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Louisiana radiologists say chest X-rays can help with COVID-19 diagnoses

por John R. Fischer, Senior Reporter | September 08, 2020
Chest X-rays can help in the diagnosis of COVID-19, say radiologists in Louisiana
Radiologists at Louisiana State University Health New Orleans are touting the use of chest X-rays as an aid for diagnosing COVID-19.

They conducted a study that found the scans could rapidly identify the presence of SARS-CoV-2, the disease which leads to COVID-19, especially in areas with limited testing capability or delayed test results.

“The presence of patchy and/or confluent, band-like ground glass opacity or consolidation in a peripheral and mid-to-lower lung zone distribution on a chest radiograph is highly suggestive of SARS-CoV-2 infection and should be used in conjunction with clinical judgment to make a diagnosis,” said Dr. Bradley Spieler, associate professor of diagnostic radiology and vice chairman of research in the department of radiology at LSU Health New Orleans School of Medicine, in a statement.

He and his colleagues said they first recognized this potential of chest X-rays back in mid-to-late March when COVID-19 cases spiked in New Orleans. They noticed an unusual pattern on these scans that appeared to correlate with positive diagnoses of the disease. They then reviewed patient chest X-rays and concurrent reverse-transcription polymerase chain reaction (RT-PCR) virus tests as part of a retrospective study of close to 400 persons under investigation (PUI) for COVID-19 in New Orleans.

Using well-documented COVID-19 imaging patterns, they categorized each scan as characteristic, nonspecific, or negative in appearance to COVID-19. They found chest X-ray images to be highly specific (96.6%) and had a high positive predictive value of 83.3% for SARS-CoV-2 infection in the setting of the pandemic.

“The chest radiograph, while low in sensitivity, can indicate COVID-19 in patients whose radiographs exhibit characteristic COVID-19 findings, when used in concert with clinical factors,” said Dr. John-Paul Grenier, an LSU Health New Orleans radiology resident. “While not a substitute for RT-PCR virus tests or Chest CT, radiographs could provide a rapid, cost-effective diagnosis of COVID-19 in a subset of infected patients during the COVID-19 pandemic. The utility of this technique is described in the context of known disadvantages of RT-PCR, considered the gold standard in COVID-19 diagnosis, and chest CT, which is currently not recommended for COVID-19 diagnosis.”

The findings contrast with a study from back in April out of Ohio State University College of Medicine which found chest X-rays did very little good in helping to diagnose respiratory infections brought on by COVID-19. Some critics have said that chest X-rays cannot accurately distinguish between COVID-19 and other respiratory infections like the flu or pneumonia. A study by Mount Sinai Health System in May, however, found chest X-rays could help identify faster which patients require hospitalization and intubation based on the severity of coronavirus patterns in their lungs.

"These findings underscore how COVID-19, despite its many manifestations, is largely a respiratory illness and the lung changes identifiable on X-ray are a primary predictor of disease progression," said Dr. Adam Bernheim, assistant professor of diagnostic, molecular and interventional radiology at the Icahn School of Medicine at Mount Sinai, at the time.

The findings were published in Cardiothoracic Imaging.

Louisiana State University Health New Orleans did not respond for comment.

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