Comparison of admission chest computed tomography and lung ultrasound performance for diagnosis of COVID-19 pneumonia in populations with different disease prevalence. Issue 133 (December 2020)

• Record Type: Journal Article
• Authors: Colombi, Davide; Petrini, Marcello; Maffi, Gabriele; Villani, Gabriele D.; Bodini, Flavio C.; Morelli, Nicola; Milanese, Gianluca; Silva, Mario; Sverzellati, Nicola; Michieletti, Emanuele
• Is Part Of: European journal of radiology. Issue 133(2020)
• Publication Date: 2020-12
• Subjects: COVID-19 Coronavirus disease 2019 -- CRP C-reactive protein -- EG early outbreak group -- LDH lactate dehydrogenase -- LG late outbreak group -- LUS lung ultrasound -- RT-PCR real-time reverse transcriptase polymerase chain reaction -- SARS-CoV-2 severe acute respiratory syndrome-coronavirus 2 -- WBC white blood cell count; COVID-19 -- Diagnostic ultrasound -- Computed tomography -- Spiral; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2020.109344
• Languages: English
• ISSNs: 0720-048X

Abstract

Abstract: Purpose: Chest computed tomography (CT) is considered a reliable imaging tool for COVID-19 pneumonia diagnosis, while lung ultrasound (LUS) has emerged as a potential alternative to characterize lung involvement. The aim of the study was to compare diagnostic performance of admission chest CT and LUS for the diagnosis of COVID-19. Methods: We included patients admitted to emergency department between February 21-March 6, 2020 (high prevalence group, HP) and between March 30-April 13, 2020 (moderate prevalence group, MP) undergoing LUS and chest CT within 12 h. Chest CT was considered positive in case of "indeterminate"/"typical" pattern for COVID-19 by RSNA classification system. At LUS, thickened pleural line with ≥ three B-lines at least in one zone of the 12 explored was considered positive. Sensitivity, specificity, PPV, NPV, and AUC were calculated for CT and LUS against real-time reverse transcriptase polymerase chain reaction (RT-PCR) and serology as reference standard. Results: The study included 486 patients (males 61 %; median age, 70 years): 247 patients in HP (COVID-19 prevalence 94 %) and 239 patients in MP (COVID-19 prevalence 45 %). In HP and MP respectively, sensitivity, specificity, PPV, and NPV were 90–95 %, 43–69 %, 96−72 %, 20–95 % for CT and 94−93 %, 7–31 %, 94−52 %, 7–83 % for LUS. CT demonstrated better performance than LUS in diagnosis of COVID-19, both in HP (AUC 0.75 vs 0.51; P < 0.001) and MP (AUC 0.85 vs 0.62; P < 0.001). Conclusions: Admission chest CT shows better performance than LUS for COVID-19 diagnosis, at varying disease prevalence. LUS is highly sensitive, but not specific for COVID-19.