Coronavirus Disease 2019 (COVID-19): Role of Chest CT in Diagnosis and Management
Top Cited Papers
- 1 June 2020
- journal article
- research article
- Published by American Roentgen Ray Society in American Journal of Roentgenology
- Vol. 214 (6), 1280-1286
- https://doi.org/10.2214/ajr.20.22954
Abstract
OBJECTIVE. The objective of our study was to determine the misdiagnosis rate of radiologists for coronavirus disease 2019 (COVID-19) and evaluate the performance of chest CT in the diagnosis and management of COVID-19. The CT features of COVID-19 are reported and compared with the CT features of other viruses to familiarize radiologists with possible CT patterns. MATERIALS AND METHODS. This study included the first 51 patients with a diagnosis of COVID-19 infection confirmed by nucleic acid testing (23 women and 28 men; age range, 26–83 years) and two patients with adenovirus (one woman and one man; ages, 58 and 66 years). We reviewed the clinical information, CT images, and corresponding image reports of these 53 patients. The CT images included images from 99 chest CT examinations, including initial and follow-up CT studies. We compared the image reports of the initial CT study with the laboratory test results and identified CT patterns suggestive of viral infection. RESULTS. COVID-19 was misdiagnosed as a common infection at the initial CT study in two inpatients with underlying disease and COVID-19. Viral pneumonia was correctly diagnosed at the initial CT study in the remaining 49 patients with COVID-19 and two patients with adenovirus. These patients were isolated and obtained treatment. Ground-glass opacities (GGOs) and consolidation with or without vascular enlargement, interlobular septal thickening, and air bronchogram sign are common CT features of COVID-19. The The “reversed halo” sign and pulmonary nodules with a halo sign are uncommon CT features. The CT findings of COVID-19 overlap with the CT findings of adenovirus infection. There are differences as well as similarities in the CT features of COVID-19 compared with those of the severe acute respiratory syndrome. CONCLUSION. We found that chest CT had a low rate of missed diagnosis of COVID-19 (3.9%, 2/51) and may be useful as a standard method for the rapid diagnosis of COVID-19 to optimize the management of patients. However, CT is still limited for identifying specific viruses and distinguishing between viruses.Keywords
This publication has 10 references indexed in Scilit:
- A Novel Coronavirus from Patients with Pneumonia in China, 2019The New England Journal of Medicine, 2020
- Treatment patterns and direct medical costs of metastatic colorectal cancer patients: a retrospective study of electronic medical records from urban ChinaJournal of Medical Economics, 2020
- Clinical features of patients infected with 2019 novel coronavirus in Wuhan, ChinaThe Lancet, 2020
- Emerging coronaviruses: Genome structure, replication, and pathogenesisJournal of Medical Virology, 2020
- Radiographic and CT Features of Viral PneumoniaRadioGraphics, 2018
- Middle East respiratory syndrome coronavirus in pediatrics: a report of seven cases from Saudi ArabiaFrontiers of Medicine, 2018
- Middle East Respiratory Syndrome Coronavirus: What Does a Radiologist Need to Know?American Journal of Roentgenology, 2016
- Angiotensin-converting enzyme 2 protects from severe acute lung failureNature, 2005
- Radiologic Pattern of Disease in Patients with Severe Acute Respiratory Syndrome: The Toronto ExperienceRadioGraphics, 2004
- Viral Pneumonias in Adults: Radiologic and Pathologic FindingsRadioGraphics, 2002