• Maximilian Schulze-Hagen, Christian Hübel, Michael Meier-Schroers, Can Yüksel, Anton Sander, Marwin Sähn, Michael Kleines, Peter Isfort, Christian Cornelissen, Sebastian Lemmen, Nikolaus Marx, Michael Dreher, Jörg Brokmann, Andreas Kopp, and Christiane Kuhl.
• RWTH Aachen University Hospital: Department of Diagnostic and Interventional Radiology; Central Emergency Unit; Center of Laboratory Diagnostics, Department Virology/Serology; Department of Pneumology and Internal Intensive Care Medicine (Med. Clinic V); Central Department of Hospital Hygiene and Infectiology; Department of Cardiology, Angiology, and Internal Intensive Medicine (Med. Clinic 1); Hospital of Düren gGmbH, Department of Diagnostic and Interventional Radiology.
• Dtsch Arztebl Int. 2020 Jun 1; 117 (22-23): 389395389-395.

BackgroundOnly limited evidence has been available to date on the accuracy of systematic low-dose chest computed tomography (LDCT) use in the diagnosis of COVID-19 in patients with non-specific clinical symptoms.MethodsThe COVID-19 Imaging Registry Study Aachen (COVID-19-Bildgebungs-Register Aachen, COBRA) collects data on imaging in patients with COVID-19. Two of the COBRA partner hospitals (RWTH Aachen University Hospital and Dueren Hospital) systematically perform reverse transcriptase polymerase chain reaction (RT-PCR) from nasopharyngeal swabs as well as LDCT in all patients presenting with manifestations that are compatible with COVID-19. In accordance with the COV-RADS protocol, the LDCT scans were prospectively evaluated before the RT-PCR findings were available in order to categorize the likelihood of COVID-19.ResultsFrom 18 March to 5 May 2020, 191 patients with COVID-19 manifestations (117 male, age 65 ± 16 years) underwent RT-PCR testing and LDCT. The mean time from the submission of the sample to the availability of the RT-PCR findings was 491 minutes (interquartile range [IQR: 276-1066]), while that from the performance of the CT to the availability of its findings was 9 minutes (IQR: 6-11). A diagnosis of COVID-19 was made in 75/191 patients (39%). The LDCT was positive in 71 of these 75 patients and negative in 106 of the 116 patients without COVID-19, corresponding to 94.7% sensitivity (95% confidence interval [86.9; 98.5]), 91.4% specificity [84.7; 95.8], positive and negative predictive values of 87.7% [78.5; 93.9] and 96.4% [91.1; 98.6], respectively, and an AUC (area under the curve) of 0.959 [0.930; 0.988]. The initial RT-PCR test results were falsely negative in six patients, yielding a sensitivity of 92.0% [83.4; 97.0]; these six patients had positive LDCT findings. 47.4% of the LDCTs that were negative for COVID-19 (55/116) exhibited pathological pulmonary changes, including infiltrates, that were correctly distinguished from SARS-CoV-2 related changes.ConclusionIn patients with symptoms compatible with COVID-19, LDCT can esablish the diagnosis of COVID-19 with comparable sensitivity to RT-PCR testing. In addition, it offers a high specificity for distinguishing COVID-19 from other diseases associated with the same or similar clinical symptoms. We propose the systematic use of LDCT in addition to RT-PCR testing because it helps correct false-negative RT-PCR results, because its results are available much faster than those of RT-PCRtesting, and because it provides additional diagnostic information useful for treatment planning regardless of the type of the infectious agent.

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