Coronavirus Disease 2019: Initial Detection on Chest CT in a Retrospective Multicenter Study of 103 Chinese Subjects

Wen, Zeying; Chi, Yonge; Zhang, Liang; Liu, Huan; Du, Kun; Li, Zhengxing; Chen, Jie; Cheng, Liuhui; Wang, Daoqing

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a new viral respiratory disease that has recently emerged from China, becoming a pandemic. However, few studies have analyzed data regarding the clinical performance of chest computed tomography (CT) obtained in subjects with suspected COVID-19 at the initial presentation to medical facilities. OBJECTIVE: The purpose of the present study was to evaluate the performance of chest CT the initial presentation of patients with suspected COVID-19. METHODS: Data from 103 patients who were under investigation for COVID-19 based on inclusion criteria according to WHO Interim Guidance were retrospectively collected from January 21, 2020 to February 14, 2020. All patients underwent chest CT scanning and reverse transcription polymerase chain reaction testing (RT-PCR) for COVID-19 at hospital presentation. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) (with 95% confidence intervals) were calculated to evaluate the performance of CT. Subgroup analyses were also performed based on the geographical distribution of these cases in the province of Henan, China. RESULTS: There were 88 /103 (85%) patients with COVID-19 confirmed by RT-PCR. The overall sensitivity, specificity, PPV, and NPV were 93% (85-97%), 53% (27-77%), 92% (83-96%), and 42% (18-70%), respectively. Similar results were shown in both geographic regions. The respective sensitivity, specificity, PPV, and NPV for chest CT in the districts of Xinyang and Zhumadian (n = 56) were 92% (80-97%), 63% (26-90%), 93% (81-98%), and 56% (23-85%), while these indicators in the district of Anyang (n = 47) were 95% (81-99%), 43% (12-80%), 90% (76-97%), and 60% (17-93%). There were no significant differences in the prevalence of positive exams in the two geographic subgroups for CT (P=0.423) or RT-PCR (P=0.931). CONCLUSION: Although initial chest CT obtained at hospital presentation showed high sensitivity in patients under investigation for COVID-19 in the two geographic regions in Henan province, the NPV was only modest, suggesting low value of CT as a screening tool.