Comparison of admission chest computed tomography and lung ultrasound performance for diagnosis of COVID-19 pneumonia in populations with different disease prevalence

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...

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Published in:European journal of radiology Vol. 133; p. 109344
Main Authors: Colombi, Davide, Petrini, Marcello, Maffi, Gabriele, Villani, Gabriele D., Bodini, Flavio C., Morelli, Nicola, Milanese, Gianluca, Silva, Mario, Sverzellati, Nicola, Michieletti, Emanuele
Format: Journal Article
Language:English
Published: Ireland Elsevier B.V 01.12.2020
Subjects:
Aged
Cohort Studies
Computed tomography
COVID-19
COVID-19 - diagnostic imaging
COVID-19 - epidemiology
Diagnostic ultrasound
Female
Humans
Lung - diagnostic imaging
Male
Middle Aged
Pandemics
Prevalence
Reproducibility of Results
Retrospective Studies
Sensitivity and Specificity
Spiral
Tomography, X-Ray Computed - methods
Ultrasonography - methods
COVID-19
CRP
LDH
EG
SARS-CoV-2
Computed tomography
RT-PCR
WBC
LG
LUS
Spiral
Diagnostic ultrasound
ISSN:0720-048X, 1872-7727, 1872-7727
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Summary: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. 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. 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). 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.
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ISSN:0720-048X
1872-7727
1872-7727
DOI:10.1016/j.ejrad.2020.109344