Chest CT accuracy in diagnosing COVID-19 during the peak of the Italian epidemic: A retrospective correlation with RT-PCR testing and analysis of discordant cases
Chest CT accuracy in diagnosing COVID-19 during the peak of the Italian epidemic: A retrospective correlation with RT-PCR testing and analysis of discordant cases
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DOI：
10.1016/j.ejrad.2020.109192
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发表时间：
2020-09-01
影响因子：
3.3
通讯作者：
Carriero, Alessandro
中科院分区：
文献类型：
--
作者：
Falaschi, Zeno;Danna, Pietro S. C.;Carriero, Alessandro
目的：本研究的目的是评估胸部计算机断层扫描（CT）诊断的准确性，在临床实践中使用RT-PCR作为参考标准。2020年3月4日至4月9日，意大利新冠肺炎疫情高峰期，我们招募了773名疑似SARS冠状病毒的患者，他们进行了非造影胸部CT和RT-PCR，时间间隔不超过一周，2感染。以RT-PCR为参考标准，从敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和诊断准确性等方面评价CT的诊断性能。结果：RT-PCR检测阳性率为59.8%，CT与RT-PCR检测结果不一致的病例及两者均阴性的病例进行分析。CT诊断SARS-CoV-2感染的敏感性、特异性、PPV、NPV和准确性分别为90.7%[95%IC，87.7%-93.2%]、78.8%[95%IC，73.8-83.2%]、86.4%[95%IC，76.1%-88.9%]、85.1%[95%IC，81.0%-88.4]和85.9%[95%IC 83.2-88.3%]。二十五/六十六CT阳性而RT-PCR阴性者占37.6%，（4.9%）两次检测均为阴性的患者仍被临床医生根据临床和流行病学标准判定为阳性病例，并随后接受治疗。根据我们的经验，在预先测试概率很高的情况下，CT扫描显示出良好的敏感性，并且与先前研究报告相比，诊断COVID-19肺炎的特异性始终更高，特别是在考虑到临床和流行病学特征时。
Objectives: The goal of this study was to assess chest computed tomography (CT) diagnostic accuracy in clinical practice using RT-PCR as standard of reference.Methods: From March 4th to April 9th 2020, during the peak of the Italian COVID-19 epidemic, we enrolled a series of 773 patients that performed both non-contrast chest CT and RT-PCR with a time interval no longer than a week due to suspected SARS-CoV-2 infection. The diagnostic performance of CT was evaluated according to sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy, considering RT-PCR as the reference standard. An analysis on the patients with discrepant CT scan and RT-PCR result and on the patient with both negative tests was performed.Results: RT-PCR testing showed an overall positive rate of 59.8 %. CT sensitivity, specificity, PPV, NPV, and accuracy for SARS-CoV-2 infection were 90.7 % [95 % IC, 87.7%-93.2%], 78.8 % [95 % IC, 73.8-83.2%], 86.4 % [95 % IC, 76.1 %-88.9 %], 85.1 % [95 % IC, 81.0 %-88.4] and 85.9 % [95 % IC 83.2-88.3%], respectively. Twenty-five/66 (37.6 %) patients with positive CT and negative RT-PCR results and 12/245 (4.9 %) patients with both negative tests were nevertheless judged as positive cases by the clinicians based on clinical and epidemiological criteria and consequently treated.Conclusions: In our experience, in a context of high pre-test probability, CT scan shows good sensitivity and a consistently higher specificity for the diagnosis of COVID-19 pneumonia than what reported by previous studies, especially when clinical and epidemiological features are taken into account.