Diagnostic Performance of Computed Tomography Imaging for COVID-19 in a Region with Low Disease Prevalence

Ho Lee, Tatsuya Suzuki, Yohei Okada, Hiromu Tanaka, Satoshi Okamori, Hirofumi Kamata, Makoto Ishii, Masahiro Jinzaki, Koichi Fukunaga

Research output: Contribution to journalArticlepeer-review

Abstract

Coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China, in December 2019 as an outbreak of pneumonia of unknown origin. Previous studies have suggested the utility of chest computed tomography (CT) in the diagnosis of COVID-19 because of its high sensitivity (93%–97%), relatively simple procedure, and rapid test results. This study, performed in Japan early in the epidemic when COVID-19 prevalence was low, evaluated the diagnostic accuracy of chest CT in a population presenting with lung diseases having CT findings similar to those of COVID-19. We retrospectively included all consecutive patients (≥18 years old) presenting to the outpatient department of Keio University Hospital between March 1 and May 31, 2020, with fever and respiratory symptoms. We evaluated the performance of diagnostic CT for COVID-19 by using polymerase chain reaction (PCR) results as the reference standard. We determined the numbers of false-positive (FP) results and assessed the clinical utility using decision curve analysis. Of the 175 patients, 22 were PCR-positive. CT had a sensitivity of 68% and a specificity of 57%. Patients with FP results on CT diagnosis were mainly diagnosed with diseases mimicking COVID-19, e.g., interstitial lung disease. Decision curve analysis indicated that the clinical utility of CT imaging was limited. The diagnostic performance of CT for COVID-19 was inadequate in an area with low COVID-19 prevalence and a high prevalence of other lung diseases with chest CT findings similar to those of COVID-19. Considering this insufficient diagnostic performance, CT findings should be evaluated in the context of additional medical information to diagnose COVID-19.

Original languageEnglish
Pages (from-to)21-30
Number of pages10
JournalKeio Journal of Medicine
Volume71
Issue number1
DOIs
Publication statusPublished - 2022

Keywords

  • chest computed tomography
  • COVID-19
  • lung disease
  • polymerase chain reaction

ASJC Scopus subject areas

  • Medicine(all)

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