Should CT be used for the diagnosis of RT-PCR-negative suspected COVID-19 patients?

Clin Respir J. 2021 May;15(5):491-498. doi: 10.1111/crj.13332. Epub 2021 Feb 2.

Abstract

Introduction: The diagnosis of patients with Coronavirus disease 2019 (COVID-19) suspicion but negative reverse transcriptase-polymerase chain reaction (RT-PCR) test is challenging.

Objective: We aimed to investigate the diagnostic value of chest computed tomography (CT) in RT-PCR-negative patients with suspected COVID-19.

Materials and methods: The study included patients who were admitted to our hospital with the suspicion of COVID-19 between 1 April 2020 and 30 April 2020 and tested negative after RT-PCR test, and underwent CT for further diagnosis. Initial CT findings were classified as typical, indeterminate, and atypical for COVID-19, and negative for pneumonia. Incidental findings on CT were noted.

Results: Of the 338 patients with a mean age of 57 years (min 18 years-max 96 years), 168 (49.70%) were male and 170 (50.29%) were female. The most common symptoms were cough (58.87%), fever (40.82%), and dyspnea (39.34%). The CT findings were typical for COVID-19 in 109 (32.24%) patients, indeterminate in 47 (13.90%) patients, and atypical in 77 (22.78%) patients. The CT findings of 105 (31.06%) patients were negative for pneumonia. Incidental lung nodules suspicious of malignancy were identified in seven patients. Seventy-seven patients (22.78%) had extrapulmonary incidental findings CONCLUSION: The diagnostic value of CT in RT-PCR-negative patients with suspected COVID-19 is not very high. Based on clinical, laboratory, and chest x-ray findings, it may be more appropriate to refer patients to CT after the first triage, when necessary.

Keywords: COVID-19; chest; computed tomography; coronavirus; negative RT-PCR; pneumonia; viral.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • COVID-19 / diagnosis*
  • COVID-19 / epidemiology
  • COVID-19 / virology
  • Female
  • Humans
  • Lung / diagnostic imaging*
  • Male
  • Middle Aged
  • Pandemics
  • RNA, Viral / analysis*
  • Retrospective Studies
  • Reverse Transcriptase Polymerase Chain Reaction / methods*
  • SARS-CoV-2 / genetics*
  • Tomography, X-Ray Computed / methods*
  • Young Adult

Substances

  • RNA, Viral