Chest CT in Patients with COVID-19: Toward a Better Appreciation of Study Results and Clinical Applicability

HomeRadiologyVol. 298, No. 2 PreviousNext CommunicationsFree AccessLetters to the EditorChest CT in Patients with COVID-19: Toward a Better Appreciation of Study Results and Clinical ApplicabilityRobert M. Kwee* , Hugo J. A. Adams, Thomas C. Kwee†Robert Kwee†Author AffiliationsDepartment Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, Henri Dunantstraat 5, 6419 PC Heerlen, Netherlands*Department Nuclear Medicine Molecular Imaging. University Center Groningen, Netherlands†e-mail: [email protected]Robert AdamsThomas Kwee†Published Online:Dec 8 2020https://doi.org/10.1148/radiol.2020203702MoreSectionsPDF ToolsImage ViewerAdd favoritesCiteTrack Citations ShareShare onFacebookTwitterLinked In Editor:We read great interest article by Dr Herpe colleagues (1) published online September Radiology. We commend authors for compiling such large study data from multiple centers France during peak national coronavirus disease 2019 (COVID-19) pandemic. The reported high diagnostic performance values chest diagnosing COVID-19, sensitivity, specificity, negative predictive value, positive value 90% (95% CI: 89, 91), 91% 91, 92), 89% 87, 90), 92% 93), respectively. These are range compared other studies countries (2,3).The were accumulated first pandemic their country, as result it was understandably difficult perform well-designed without any flaws. Nevertheless, there some rather crucial issues that may need be clarified better appreciate results, also helpful design reporting future on this topic.First, is unclear whether included consecutive or random sample patients. It appears nearly 40% patients excluded because reverse-transcription polymerase chain reaction (RT-PCR) test results lacking excessive unknown delay between RT-PCR CT. systematically differ those who remained inclusion influence performance. Furthermore, chronic pulmonary diseases. these patients, lower when nonspecific criteria used (ie, single finding bilateral ground-glass opacities peripheral distribution, “crazy-paving” appearance intralobular thickening, reverse halo sign, sign compatible organizing pneumonia). Second, would have been valuable report duration severity symptoms known both variables correlate presence lung abnormalities (4,5). longer-lasting critical illness, likely performs COVID-19. Third, formed part reference standard, which led overestimation Aforementioned methodologic potentially hamper interpretation efficacy addition, we like note not only help but has an important role revealing potential alternative diagnosis explain patient’s clinical features (6). Data regarding diagnoses established 2260 deemed COVID-19 applicability.Disclosures Conflicts Interest: R.M.K. disclosed no relevant relationships. H.J.A.A. T.C.K. relationships.References1. G, Lederlin M, Naudin et al. Efficacy Chest Pneumonia France. Radiology 2020. 10.1148/radiol.2020202568. Published 1, 2020 https://doi.org/10.1148/radiol.2020202568. Google Scholar2. Adams HJA, Kwee TC, Yakar D, Hope MD, RM. Systematic Review Meta-Analysis Value Diagnosis Coronavirus Disease (COVID-19): Sol Scientiae, Illustra Nos. AJR Am J Roentgenol 10.2214/AJR.20.23391. June https://doi.org/10.2214/AJR.20.23391. Crossref, Medline, Scholar3. Suchá van Hamersvelt RW, den Hoven AF, de Jong PA, Verkooijen HM. Suboptimal Quality High Risk Bias Diagnostic Test Accuracy Studies Radiography Computed Tomography Acute Setting Pandemic: A Review. Radiol Cardiothorac Imaging 2020;2(4):e200342. Link, Scholar4. Ding X, Xu J, Zhou Long Q. findings pneumonia symptoms. Eur 2020;127:109009. Scholar5. Francone Iafrate F, Masci GM, score patients: correlation short-term prognosis. 2020;30(12):6808–6817. Scholar6. Rubin GD, Ryerson CJ, Haramati LB, Role Patient Management Multinational Consensus Statement Fleischner Society. 2020;296(1):172–180. ScholarReferences1. Feng Z, Li Yao S, Factors Associated Progression Prolonged Viral Shedding Patients: Multicenter Study. Aging Dis 2020;11(5):1069–1081. Hani C, Trieu NH, Saab I, pneumonia: review typical differential diagnosis. Diagn Interv 2020;101(5):263–268. Bai HX, Hsieh B, Xiong Performance Radiologists Differentiating Non-COVID-19 at 2020;296(2):E46–E54. Léderlin impact assessment French radiological centers: nationwide survey. 2020;30(12):6537–6544. ScholarResponseGuillaume Herpe*,† Jean-Pierre Tasu*,‡Guillaume Tasu*,‡Author Hospital Poitiers, rue la Milétrie, 86021 France*Dactim Mis, LMA, UMR CNRS 7348, France†LaTIM, 1101, INSERM, Bretagne University, Brest, France‡e-mail: protected]We thank our work (1). remarks respond each point.The point concerns how included; whatever medical history, consulting participating suspected having included. true secondarily rate secondary exclusion could introduced bias. self-assessed survey constructed reflect practice, obviously able control all bias.The second most accurate representation population (2). Even though did find scientific support accuracy population, remark interesting calls further studies.The concerning interesting. However, collect time survey, therefore answer study.The fourth Because end point, record data, underline already exist substantial literature (3,4).Last, pinpointed colleagues, standard (5). remind reader diagnosis, multiparametric used, including level exposures prevalence, evolution, biologic parameters, repeated tests. estimate bias, must underlined weight pondered criteria.To conclude, obvious limits, mainly due design. demonstrate current useful radiology leaders organization local patient workflow. Disclosures G.H. J.P.T. ScholarArticle HistoryPublished online: Dec 2020Published print: Feb 2021 FiguresReferencesRelatedDetailsCited ByThe Association Between Severity Scores, CO-RADS, Vitamin D Levels Other Laboratory Parameters PatientsKaanAlişar, DilekÇetinkaya Alişar, GoncaSaglam, SerdarKarakullukçu2022 | Turkish Journal Osteoporosis, Vol. 28, 2Recommended Articles RSNA Education Exhibits Case Collection Metrics Altmetric Score Open AccessThis made available via PMC Access Subset unrestricted re-use analyses form means acknowledgement original source. permissions granted until revoked writing. Upon expiration permissions, perpetual license make Europe PMC, consistent existing copyright protections.PDF download