronavirus Disease 2019 Infection: in Pursuit of the Scientific Evidence. Chest. 2020;158(5):1885-1895. PubMed PMID: 32592709.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chest CT Imaging Signature of Coronavirus Disease 2019 Infection: In Pursuit of the Scientific Evidence. AU - Adams,Hugo J A, AU - Kwee,Thomas C, AU - Yakar,Derya, AU - Hope,Michael D, AU - Kwee,Robert M, Y1 - 2020/06/25/ PY - 2020/04/16/received PY - 2020/06/01/revised PY - 2020/06/12/accepted PY - 2020/6/28/pubmed PY - 2020/11/27/medline PY - 2020/6/28/entrez KW - COVID-19 KW - CT KW - chest KW - meta-analysis KW - systematic review SP - 1885 EP - 1895 JF - Chest JO - Chest VL - 158 IS - 5 N2 - BACKGROUND: Chest CT may be used for the diagnosis of coronavirus disease 2019 (COVID-19), but clear scientific evidence is lacking. Therefore, we systematically reviewed and meta-analyzed the chest CT imaging signature of COVID-19. RESEARCH QUESTION: What is the chest CT imaging signature of COVID-19 infection? STUDY DESIGN AND METHODS: A systematic literature search was performed for original studies on chest CT imaging findings in patients with COVID-19. Methodologic quality of studies was evaluated. Pooled prevalence of chest CT imaging findings were calculated with the use of a random effects model in case of between-study heterogeneity (predefined as I2 ≥50); otherwise, a fixed effects model was used. RESULTS: Twenty-eight studies were included. The median number of patients with COVID-19 per study was 124 (range, 50-476), comprising a total of 3,466 patients. Median prevalence of symptomatic patients was 99% (range, >76.3%-100%). Twenty-seven of the studies (96%) had a retrospective design. Methodologic quality concerns were present with either risk of or actual referral bias (13 studies), patient spectrum bias (eight studies), disease progression bias (26 studies), observer variability bias (27 studies), and test review bias (14 studies). Pooled prevalence was 10.6% for normal chest CT imaging findings. Pooled prevalences were 90.0% for posterior predilection, 81.0% for ground-glass opacity, 75.8% for bilateral abnormalities, 73.1% for left lower lobe involvement, 72.9% for vascular thickening, and 72.2% for right lower lobe involvement. Pooled prevalences were 5.2% for pleural effusion, 5.1% for lymphadenopathy, 4.1% for airway secretions/tree-in-bud sign, 3.6% for central lesion distribution, 2.7% for pericardial effusion, and 0.7% for cavitation/cystic changes. Pooled prevalences of other CT imaging findings ranged between 10.5% and 63.2%. INTERPRETATION: Studies on chest CT imaging findings in COVID-19 suffer from methodologic quality concerns. More high-quality research is necessary to establish diagnostic CT criteria for COVID-19. Based on the available evidence that requires cautious interpretation, several chest CT imaging findings appear to be suggestive of COVID-19, but normal chest CT imaging findings do not exclude COVID-19, not even in symptomatic patients. SN - 1931-3543 UR - https://www.unboundmedicine.com/medline/citation/32592709/Chest_CT_Imaging_Signature_of_Coronavirus_Disease_2019_Infection:_In_Pursuit_of_the_Scientific_Evidence_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0012-3692(20)31733-5 DB - PRIME DP - Unbound Medicine ER -