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LETTER TO THE EDITOR
Year : 2021  |  Volume : 8  |  Issue : 4  |  Page : 168-169

Comparative study on the diagnostic value of chest X-ray and computed tomography in patients with COVID- 19


Department of Medical Imaging, Peking University Shenzhen Hospital, Shenzhen, China

Date of Submission10-Jul-2021
Date of Acceptance05-Nov-2021
Date of Web Publication17-Aug-2022

Correspondence Address:
Guanxun Cheng
Department of Medical Imaging, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/RID.RID_18_22

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How to cite this article:
Deng L, Zhu Y, Zhou W, Cheng G. Comparative study on the diagnostic value of chest X-ray and computed tomography in patients with COVID- 19. Radiol Infect Dis 2021;8:168-9

How to cite this URL:
Deng L, Zhu Y, Zhou W, Cheng G. Comparative study on the diagnostic value of chest X-ray and computed tomography in patients with COVID- 19. Radiol Infect Dis [serial online] 2021 [cited 2022 Oct 6];8:168-9. Available from: http://www.ridiseases.org/text.asp?2021/8/4/168/353893



Coronavirus disease 2019 (COVID-19) spread worldwide in 2020.[1] Novel coronavirus-infected pneumonia (NCIP) is a pulmonary inflammation caused by the new coronavirus.[2] Chest computed tomography (CT) can detect lesions in the lungs allowing early diagnosis, isolation, and treatment, as well as evaluation of the effects of treatment.[3],[4] We retrospectively analyzed the radiographic data of 17 confirmed COVID-19 cases and compared the clinical and epidemiological characteristics with imaging data of imported COVID-19 cases.


  X-ray Radiograph and Computed Tomography Imaging Findings of Covid-19 Top


We studied 17 patients hospitalized in Peking University Shenzhen Hospital between January 10 and March 5, 2020. Six of the 17 cases with COVID-19 did not show chest X-ray abnormalities. Slight thin patch opacity was detected in the lower left lung field in one patient. Two ground-glass opacities (GGOs) were detected in the right lung in one patient. The other nine patients showed multiple opacities with different sizes, uneven densities, and fuzzy boundaries in the two lungs. Cords could be seen at the edge of some lesions. The chest CT of 1 of the 17 patients with COVID-19 was normal. However, multiple lesions with multiple subpleural lesions in the lower lobe of both lungs were detected on the chest CT scans of 16 patients. GGOs were detected in all these 16 patients, and we divided them into the following four types based on lesion density: (1) pure GGO was detected in five cases, (2) GGOs and consolidation were present in seven cases, (3) GGOs and grids were present in one case, and (4) GGOs and linear opacities were present in three cases.


  Comparison of Diagnostic Value between X-rays and Computed Tomography Scans of Covid-19 Top


Sixteen cases with confirmed COVID-19 showed GGOs or consolidation on chest X-rays and/or CT scans, except for one case with normal chest X-ray and CT scan. The incidence of NCIP in patients with COVID-19 was 94%. Among the 11 cases with positive findings on chest X-ray, 56 lesions were detected on CT scan but only 27 on X-ray. The detection rate on X-ray was significantly lower than that on CT. CT test results were used as the reference standard for the diagnosis of NCIP, and a sensitivity of 68.75%, a specificity of 100%, a diagnostic accuracy rate of 70.59%, and a missed diagnosis rate of 31.5% were calculated with a four-segment table [Table 1].
Table 1: Evaluation of coronavirus disease 2019 in the four-division table for chest X-ray diagnosis using computed tomography diagnostic results as the reference standard

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Given the low space and density resolution of X-rays, the lesions' low densities, and the small scope of early NCIP, the early lesions located mainly in the lower lobes would be easily covered by the diaphragm and the heart's shadow. X-rays should not be used for the accurate diagnosis of early NCIP, which can be easily misdiagnosed. By contrast, high-resolution CT scans can be accurately used to observe fine lung structures, such as the secondary pulmonary lobule, and can detect fine lesions such as GGOs and grids. A high-resolution CT scan is recommended as one of the most important methods for the early screening of COVID-19.[5],[6] Given that the pathological features caused by most viruses are similar, the CT manifestations of viral pneumonia are also similar to those of NCIP. When CT findings are used to diagnose patients with suspected NCIP, comprehensive judgment must be made on the basis of epidemiological history and laboratory tests.

Limitations

Because our hospital is not a fixed-point treatment unit for NCIP, the collected cases were only thefirst screening of patients at the onset of the disease, and could not be followed up further. With the development of the epidemic, CT became the main means to screen for NCIP, and the number of patients who underwent both an X-ray examination and CT declined, which is the reason for the low number of comparison cases in this report.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lin C, Ding Y, Xie B, Sun Z, Li X, Chen Z, et al. Asymptomatic novel coronavirus pneumonia patient outside Wuhan: The value of CT images in the course of the disease. Clin Imaging 2020;63:7-9.  Back to cited text no. 1
    
2.
WHO. Statement on Novel Coronavirusin Thailand. Geneva: World Health Organization; 2020.  Back to cited text no. 2
    
3.
Chen H, Ai L, Lu H, Li H. Clinical and imaging features of COVID-19. Radiol Infect Dis 2020;7:43-50.  Back to cited text no. 3
    
4.
Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of chest CT and RT-PCR testing for coronavirus disease 2019 (COVID-19) in China: A report of 1014 cases. Radiology 2020;296:E32-40.  Back to cited text no. 4
    
5.
Huang L, Han R, Yu P, Wang S, Xia L. A correlation study of CT and clinical features of different clinical types of 2019 novel coronavirus pneumonia. Chin J Radiol 2020;54:300-4.  Back to cited text no. 5
    
6.
Wang W, Hu H, Song L, Gong X, Qu Y, Lu Y. Image of pulmonary and diagnosis of atypical novel coronavirus (2019-nCoV) infected pneumonia: Case series of 14 patients. New Med 2020;30:7-9.  Back to cited text no. 6
    



 
 
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