Should CT be used for the diagnosis of RT‐PCR‐negative suspected COVID‐19 patients?

Abstract

Introduction The diagnosis of patients with Coronavirus disease 2019 (COVID‐19) suspicion but negative reverse transcriptase‐polymerase chain reaction (RT‐PCR) test is challenging. Objective We aimed to investigate the diagnostic value of chest computed tomography (CT) in RT‐PCR‐negative patients with suspected COVID‐19. Materials and methods The study included patients who were admitted to our hospital with the suspicion of COVID‐19 between 1 April 2020 and 30 April 2020 and tested negative after RT‐PCR test, and underwent CT for further diagnosis. Initial CT findings were classified as typical, indeterminate, and atypical for COVID‐19, and negative for pneumonia. Incidental findings on CT were noted. Results Of the 338 patients with a mean age of 57 years (min 18 years–max 96 years), 168 (49.70%) were male and 170 (50.29%) were female. The most common symptoms were cough (58.87%), fever (40.82%), and dyspnea (39.34%). The CT findings were typical for COVID‐19 in 109 (32.24%) patients, indeterminate in 47 (13.90%) patients, and atypical in 77 (22.78%) patients. The CT findings of 105 (31.06%) patients were negative for pneumonia. Incidental lung nodules suspicious of malignancy were identified in seven patients. Seventy‐seven patients (22.78%) had extrapulmonary incidental findings Conclusion The diagnostic value of CT in RT‐PCR‐negative patients with suspected COVID‐19 is not very high. Based on clinical, laboratory, and chest x‐ray findings, it may be more appropriate to refer patients to CT after the first triage, when necessary.