ORIGINAL ARTICLE   Free access

Journal of Radiological Review 2021 September;8(3):230-9

DOI: 10.23736/S2723-9284.21.00108-5

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Role of chest computed tomography to differentiate COVID-19 pneumonia in a low-prevalence area of disease in Southern Italy

Lucio TARANTO ¹ ✉, Valentina SETTINO ¹, Michele FLORIO ¹, Antonio BARCA ¹, Nicoletta CAPUTO ¹, Raffaella SBANO ¹, Antonio MASTROIANNI ², Domenico LAGANÀ ³, Alfredo ZANOLINI ¹

¹ Division of Radiology, Department of Service, SS Annunziata Hospital, Cosenza, Italy; ² Department of Infectious Diseases, SS Annunziata Hopital, Cosenza, Italy; ³ Division of Radiology, Department of Experimental and Clinical Medicine, Mater Domini University Hospital, Catanzaro, Italy

BACKGROUND: The gold standard for the diagnosis of SARS-CoV-2 infection is the real-time reverse-transcription polymerase chain reaction (RT-PCR) swab test. Most radiology societies do not recommend use of chest CT to identify COVID-19 pneumonia as a screening test. Despite this, many studies evaluated the performance of CT to identify patients with COVID-19 pneumonia.
METHODS: This observational retrospective study included 131 patients with clinically suspected of COVID-19 pneumonia symptoms who underwent both chest CT and molecular test. Seventy-three patients were RT-PCR positive and the other 58 were RT-PCR negative. Two radiologists evaluated the following CT features: ground glass opacity (GGO), consolidation, extension, distribution, cranio-caudal gradient, characteristics of opacity, bronchial wall thickening, air bronchogram, bronchioloectasis, pulmonary nodules, subsegmental vessel diameter, lymphadenopathy and pleural effusion. Age, comorbidities, extent of pneumonia, length of hospital stay and outcome were analyzed in patients with COVID-19 pneumonia.
RESULTS: Sixty-seven RT-PCR positive patients and 41 negative ones revealed abnormal chest CT findings. RT-PCR positive cases showed, more frequently than negative cases, GGO with or without consolidation (67 vs. 18), bilateral extension (65 vs. 26) and peripheral distribution (39 vs. 10). The following CT pattern: GGO with or without consolidation, multilobar and bilateral involvement, peripheral distribution without pulmonary nodules, showed 100% specificity, 100% positive predictive value. There was a possible correlation among age, severity of clinical conditions and mortality.
CONCLUSIONS: Chest CT would be useful to identify COVID-19 pneumonia and differentiate this from other pulmonary diseases also in a low prevalence area of disease. In selected patient populations, chest CT might play an additional role in patient management.

KEY WORDS: SARS-CoV-2; COVID-19; Mass chest X-ray; X-ray computed tomography; Pneumonia