Diagnostic accuracy of chest computed tomography in improving the false negative rate as compared to reverse transcriptase polymerase chain reaction in coronavirus disease 2019 pneumonia: A cross sectional analysis of 348 cases from India.
Diagnostic accuracy of chest computed tomography in improving the false negative rate as compared to reverse transcriptase polymerase chain reaction in coronavirus disease 2019 pneumonia: A cross sectional analysis of 348 cases from India.
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DOI：
10.4103/lungindia.lungindia_410_20
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Ravikanth R
中科院分区：
文献类型：
--
作者：
Ravikanth R
早期区分急诊科（艾德）患者是否患有2019冠状病毒病（COVID-19）非常重要。COVID-19的诊断依赖于实时逆转录聚合酶链反应（RT-PCR）。在影像学上，计算机断层扫描（CT）表现与病毒性肺炎相似，多灶性磨玻璃影和周围分布的实变是最常见的表现。尽管这些发现在影像学上对COVID-19诊断缺乏特异性，但CT可用于提供有关肺部阴影范围的客观评估，可用作疾病负担的影像学替代品。我们着手研究胸部CT扫描在疑似COVID-19患者人群中检测COVID-19的诊断准确性。在这项对348例临床疑似COVID-19病例进行的横断面单中心研究中，所有成年症状性艾德患者在到达时都进行了CT扫描和PCR。将CT结果与PCR检测结果进行比较，并计算诊断准确性。在2020年2月15日至2020年6月30日期间，纳入了348名有症状的患者。总的来说，62.3%的患者PCR阳性，69.8%的患者CT阳性，灵敏度为94.2%，特异性为76.7%，似然比（LR）为+2.94和（LR）-0.18。急性呼吸窘迫综合征（100.0%，P = 0.017）和重度COVID-19（98.5%，P = 0.027）患者的CT敏感性高于轻度COVID-19（82.5%，P = 0.047）和中度COVID-19（89.3%，P = 0.039）患者。胸部CT诊断符合率为86.3%，与PCR诊断符合率为86.3%。48例（13.7%）患者的CT和PCR结果不一致。在大多数情况下，CT扫描被认为是可疑的COVID-19，而PCR是阴性的（37/48，77.0%）。在大多数患者中，出院时诊断为肺部感染（n = 26; 54.1%）。胸部CT在有症状的COVID疑似患者中的准确性很高，但当作为单一诊断检测时，CT无法准确诊断或排除COVID-19。因此，我们建议结合CT和RT-PCR用于未来的随访、管理和医学监测。
Early differentiation between emergency department (ED) patients with and without coronavirus disease 2019 (COVID-19) is very important. The diagnosis of COVID-19 depends on real-time reverse transcriptase polymerase chain reaction (RT-PCR). On imaging, computed tomography (CT) manifestations resemble those seen in viral pneumonias, with multifocal ground-glass opacities and consolidation in a peripheral distribution being the most common findings. Although these findings lack specificity for COVID-19 diagnosis on imaging grounds, CT could be used to provide objective assessment about the extension of the lung opacities, which could be used as an imaging surrogate for disease burden. We set out to investigate the diagnostic accuracy of chest CT scanning in detecting COVID-19 in a population with suspected COVID-19 patients. In this cross-sectional single-center study performed on 348 cases with clinical suspicion of COVID-19, all adult symptomatic ED patients had both a CT scan and a PCR upon arrival at. CT results were compared with PCR test (s) and diagnostic accuracy was calculated. Between February 15, 2020, and June 30, 2020, 348 symptomatic patients were included. In total, 62.3% of patients had a positive PCR and 69.8% had a positive CT, resulting in a sensitivity of 94.2%, specificity of 76.7%, likelihood ratio (LR) of +2.94 and (LR) −0.18. The sensitivity of the CT tended to be higher in those with acute respiratory distress syndrome (100.0%, P = 0.017) and severe COVID-19 (98.5%, P = 0.027) than in patients with mild (82.5%, P = 0.047) and moderate COVID-19 (89.3%, P = 0.039). The diagnostic ability of chest CT was found to be high with 86.3% concordance between findings of CT and PCR. In 48 (13.7%) patients, discordant findings between CT and PCR were observed. In most cases, the CT scan was considered suspicious for COVID-19, while the PCR was negative (37/48, 77.0%). In the majority of these, the diagnosis at discharge was pulmonary infection (n = 26; 54.1%). The accuracy of chest CT in symptomatic COVID suspect patients is high, but when used as a single diagnostic test, CT cannot accurately diagnose or exclude COVID-19. Therefore, we recommend a combination of both CT and RT-PCR for future follow-up, management, and medical surveillance.
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影响因子：
158.5
作者：
Li, Qun;Guan, Xuhua;Feng, Zijian
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Stard 2015：用于报告诊断准确性研究的基本项目的更新列表。
DOI：
10.1136/bmj.h5527
发表时间：
2015-10-28
期刊：
BMJ (Clinical research ed.)
影响因子：
--
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作者：
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