Chest CT-based differential diagnosis of 28 patients with suspected corona virus disease 2019 (COVID-19)

• Published in: British journal of radiology Vol. 93; no. 1112; p. 20200243
• Main Authors: Xie, Sidong, Lei, Ziying, Chen, Xiuzhen, Liu, Weimin, Wang, Xiaohong, Dong, Yunxu, Guo, Yuefei, Duan, Yani, Cao, Huijuan, Qin, Jie, Lin, Bingliang
• Format: Journal Article
• Language: English
• Published: England The British Institute of Radiology 01.08.2020
• Subjects: Adult; Betacoronavirus; Coronavirus Infections - diagnostic imaging; COVID-19; Diagnosis, Differential; Female; Humans; Lung - diagnostic imaging; Male; Middle Aged; Pandemics; Pneumonia, Viral - diagnostic imaging; Retrospective Studies; Reverse Transcriptase Polymerase Chain Reaction; RNA, Viral - analysis; SARS-CoV-2; Tomography, X-Ray Computed
• ISSN: 0007-1285; 1748-880X
• DOI: 10.1259/bjr.20200243

The chest CT findings that can distinguish patients with corona virus disease 2019 (COVID-19) from those with clinically suspected COVID-19 but subsequently found to be COVID-19 negative have not previously been described in detail. The purpose of this study was to determine the distinctions among patients with COVID-19 by comparing the imaging findings of patients with suspected confirmed COVID-19 and those of patients initially suspected to have COVID-19 who were ultimately negative for the disease. 28 isolated suspected in-patients with COVID-19 were enrolled in this retrospective study from January 22, 2020 to February 6, 2020. 12 patients were confirmed to have positive severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) RNA results, and 16 patients had negative results. The thin-section CT imaging findings and clinical and laboratory data of all the patients were evaluated. There were no significant differences between the 12 confirmed COVID-19 (SARS-Cov-2-positive) patients and 16 SARS-CoV-2-negative patients in epidemiology and most of the clinical features or laboratory data. The CT images showed that the incidence of pure/mixed ground-glass opacities (GGOs) was not different between COVID-19 and SARS-CoV-2-negative patients [9/12 (75.0%) 10/16 (62.5%), = 0.687], but pure/mixed GGOs in the peripheral were more common in patients with COVID-19 [11/12 (91.7%) 6/16 (37.5%), = 0.006]. There were no significant differences in the number of lesions, bilateral lung involvement, large irregular/patchy opacities, rounded opacities, linear opacities, crazy-paving patterns, halo signs, interlobular septal thickening or air bronchograms. Although peripheral pure/mixed GGOs on CT may help distinguish patients with COVID-19 from clinically suspected but negative patients, CT cannot replace RT-PCR testing. Peripheral pure/mixed GGOs on-chest CT findings can be helpful in distinguishing patients with COVID-19 from those with clinically suspected COVID-19 but subsequently found to be COVID-19 negative.