Introduction: Currently the main diagnostic modality for COVID-19 (Coronavirus disease-2019) is reverse transcriptase polymerase chain reaction (RT-PCR) via nasopharyngeal swab which has high false negative rates. We evaluated the performance of high-resolution computed tomography (HRCT) imaging in the diagnosis of suspected COVID-19 infection compared to RT-PCR nasopharyngeal swab alone in patients hospitalized for suspected COVID-19 infection. Methods: This was a retrospective analysis of 324 consecutive patients admitted to Temple University Hospital. All hospitalized patients who had RT-PCR testing and HRCT were included in the study. HRCTs were classified as Category 1, 2 or 3. Patients were then divided into four groups based on HRCT category and RT-PCR swab results for analysis. Results: The average age of patients was 59.4 (+15.2) years and 123 (38.9%) were female. Predominant ethnicity was African American 148 (46.11%). 161 patients tested positive by RT-PCR, while 41 tested positive by HRCT. 167 (52.02%) had category 1 scan, 63 (19.63%) had category 2 scan and 91 (28.35%) had category 3 HRCT scans. There was substantial agreement between our radiologists for HRCT classification (κ = 0.64). Sensitivity and specificity of HRCT classification system was 77.6 and 73.7 respectively. Ferritin, LDH, AST and ALT were higher in Group 1 and D-dimers levels was higher in Group 3; differences however were not statistically significant. Conclusion: Due to its high infectivity and asymptomatic transmission, until a highly sensitive and specific COVID-19 test is developed, HRCT should be incorporated into the assessment of patients who are hospitalized with suspected COVID-19.

A 29 year old Caucasian female with a history of intravenous drug use presents with one week of worsening right hip and back pain, subjective fevers, chills, and lower back pain. Magnetic Resonance (MR) of the bilateral hips was performed (Fig. 1).

Introduction: Currently the main diagnostic modality for COVID-19 (Coronavirus disease-2019) is reverse transcriptase polymerase chain reaction (RT-PCR) via nasopharyngeal swab which has high false negative rates (diagnostic yield∼70%). We evaluated the performance of high-resolution computed tomography (HRCT) imaging in the diagnosis of suspected COVID-19 infection compared to RT-PCR nasopharyngeal swab alone in patients hospitalized for suspected COVID-19 infection. Methods: This was a retrospective analysis of 324 consecutive patients admitted to Temple University Hospital. All hospitalized patients who had RT-PCR testing and HRCT were included in the study. HRCTs were classified as Category 1, 2 or 3. Category 1 scans were high probability scans (i.e: ground glass opacities (GGOs), crazy-paving, reverse halo/peri lobular pattern irrespective of location and laterality). Category 3 were low probability scans consistent with an alternate diagnosis. Category 2 scans were indeterminate. Patients were then divided into four groups based on HRCT category and RT-PCR swab results for analysis (Group 1: COVID (+) PCR and Category 1 CT scan, Group 2: COVID (+) PCR and Category 2 and 3 CT scan, Group 3: COVID (-) PCR and Category 1 CT scan, Group 4: COVID (-) PCR and Category 2 and 3 CT scan). Inflammatory markers and treatments were compared across these groups. Results: The average age of patients was 59.4(+15.2) years and 123(38.9%) were female. Predominant ethnicity was African American 148 (46.11%). 161 patients tested positive by RT-PCR, while 41 tested positives by HRCT. 167 (52.02%) had category 1 scan, 63 (19.63%) had category 2 scan and 91 (28.35%) had category 3 HRCT scans. There was substantial agreement between our radiologists for HRCT classification (κ = 0.64). Sensitivity and specificity of HRCT classification system was 77.6 and 73.7 respectively. 38.9 % (n=125) patients were classified as Group 1); 11.2% (n=36) as Group 2, 12.8% (n=41) as Group 3 and 34.8 % (n=115) as Group 4. In group 3, 38 (92.7 %) patients received respiratory viral panels (RVP) which were all negative; 21(51.2%) had sputum cultures, only 1 was positive for staph aureus. When comparing Group 1 to Group 3, there were no statistically significant differences in inflammatory markers. There were no statistically significant differences amongst Groups 1 and 3 with respect to treatments Conclusion: Due to its high infectivity and asymptomatic transmission, until a highly sensitive and specific COVID-19 test is developed, HRCT is a valuable assessment tool for patients who are hospitalized with suspected COVID-19.

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