Coronavirus Disease 2019 (COVID-19): Role of Chest CT in Diagnosis and Management

• Published in: American journal of roentgenology (1976) Vol. 214; no. 6; pp. 1280 - 1286
• Main Authors: Li, Yan, Xia, Liming
• Format: Journal Article
• Language: English
• Published: United States 01-06-2020
• Subjects: Adult; Aged; Aged, 80 and over; Coronavirus Infections - diagnostic imaging; Coronavirus Infections - therapy; COVID-19; Diagnostic Errors - statistics & numerical data; Female; Humans; Male; Middle Aged; Pandemics; Pneumonia, Viral - diagnostic imaging; Pneumonia, Viral - therapy; Radiography, Thoracic - methods; Retrospective Studies; Tomography, X-Ray Computed; CT; SARS-CoV-2; lung disease; coronavirus disease 2019 (COVID-19); infectious diseases
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/ajr.20.22954

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.
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.
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.
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.