コロナウイルス疾患における胸部CT所見の標準化診断基準の使用の初期結果 2019

Initial Results of the Use of a Standardized Diagnostic Criteria for Chest Computed Tomography Findings in Coronavirus Disease 2019.

• João Manoel Miranda Magalhães Santos
• Ana Paula Alves Fonseca
• Eduardo Pinheiro Zarattini Anastacio
• Fernanda Formagio Minenelli
• Conrado Furtado de Albuquerque Cavalcanti
• Gustavo Borges da Silva Teles

抄録

目的:

本研究の目的は，コロナウイルス疾患2019（COVID-19）において，北米放射線学会が提唱する胸部CT（胸部コンピュータ断層撮影）標準化診断基準を逆転写ポリメラーゼ連鎖反応（RT-PCR）と比較して，初期結果を評価することであった。

OBJECTIVE: The objective of this study was to assess the initial results of chest computed tomography (CT) standardized diagnostic criteria proposed by the Radiological Society of North America in coronavirus disease 2019 (COVID-19) compared with reverse transcription-polymerase chain reaction (RT-PCR).

方法:

4 日以内の間隔で COVID-19 の RT-PCR 検査と胸部 CT を受けた患者 71 例を対象とした。75 例の CT をレビューし、2 名の放射線科医が典型的、不確定、非定型の外観または肺炎陰性として分類した。RT-PCR を参照標準とし、COVID-19 の診断における CT 診断基準の性能を評価した。

METHODS: Seventy-one patients who underwent RT-PCR test for COVID-19 and chest CT within an interval of 4 days or less were included. Seventy-five CTs were reviewed and classified as typical, indeterminate, or atypical appearance or negative for pneumonia by 2 radiologists. With RT-PCR as reference standard, the performance of the CT diagnostic criteria in diagnosing COVID-19 was assessed.

結果:

RT-PCR 陽性の有病率は 45.1%であった。感度83％（95％信頼区間[CI]、78％～89％）、特異度97％（95％CI、92％～99％）、精度91％（95％CI、85％～96％）、陽性予測値97％（95％CI、91％～99％）、陰性予測値86％（95％CI、80％～92％）が得られた。曲線下面積が0.92（95％CI、0.84-0.99）であることを考慮すると、診断性能は良好であった。

RESULTS: The prevalence of positive RT-PCR was 45.1%. It was obtained a sensitivity of 83% (95% confidence interval [CI], 78%-89%), a specificity of 97% (95% CI, 92%-99%), an accuracy of 91% (95% CI, 85%-96%), a positive predictive value of 97% (95% CI, 91%-99%), and a negative predictive value of 86% (95% CI, 80%-92%). The diagnostic performance was excellent, considering the area under the curve of 0.92 (95% CI, 0.84-0.99).

結論:

胸部CT標準化診断基準は，典型的な外観を呈した場合にCOVID-19の診断に高い特異性と正の予測値を示した．

CONCLUSIONS: Chest CT standardized diagnostic criteria had high specificity and positive predictive value for the diagnosis of COVID-19 when presenting a typical appearance.