Tags

Type your tag names separated by a space and hit enter

Chest CT in patients with a moderate or high pretest probability of COVID-19 and negative swab.
Radiol Med. 2020 Dec; 125(12):1260-1270.RM

Abstract

OBJECTIVES

We aimed to assess the diagnostic performance of CT in patients with a negative first RT-PCR testing and to identify typical features of COVID-19 pneumonia that can guide diagnosis in this case.

METHODS

Patients suspected of COVID-19 with a negative first RT-PCR testing were retrospectively revalued after undergoing CT. CT was reviewed by two radiologists and classified as suspected COVID-19 pneumonia, non-COVID-19 pneumonia or negative. The performance of both first RT-PCR result and CT was evaluated by using sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC) and by using the second RT-PCR test as the reference standard. CT findings for confirmed COVID-19 positive or negative were compared by using the Pearson chi-squared test (P values < 0.05) RESULTS: Totally, 337 patients suspected of COVID-19 underwent CT and nasopharyngeal swabs in March 2020. Eighty-seven out of 337 patients had a negative first RT-PCR result; of these, 68 repeated RT-PCR testing and were included in the study. The first RT-PCR test showed SE 0, SP = 100%, PPV = NaN, NPV = 70%, AUC = 50%, and CT showed SE = 70% SP = 79%, PPV = 86%, NPV = 76%, AUC = 75%. The most relevant CT variables were ground glass opacity more than 50% and peripheral and/or perihilar distribution.

DISCUSSION

Negative RT-PCR test but positive CT features should be highly suggestive of COVID-19 in a cluster or community transmission scenarios, and the second RT-PCR test should be promptly requested to confirm the final diagnosis.

Authors+Show Affiliations

Radiology Division, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy. caterina.giannitto@gmail.com.Radiology Division, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy.Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.Radiology Division, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy. Training School in Radiology, Humanitas University, Pieve Emanuele, Milan, Italy.Department of Computer Science (DI), University of Milan, Via G. Celoria 18, Milan, Italy.Laboratory Medicine, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy.Division of Thoracic Surgery, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy.Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy.Laboratory Medicine, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy.Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy. Department of Nuclear Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy.Radiology Division, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32862406

Citation

Giannitto, Caterina, et al. "Chest CT in Patients With a Moderate or High Pretest Probability of COVID-19 and Negative Swab." La Radiologia Medica, vol. 125, no. 12, 2020, pp. 1260-1270.
Giannitto C, Sposta FM, Repici A, et al. Chest CT in patients with a moderate or high pretest probability of COVID-19 and negative swab. Radiol Med. 2020;125(12):1260-1270.
Giannitto, C., Sposta, F. M., Repici, A., Vatteroni, G., Casiraghi, E., Casari, E., Ferraroli, G. M., Fugazza, A., Sandri, M. T., Chiti, A., & Luca, B. (2020). Chest CT in patients with a moderate or high pretest probability of COVID-19 and negative swab. La Radiologia Medica, 125(12), 1260-1270. https://doi.org/10.1007/s11547-020-01269-w
Giannitto C, et al. Chest CT in Patients With a Moderate or High Pretest Probability of COVID-19 and Negative Swab. Radiol Med. 2020;125(12):1260-1270. PubMed PMID: 32862406.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chest CT in patients with a moderate or high pretest probability of COVID-19 and negative swab. AU - Giannitto,Caterina, AU - Sposta,Federica Mrakic, AU - Repici,Alessandro, AU - Vatteroni,Giulia, AU - Casiraghi,Elena, AU - Casari,Erminia, AU - Ferraroli,Giorgio Maria, AU - Fugazza,Alessandro, AU - Sandri,Maria Teresa, AU - Chiti,Arturo, AU - Luca,Balzarini, Y1 - 2020/08/29/ PY - 2020/06/04/received PY - 2020/08/16/accepted PY - 2020/8/31/pubmed PY - 2020/11/20/medline PY - 2020/8/31/entrez KW - COVID-19 KW - Computed tomography KW - Nasopharyngeal swab KW - RT-PCR SP - 1260 EP - 1270 JF - La Radiologia medica JO - Radiol Med VL - 125 IS - 12 N2 - OBJECTIVES: We aimed to assess the diagnostic performance of CT in patients with a negative first RT-PCR testing and to identify typical features of COVID-19 pneumonia that can guide diagnosis in this case. METHODS: Patients suspected of COVID-19 with a negative first RT-PCR testing were retrospectively revalued after undergoing CT. CT was reviewed by two radiologists and classified as suspected COVID-19 pneumonia, non-COVID-19 pneumonia or negative. The performance of both first RT-PCR result and CT was evaluated by using sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC) and by using the second RT-PCR test as the reference standard. CT findings for confirmed COVID-19 positive or negative were compared by using the Pearson chi-squared test (P values < 0.05) RESULTS: Totally, 337 patients suspected of COVID-19 underwent CT and nasopharyngeal swabs in March 2020. Eighty-seven out of 337 patients had a negative first RT-PCR result; of these, 68 repeated RT-PCR testing and were included in the study. The first RT-PCR test showed SE 0, SP = 100%, PPV = NaN, NPV = 70%, AUC = 50%, and CT showed SE = 70% SP = 79%, PPV = 86%, NPV = 76%, AUC = 75%. The most relevant CT variables were ground glass opacity more than 50% and peripheral and/or perihilar distribution. DISCUSSION: Negative RT-PCR test but positive CT features should be highly suggestive of COVID-19 in a cluster or community transmission scenarios, and the second RT-PCR test should be promptly requested to confirm the final diagnosis. SN - 1826-6983 UR - https://www.unboundmedicine.com/medline/citation/32862406/Chest_CT_in_patients_with_a_moderate_or_high_pretest_probability_of_COVID_19_and_negative_swab_ L2 - https://dx.doi.org/10.1007/s11547-020-01269-w DB - PRIME DP - Unbound Medicine ER -