statement: Chest computed tomography scans for the primary screening or diagnosis of coronavirus disease 2019 would not be beneficial in a low-prevalence region due to the substantial rate of false-positives.This copy is for personal use only. To order printed copies, contact reprints@rsna.org I n P r e s s
Key Results• The pooled sensitivity and specificity were 94% (95% CI: 91%, 96%) and 37% (95% CI: 26%, 50%), respectively, for chest CT. The pooled sensitivity of reverse transcriptasepolymerase chain reaction (RT-PCR) was 89% (95% CI: 81%, 94%).• In low-prevalence (<10%) countries, the positive predictive value of RT-PCR (range: 47.3%, 84.3%) was more than ten times higher than that of CT scans (range: 1.5%, 8.3%).The negative predictive value of both methods ranged from 99.0% to 99.9%.
AbbreviationsCI = confidence interval, COVID-19 = coronavirus disease 2019, NPV = negative predictive value, ORF = open reading frame, PPV = positive predictive value, PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-analyses, QUADAS-2 = Quality Assessment of Diagnostic Accuracy Studies-2, RT-PCR = reverse transcriptase-polymerase chain reaction, SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2, WHO = World Health Organization I n P r e s s Abstract Background: Recent studies have suggested that chest computed tomography (CT) scans could be used as a primary screening or diagnostic tool for coronavirus disease 2019 (COVID-19) in epidemic areas.Purpose: To perform a meta-analysis to evaluate diagnostic performance measures, including predictive values, of chest CT and initial reverse transcriptase-polymerase chain reaction (RT-PCR). studies on COVID-19 that reported the sensitivity and/or specificity of CT scans and/or RT-PCR assays. The pooled sensitivity and specificity were estimated by using random-effects models. The actual prevalence (i.e., the proportion of confirmed patients among those tested) in eight countries was obtained from web sources, and the predictive values were calculated. Meta-regression was performed to reveal the effect of potential explanatory factors on the diagnostic performance measures.
Results:The pooled sensitivity was 94% (95% CI: 91%, 96%; I 2 =95%) for chest CT and 89% (95% CI: 81%, 94%; I 2 =90%) for RT-PCR. The pooled specificity was 37% (95% CI: 26%, 50%; I 2 =83%) for chest CT. The prevalence of COVID-19 outside China ranged from 1.0% to 22.9%. For chest CT scans, the positive predictive value (PPV) ranged from 1.5% to 30.7%, and the negative predictive value (NPV) ranged from 95.4% to 99.8%. For RT-PCR, the PPV ranged from 47.3% to 96.4%, while the NPV ranged from 96.8% to 99.9%. The sensitivity of CT was affected by the distribution of disease severity, the proportion of patients with comorbidities, and the proportion of asymptomatic patients (all p < 0.05). The sensitivity of RT-PCR was negatively associated with the proportion of elderly patients (p = 0.01).
Conclusion:Outside of China where there is a low-prevalence of COVID-19 (1-22.9%), chest CT screening...