Correlation Between Low-Dose Chest Computed Tomography and RT-PCR Results for the Diagnosis of COVID-19: A Report of 27,824 Cases in Tehran, Iran

Alireza Zali; Mohammad-Reza Sohrabi; Ali Mahdavi; Nastaran Khalili; Morteza Sanei Taheri; Ali Maher; Mohammadmehdi Sadoughi; Afshin Zarghi; Seyed Ali Ziai; Abbas Arjmand Shabestari; Mehrdad Bakhshayeshkaram; Hamidreza Haghighatkhah; Babak Salevatipour; Alireza Abrishami; Masoomeh Raoufi; Pooneh Dehghan; Arash Khameneh Bagheri; Reza Jalili Khoshnoud; Khatereh Hanani

doi:10.1016/j.acra.2020.09.003

Correlation Between Low-Dose Chest Computed Tomography and RT-PCR Results for the Diagnosis of COVID-19: A Report of 27,824 Cases in Tehran, Iran

Acad Radiol. 2021 Dec;28(12):1654-1661. doi: 10.1016/j.acra.2020.09.003. Epub 2020 Sep 21.

Authors

Alireza Zali¹, Mohammad-Reza Sohrabi², Ali Mahdavi³, Nastaran Khalili⁴, Morteza Sanei Taheri⁵, Ali Maher⁶, Mohammadmehdi Sadoughi⁷, Afshin Zarghi⁸, Seyed Ali Ziai⁹, Abbas Arjmand Shabestari¹⁰, Mehrdad Bakhshayeshkaram¹¹, Hamidreza Haghighatkhah¹², Babak Salevatipour¹³, Alireza Abrishami¹⁴, Masoomeh Raoufi¹⁵, Pooneh Dehghan¹⁶, Arash Khameneh Bagheri¹⁷, Reza Jalili Khoshnoud¹⁸, Khatereh Hanani¹⁹

Affiliations

¹ Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: azalimd99@gmail.com.
² Community Medicine Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
³ Shahid Beheshti University of Medical Sciences, Radiology Department, Imam Hossein Hospital, Tehran, Iran.
⁴ School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
⁵ Radiology Department, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran.
⁶ School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁷ Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁸ School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁹ Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
¹⁰ Department of Radiology, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
¹¹ National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
¹² Department of Diagnostic Imaging, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
¹³ Department of Diagnostic Imaging, Loghman Hakim Hospital; Shahid Behesti University of Medical Sciences, Tehran, Iran.
¹⁴ Department of Radiology, Shahid Labbafinejad hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
¹⁵ Department of Radiology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences.
¹⁶ Imaging Department, Taleghani Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran.
¹⁷ Shahid Beheshti University of Medical Sciences, Shohadaye Tajrish Hospital, Tehran, Iran.
¹⁸ Department of Neurosurgery, Shahid Beheshti University of Medical Science, Tehran, Iran.
¹⁹ School of Statistics & Information Technology Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Rationale and objectives: Real-time polymerase chain reaction (RT-PCR) remains the gold standard for confirmation of Coronavirus Disease 2019 (COVID-19) despite having many disadvantages. Here, we investigated the diagnostic performance of chest computed tomography (CT) as an alternative to RT-PCR in patients with clinical suspicion of COVID-19 infection.

Methods: In this descriptive cross-sectional study, 27,824 patients with clinical suspicion of COVID-19 infection who underwent unenhanced low-dose chest CT from 20 February, 2020 to 21 May, 2020 were evaluated. Patients were recruited from seven specifically designated hospitals for patients with COVID-19 infection affiliated to Shahid Beheshti University of Medical Sciences. In each hospital, images were interpreted by two independent radiologists. CT findings were considered as positive/negative for COVID-19 infection based on RSNA diagnostic criteria. Then, the correlation between the number of daily positive chest CT scans and number of daily PCR-confirmed cases and COVID-19-related deaths in Tehran province during this three-month period was assessed. The trends of admission rate and patients with positive CT scans were also evaluated.

Results: A strong positive correlation between the numbers of daily positive CT scans and daily PCR-confirmed COVID-19 cases (r = 0.913, p < 0.001) was observed. Furthermore, in hospitals located in regions with a lower socioeconomic status, the admission rate and number of positive cases within this three-month period was higher as compared to other hospitals.

Conclusion: Low-dose chest CT is a safe, rapid and reliable alternative to RT-PCR for the diagnosis of COVID-19 in high-prevalence regions. In addition, our study provides further evidence for considering patients' socioeconomic status as an important risk factor for COVID-19.

Keywords: COVID-19; RT-PCR; computed tomography; correlation; diagnosis; polymerase chain reaction; socioeconomic.

MeSH terms

COVID-19*
Cross-Sectional Studies
Humans
Iran / epidemiology
Reverse Transcriptase Polymerase Chain Reaction
SARS-CoV-2
Sensitivity and Specificity
Tomography, X-Ray Computed