Computed tomography chest in COVID-19: When & why?

Area of Science:

• Radiology
• Infectious Diseases
• Pulmonology

Background:

• Computed tomography (CT) of the chest is frequently utilized in the diagnosis and management of coronavirus disease 2019 (COVID-19).
• However, the indiscriminate use of CT chest may lead to unnecessary radiation exposure and healthcare costs.
• Clear guidelines are needed to define the appropriate role of CT chest in various COVID-19 patient cohorts.

Purpose of the Study:

• To review and delineate the specific indications for performing CT chest in patients with suspected, confirmed, or recovered COVID-19.
• To provide evidence-based recommendations for the judicious application of CT chest in the context of the COVID-19 pandemic.
• To differentiate scenarios where CT chest offers significant clinical value versus those where alternative imaging modalities suffice.

Main Methods:

• Systematic review of current scientific evidence regarding CT chest utilization in COVID-19.
• Analysis of personal clinical experience in managing COVID-19 patients with varying imaging needs.
• Evaluation of CT chest's diagnostic performance (sensitivity, specificity) in different clinical settings.

Main Results:

• CT chest is not recommended for routine screening due to low sensitivity and specificity.
• Indications include specific subsets of RT-PCR negative suspects with high clinical suspicion and indeterminate chest X-rays.
• CT chest is valuable for COVID-19 patients with unexplained deterioration, suspected pulmonary embolism, or concurrent lung pathology, and in specific high-risk comorbid patients.
• CT chest is crucial for ruling out lung fibrosis in recovered COVID-19 patients presenting with persistent respiratory symptoms.

Conclusions:

• CT chest is an indispensable, yet not universally indicated, diagnostic tool in COVID-19 management.
• Its use should be reserved for specific clinical scenarios where it significantly impacts patient care and decision-making.
• Judicious application of CT chest, guided by clinical suspicion and patient characteristics, is paramount.