A systematic review of CT chest in COVID-19 diagnosis and its potential application in a surgical setting

The aim of this work was to investigate the sensitivity and utility of CT of the chest in diagnosing active SARS-Cov-2 (COVID-19) infection, and its potential application to the surgical setting.

A literature review was conducted using Google Scholar® and MEDLINE®/PubMed® to identify current available evidence regarding the sensitivity of CT chest compared with RT-PCR for the diagnosis of COVID-19-positive patients. GRADE criteria and the QUADAS 2 tool were used to assess the level of evidence.

A total of 20 articles were identified that addressed the question of sensitivity of CT for diagnosis of symptomatic and asymptomatic COVID-19-positive patients. Overall sensitivity of CT scan ranged from 57%-100% for symptomatic and 46%-100% for asymptomatic COVID-19 patients, while that of RT-PCR ranged from 39%-89%. CT chest was a better diagnostic modality and capable of detecting active infection earlier in the time course of infection than RT-PCR in symptomatic patients. In asymptomatic patients, disease prevalence seems to play a role in the positive predictive value. Minimal evidence exists regarding the sensitivity of CT in patients who are asymptomatic.

In surgical patients, CT chest should be considered as an important adjunct for detection of COVID-19 infection in patients who are symptomatic with negative RT-PCR prior to any operation. For surgical patients who are asymptomatic, there is insufficient evidence to recommend routine preoperative CT chest for COVID-19 screening.