COVID-19 pneumonia: Diagnostic and prognostic role of CT based on a retrospective analysis of 214 consecutive patients from Paris, France

Eur J Radiol. 2020 Oct;131:109209. doi: 10.1016/j.ejrad.2020.109209. Epub 2020 Aug 8.

Abstract

Objectives: To evaluate the diagnostic and prognostic performance of CT in patients referred for COVID19 suspicion to a French university hospital, depending on symptoms and date of onset.

Methods: From March 1st to March 28th, 214 patients having both chest CT scan and reverse transcriptase polymerase chain reaction (RT- PCT) within 24 h were retrospectively evaluated. Sensitivity, specificity, negative and positive predictive values of first and expert readings were calculated together with inter reader agreement, with results of RT-PCR as standard of reference and according to symptoms and onset date. Patient characteristics and disease extent on CT were correlated to short-term outcome (death or intubation at 3 weeks follow-up).

Results: Of the 214 patients (119 men, mean age 59 ± 19 years), 129 had at least one positive RT-PCR result. Sensitivity, specificity, negative and positive predictive values were 79 % (95 % CI: 71-86 %), 84 %(74-91 %), 72 %(63-81 %) and 88 % (81-93 %) for initial CT reading and 81 %(74-88 %), 91 % (82-96 %), 76 % (67-84 %) and 93 % (87-97 %), for expert reading, with strong inter-reader agreement (kappa index: 0.89). Considering the 123 patients with symptoms for more than 5 days, the corresponding figures were 90 %, 78 %, 80 % and 89 % for initial reading and 93 %, 88 %, 86 % and 94 % for the expert. Disease extent exceeded 25 % for 68 % and 26 % of severe and non-severe patients, respectively (p < 0.001).

Conclusion: CT sensitivity increased after 5 days of symptoms. A disease extent > 25 % was associated with poorer outcome.

Keywords: COVID; Diagnostic tests; Multidetector computed tomography; Prognosis; Routine.

MeSH terms

  • Adult
  • Aged
  • Betacoronavirus*
  • Coronavirus Infections / diagnostic imaging*
  • Female
  • France
  • Humans
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / diagnostic imaging*
  • Prognosis
  • Retrospective Studies
  • Thorax
  • Tomography, X-Ray Computed / methods

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2