Demographic and clinico-radiological profile on High-Resolution Computerized Tomography (HRCT) thorax in mild or asymptomatic clinically suspected COVID-19 patients in high-endemicity area of India—Can HRCT be the first screening tool? —The DECRYPTION study

 

 Permissions and Reprints

Abstract

Background: With COVID-19 cases rising, despite CT chest being of value in diagnosis and prognostication in COVID-19, its role in mild or asymptomatic suspected COVID-19, before RT-PCR test is lacking. Method: This is a retrospective observational study involving asymptomatic or mildly symptomatic clinically suspected COVID-19 infection in a high endemicity area. Of 2532 HRCT chest database, 376 eligible cases were analyzed for clinico-radiological correlation for CT findings based CORADS and CT severity score between positive vs negative group. Results: Of 376, 186 (48.46%) had COVID-19 features on HRCT in mild and asymptomatic suspected patients. 98 (26.06%) had CO-RARDS - 5, 88 (23.40%) had CO-RADS - 4. 48 (12.76%), 128 (34.04%), 14 (3.72%) had CO-RADS score of 3,2,1, respectively. Positive CT findings were more likely beyond 3 days of symptoms compared to those presenting earlier {days: (Mean) 4.2 vs 2.76} Positive CT was significantly associated with patients with anosmia and dyspnea. The common presenting symptoms were Fever 196 (52.12%) and followed by sore throat in 173 (46.01%). The common HRCT findings were Ground glass opacity (GGO) (74.60%), followed by Lymphadenopathy (LN) (27.92%). LN which was more prevalent in symptomatic patients {99/343 (28.86%) vs {6/33 (18.18%)} asymptomatics (P: 0.04)}. Consolidation was significantly more in asymptomatics with COPD (P: 0.004). 6 (3.22%) patients had CT score >17/25. Conclusion: Chest HRCT picked 48.46% positive cases in mildly symptomatic and asymptomatic patients of which 3.22% had severe involvement (>17). Being a noninvasive, rapid, sensitive, low risk of cross infection with high reproducibility, chest CT is worth evaluating as screening modality even in asymptomatic and mildly symptomatic clinically suspected COVID-19.

Publication History

Received: 26 September 2020

Accepted: 02 January 2021

Article published online:
13 July 2021

© 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

• References

• 1 Desai HD, Jadeja DM, Sharma K. Takotsubo syndrome a rare entity in patients with COVID-19: An updated review of case-reports and case-series. Int J Cardiol Heart Vasc 2020; 29: 100604
  PubMedGoogle Scholar
• 2 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
  CrossrefPubMedGoogle Scholar
• 3 Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P. et al. Sensitivity of chest CT for COVID-19: Comparison to RT-PCR. Radiology 2020; 296: E115-7
  CrossrefPubMedGoogle Scholar
• 4 Himoto Y, Sakata A, Kirita M, Hiroi T, Kobayashi KI, Kubo K. et al. Diagnostic performance of chest CT to differentiate COVID-19 pneumonia in non-high-epidemic area in Japan. Jpn J Radiol 2020; 38: 400-6
  CrossrefPubMedGoogle Scholar
• 5 Clinical Management protocol COVID-19 “Ministry of Health and Family welfare Government of India” June 13^th 2020, Available from: https://www.mohfw.gov.in/pdf/ClinicalManagementProtocolforCOVID19.pdf.
• 6 Chang YC, Yu CJ, Chang SC, Galvin JR, Liu HM, Hsiao CH. et al. Pulmonary sequelae in convalescent patients after severe acute respiratory syndrome: Evaluation with thin-section CT. Radiology 2005; 236: 1067-75
  CrossrefPubMedGoogle Scholar
• 7 Prokop M, van Everdingen W, van Rees Vellinga T, van Ufford HQ, Stöger L, Beenen L. et al. CO-RADS: A categorical CT assessment scheme for patients suspected of having COVID-19-definition and evaluation. Radiology 2020; 296: E97-104
  CrossrefPubMedGoogle Scholar
• 8 Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX. et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708-20
  CrossrefPubMedGoogle Scholar
• 9 ”The Times of India.” Available from: https://timesofindia.indiatimes.com/city/ahmedabad/ahmedabad-has-no-herd-immunity-only-17-6-have-antibodies/articleshow/77137851.cms.
• 10 Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N. et al. Chest CT findings in coronavirus disease-19 (COVID-19): Relationship to duration of infection. Radiology 2020; 295: 200463
  CrossrefPubMedGoogle Scholar
• 11 Francone M, Iafrate F, Masci GM, Coco S, Cilia F, Manganaro L. et al. Chest CT score in COVID-19 patients: Correlation with disease severity and short-term prognosis. Eur Radiol. 2020; 30: 6808-17
  CrossrefPubMedGoogle Scholar
• 12 Wu J, Wu X, Zeng W, Guo D, Fang Z, Chen L. et al. Chest CT findings in patients with corona virus disease 2019 and its relationship with clinical features. Invest Radiol 2020; 55: 257-61
  CrossrefPubMedGoogle Scholar
• 13 Yang R, Li X, Zhen Y, Liu H, Zhen Y, Zhang X. et al. Chest CT score: An imaging tool for assessing severe COVID-19. Radiol Cardiothorac Imaging 2020; 2: e200047
  CrossrefPubMedGoogle Scholar
• 14 Bai HX, Hsieh B, Xiong Z, Halsey K, Choi JW, Tran TML. et al. Performance of radiologists in differentiating COVID-19 from non-COVID-19 viral pneumonia at chest CT. Radiology 2020; 296: E46-54
  CrossrefPubMedGoogle Scholar