Computerised Tomography (CT) findings and COVID-19 Infection (multiple reviews)

Added August 6, 2020

What is this?  COVID-19 is a novel infection and research around diagnostic features is important for clinicians. In particular, information on common computerised tomography (CT) findings may be helpful.

Several rapid reviews have been done. For more details on these, including citations and links to the full reviews, please scroll down this summary.

What was found: At the time of these reviews, the included studies showed that Ground-Glass Opacities (GGO) were the most common chest CT finding observed in COVID-19 patients.

At the time of these reviews, the included studies showed that consolidation was frequently reported at CT and pathological signs of COVID-19 were frequently found in multiple lung lobes and bilaterally. Xu et al. and Lv et al. reported that lower lobes were frequently affected, and Wan et al. reported that most patients within their review had CT abnormalities noted in the right lower lobe.

At the time of these reviews, the included studies showed that normal chest CT findings were rarely reported.

Xu et al., Lv et al. and Kim et al. reported that Chest CT is very good at detecting COVID-19 imaging abnormalities when symptomatic infection is present (sensitivity), particularly in severe epidemic areas; but Lv et al. noted CT sensitivity was reduced in children. Xu et al. noted that CT also has high sensitivity for patients who receive an initial false-negative COVID-19 result.

Xu et al. contained limited data about specificity, and noted at the time of this review that CT is not good at excluding typical COVID-19 imaging abnormalities in people who do not have COVID-19 infection (specificity). Kim et al. reported similar findings in relation to specificity.

Park et al. concluded that there was insufficient evidence to support the role of CT in COVID-19 screening, and that their findings do not support a specific conclusion regarding the role of CT in COVID-19 diagnosis.

What are the reviews:

Citation: Lv M, Wang M, Yang N, et al. Chest Computed Tomography for the Diagnosis of Patients with Coronavirus Disease 2019 (COVID-19): A Rapid Review and Meta-Analysis. Ann Transl Med. 2020 May; 8(10):622.

In this rapid review, the authors searched for observational studies investigating the sensitivity of chest CT imaging in the diagnosis of COVID-19 infection in adults and children. The review was restricted to publications in English or Chinese up to 31 March 2020. The studies were mostly from China (95) and included a total of 5673 patients; all of the included studies were assessed as low-quality evidence.

Citation: Wan S, Li M, Ye Z, et al. CT manifestations and clinical characteristics of 1115 patients with coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. Academic Radiology. 2020 Jul 1;27(7):910-21.

In this systematic review the authors searched for observational studies assessing CT features, clinical features and laboratory results of patients with confirmed COVID-19 infection. They restricted their search to articles published between 1 January 2019 and 15 March 2020. They included 14 observational studies, which were all conducted in China (total 1115 participants) and assessed as being of ‘fair’ quality.

Citation: Zhu J, Zhong Z, Li H, et al. CT imaging features of 4121 patients with COVID-19: a meta-analysis. Journal of Medical Virology 2020 Jul;92(7):891-902.

In this rapid review, the authors searched for observational studies examining CT imaging features of patients with COVID-19 infection. They did not restrict their search by language of publication, and included studies with at least 30 patients published between 1 January 2020 and 16 March 2020. They included 34 observational studies (total: 4121 participants), which were conducted in China and assessed as being high-quality observational studies.

Citation: Park JH, Jang W, Kim SW, et al. The clinical manifestations and chest computed tomography findings of coronavirus disease 2019 (COVID-19) patients in China: a proportion meta-analysis. Clinical and experimental otorhinolaryngology. 2020 May;13(2):95.

In this rapid review, the authors searched for observational studies analysing CT findings of patients with COVID-19 infection. They restricted their search to articles published in English that included at least four patients, and did the search on 17 March 2020. They included four studies from Wuhan and five studies from outside Wuhan in China (total: 627 participants. They assessed all included studies as being low-quality evidence and noted marked variation between studies.

Citation: Xu B, Xing Y, Peng J, et al. Chest CT for detecting COVID-19: a systematic review and meta-analysis of diagnostic accuracy. European Radiology. 2020 May 15:1-8.

In this rapid review, the authors searched for diagnostic studies investigating the diagnostic test accuracy of chest CT for detecting COVID-19 infection. They did not restrict by language of publication and included studies with at least 30 patients, published up to 31 March 2020. They included 16 studies (total: 3186 patients), which were all from China and noted marked variation between studies.

Citation: Kim H, Hong H, Yoon SH. Diagnostic performance of CT and reverse transcriptase-polymerase chain reaction for coronavirus disease 2019: a meta-analysis. Radiology. 2020 Apr 17:201343

In this rapid review, the authors searched for studies of chest CT scans or ‘reverse transcriptase-polymerase chain reaction’ (RT-PCR) assays as diagnostic tests for COVID-19 infection. They restricted their search to articles published between 1 December 2019 and 16 March 2020 and did the search on 3 April 2020. They included 68 articles.

Other Reviews of this Topic:

Citation: Altmayer S, Zanon M, Pacini GS, et al. Comparison of the Computed Tomography Findings in COVID-19 and Other Viral Pneumonia in Immunocompetent Adults: A Systematic Review and Meta-Analysis. European Radiology 2020 Jun 27. 

Disclaimer: This summary has been written by staff and volunteers of Evidence Aid in order to make the content of the original document accessible to decision makers who are searching for the available evidence on the coronavirus (COVID-19) but may not have the time, initially, to read the original report in full. This summary is not intended as a substitute for the medical advice of physicians, other health workers, professional associations, guideline developers, or national governments and international agencies. If readers of this summary think that the evidence that is presented within it is relevant to their decision-making they should refer to the content and details of the original article, and the advice and guidelines offered by other sources of expertise, before making decisions. Evidence Aid cannot be held responsible for any decisions made about the coronavirus (COVID-19) on the basis of this summary alone.

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