Diagnostic Yield of Computed Tomography for the Identification of Coronavirus Disease 2019 Using Repeated Reverse Transcriptase Polymerase Chain Reaction Testing or Confirmed True-Negative State as Reference Standard: Systematic Review and Meta-Analysis

J Comput Assist Tomogr. 2020 Nov/Dec;44(6):812-820. doi: 10.1097/RCT.0000000000001105.

Abstract

Objective: The aim of this study was to perform a meta-analysis assessing the diagnostic yield of computed tomography (CT) for the identification of coronavirus disease 2019 (COVID-19) using repeated reverse transcriptase polymerase chain reaction testing or confirmed true-negative state as reference standard.

Methods: In May 2020, we interrogated the MEDLINE, Embase, and CENTRAL databases. Pooled sensitivity, specificity, and diagnostic odds ratios of CT for COVID-19 identification were computed. Cumulative positive predictive value (PPV) and negative predictive value, stratified by disease prevalence, were calculated.

Results: Ten articles were included (1332 patients). Pooled sensitivity, specificity, and summary diagnostic odds ratio of CT were 82% [95% confidence interval (CI), 79%-84%], 68% (95% CI, 65%-71%), and 18 (95% CI, 9.8-32.8). The PPV and negative predictive value were 54% (95% CI, 30%-77%) and 94% (95% CI, 88%-99%) at a COVID-19 prevalence lower than 40%, and 80% (95% CI, 62%-91%) and 77% (95% CI, 68%-85%) at a prevalence higher than 40%.

Conclusion: CT yields higher specificity and PPV, albeit lower sensitivity, than previously reported for the identification of COVID-19.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Betacoronavirus
  • COVID-19
  • COVID-19 Testing
  • Clinical Laboratory Techniques / methods*
  • Coronavirus Infections / diagnosis*
  • Humans
  • Lung / diagnostic imaging*
  • Pandemics
  • Pneumonia, Viral / diagnosis*
  • Reference Values
  • Reproducibility of Results
  • Reverse Transcriptase Polymerase Chain Reaction / methods*
  • SARS-CoV-2
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed / methods*