A systematic review of CT chest in COVID-19 diagnosis and its potential application in a surgical setting

Colorectal Dis. 2020 Sep;22(9):993-1001. doi: 10.1111/codi.15252. Epub 2020 Aug 5.

Abstract

Aim: The aim of this work was to investigate the sensitivity and utility of CT of the chest in diagnosing active SARS-Cov-2 (COVID-19) infection, and its potential application to the surgical setting.

Method: A literature review was conducted using Google Scholar® and MEDLINE®/PubMed® to identify current available evidence regarding the sensitivity of CT chest compared with RT-PCR for the diagnosis of COVID-19-positive patients. GRADE criteria and the QUADAS 2 tool were used to assess the level of evidence.

Results: A total of 20 articles were identified that addressed the question of sensitivity of CT for diagnosis of symptomatic and asymptomatic COVID-19-positive patients. Overall sensitivity of CT scan ranged from 57%-100% for symptomatic and 46%-100% for asymptomatic COVID-19 patients, while that of RT-PCR ranged from 39%-89%. CT chest was a better diagnostic modality and capable of detecting active infection earlier in the time course of infection than RT-PCR in symptomatic patients. In asymptomatic patients, disease prevalence seems to play a role in the positive predictive value. Minimal evidence exists regarding the sensitivity of CT in patients who are asymptomatic.

Conclusions: In surgical patients, CT chest should be considered as an important adjunct for detection of COVID-19 infection in patients who are symptomatic with negative RT-PCR prior to any operation. For surgical patients who are asymptomatic, there is insufficient evidence to recommend routine preoperative CT chest for COVID-19 screening.

Keywords: COVID-19; CT Chest; RT-PCR; Sensitivity.

Publication types

  • Systematic Review

MeSH terms

  • Asymptomatic Infections*
  • COVID-19 / diagnosis
  • COVID-19 / diagnostic imaging*
  • COVID-19 / epidemiology
  • COVID-19 Nucleic Acid Testing*
  • Disease Progression
  • Elective Surgical Procedures
  • Humans
  • Lung / diagnostic imaging*
  • Mass Screening
  • Predictive Value of Tests
  • Preoperative Care
  • Prevalence
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed*