The sensitivity and specificity of chest CT in the diagnosis of COVID-19.
The sensitivity and specificity of chest CT in the diagnosis of COVID-19.
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DOI：
10.1007/s00330-020-07347-x
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发表时间：
2021-05
影响因子：
5.9
通讯作者：
Kincses ZT
中科院分区：
文献类型：
--
作者：
Kovács A;Palásti P;Veréb D;Bozsik B;Palkó A;Kincses ZT
识别感染SARS-CoV-2的患者对控制疾病非常重要；然而，临床表现往往没有特异性，很大一部分患者出现轻微症状或根本没有症状。因此，重点是评估筛查的诊断工具。胸部CT扫描正在成为新冠肺炎相关病毒性肺炎病例诊断过程中的一种有用工具。本文通过与实时聚合酶链式反应(RT-PCR)的比较，探讨胸部CT检测新冠肺炎的敏感性、特异性和可行性。以逆转录聚合酶链式反应为金标准，比较胸部CT检测新冠肺炎各期的敏感性和特异性。应用一种“反向计算方法”，将胸部CT作为一个假想的金标准，并将其与RT-PCR进行比较，指出标准方法的缺陷。CT扫描的敏感性较高(67-100%)，特异性较低(25-80%)。然而，据报道，RT-PCR的灵敏度不高(53-88%)，因此不能作为一个适当的基本事实。“反向计算方法”表明，如果我们考虑到RT-PCR的中等敏感性，CT可以有更高的特异性(83-100%)。胸部CT诊断新冠肺炎的敏感性和特异度需与辐射剂量一并判断。认为胸部CT扫描对新冠肺炎的诊断有一定的价值，特别是对临床症状典型、高度感染区RT-PCR阴性的患者。·如果考虑到RT-PCR的低敏感性，CT扫描具有更高的特异性。·避免将胸部CT作为新冠肺炎感染的唯一诊断手段。·逆转录聚合酶链式反应阴性，有典型临床症状的高发区患者或与新冠肺炎感染者有密切接触者，需行胸部CT检查。
The identification of patients infected by SARS-CoV-2 is highly important to control the disease; however, the clinical presentation is often unspecific and a large portion of the patients develop mild or no symptoms at all. For this reason, there is an emphasis on evaluating diagnostic tools for screening. Chest CT scans are emerging as a useful tool in the diagnostic process of viral pneumonia cases associated with COVID-19. This review examines the sensitivity, specificity, and feasibility of chest CT in detecting COVID-19 compared with real-time polymerase chain reaction (RT-PCR). Sensitivity and specificity of chest CT in detecting COVID-19 in its various phases was compared using RT-PCR as a gold standard. A “reverse calculation approach” was applied and treated chest CT as a hypothetical gold standard and compared RT-PCR to it point out the flaw of the standard approach. High sensitivity (67–100%) and relatively low specificity (25–80%) was reported for the CT scans. However, the sensitivity of RT-PCR was reported to be modest (53–88%), hence cannot serve as an appropriate ground truth. The “reverse calculation approach” showed that CT could have a higher specificity (83–100%) if we consider the modest sensitivity of the RT-PCR. The sensitivity and specificity of the chest CT in diagnosing COVID-19 and the radiation exposure have to be judged together. Arguments are presented that chest CT scans have added value in diagnosing COVID-19 especially in patients, who exhibit typical clinical symptoms and have negative RT-PCR results in highly infected regions. • CT scans have higher specificity if we take into account the low sensitivity of the RT-PCR. • Avoid chest CT as a sole diagnostic approach for COVID-19 infection. • Patients who had negative RT-PCR result with typical clinical symptoms in highly infected regions or with close contact of COVID-19-infected patients; the use of chest CT is warranted.
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