DOI: https://doi.org/10.53350/pjmhs20221612177 ORIGINAL ARTICLE P J M H S Vol. 16, No. 12, December, 2022 177 Role of CT Imaging for the Management of COVID-19 SHAHZEB MASTOI 1 , ANEEL KUMAR 2 , TAUQEER ANJUM 3 , MAHNOOR SHAHZEB 4 , MEHAK GUL 5 , RASHID DAUDPOTA 6 1-3 Consultants, Department of Radiology, Jinnah Postgraduate Medical Centre, Karachi 4 Postgraduate Trainee, Department of Clinical Pathology, Jinnah Sindh Medical University, Karachi 5 Sindh Medical College, Karachi 6 Consultant, Department of Pulmonology, South City Hospital, Karachi Correspondence to Dr. Shahzeb Mastoi, E-mail: drshahzebmastoi@gmail.com Cell: 0333-7344014 ABSTRACT Aim: To evaluate the role of high-resolution Computer tomography imaging in the management of COVID-19. Study design: Prospective study Place and duration of study: Jinnah Postgraduate Medical Centre Karachi from 1 st December 2021 to 31 st May 2022. Methodology: One hundred patients suspected to be suffering from COVID-19 were enrolled. All patients underwent Reverse transcriptase-based polymerase chain reaction tests (RT-PCR). The patients were divided into positive or negative depending upon their test results. A high-resolution computed tomography scan was followed in every patient and the results were compared with the reverse transcriptase-based polymerase chain reaction tests findings. The sensitivity and Specificity of the CT scan test were assessed. Results: The mean age of the patients was 59±6.5 years. There were 60 (60%) male and 40 (40%) female patients. Around 58% of the patients were found as positive on PCR while 42% were negative. There 75% of the cases were positive for novel coronavirus on high-resolution computed tomography scan while only 25% were negative. Conclusion: Chest HRCT-scan proved to be a better and more sensitive tool for the diagnosis of novel coronavirus and can be considered as an alternative screening tool for COVID-19 confirmation. Keywords: SARS-CoV-2, Severity, Pulmonary, CT-scan, Serotype INTRODUCTION Coronavirus which belongs to the family of severe acute respiratory syndrome coronavirus-2 caused severe respiratory infections all over the globe. World Health Organization declared this novel viral infection a pandemic in March 2020. It affects people of every age and every background and race, causing mild flu-like symptoms to chronic illnesses. The average incubation period of COVID-19 was 10-14 days. The death toll remained to be very high till the formation of the vaccine and understanding of the nature and adverse effects of this virus. Novel coronavirus remained to be lethal for a majority of the population due to the change in its serotype. Every time it comes with a different shape and different outcomes which continued to be a serious challenge for both researchers and healthcare workers 1-3 . Common symptoms include influenza-like appearances such as dry cough, fatigue, fever, loss of sense of taste/smell, and sore throat. Reverse transcriptase polymerase chain reaction (RT-PCR) is currently considered the gold standard for the diagnosis of coronavirus. However, studies report sensitivity of this virus is ranging from 30-70% only in the case of initial representation through swab sampling. Furthermore, most of the patients are not diagnosed with PCR when the virus reaches the lower respiratory tract despite the coronavirus infection. This poses a major concern and risk to the population and possibly could be the cause of viral spread and transmission. 4-7 Moreover, COVID-19 is highly contagious and RT-PCR is also not able to determine the severity of the disease. A chest CT scan proved to be a better imaging tool for the diagnosis of coronavirus which not only asses the presence of viral infection but also proved beneficial to the severity of the disease. This is also easy to perform and studies revealed the typical pulmonary characteristic radiological findings include crazy paving pattern, multiple ground glass opacities, sub-pleural and basal areas, and patchy pulmonary consolidations in coronavirus patients 8-11 . Up-till now, RT-PCR along with chest CT scans proved to be the diagnostic tools for coronavirus diagnosis and assessing the severity of the disease respectively. In the present study, the value of chest CT-scan was compared with RT-PCR value in coronavirus patients Result of the present study proved to be helpful for the consideration of a better diagnostic tool for COVID MATERIALS AND METHODS This prospective study was conducted at Jinnah Postgraduate Medical Centre Karachi and 100 patients suspected to be suffering ----------------------------------------------------------------------------------------- Received on 14-07-2022 Accepted on 25-11-2022 from COVID-19 and aged between 16-75 years were enrolled. All the cases were enrolled before ethical approval of the study from the institutional committee. Patients' informed consent was taken before their participation. A well-structured questionnaire was sued to gather demographic as well as related clinical information, signs, and symptoms details as well as biochemical, and hematological findings documentation. The sample size was calculated based on the current prevalence of the disease. WHO sample size calculator was used for calculating sample size through 80% power of the test and 95% CI. The patients who were already confirmed through CT scanning or those who were suffering from chronic respiratory complications were excluded from this study. All patients underwent Reverse transcriptase-based polymerase chain reaction tests (RT-PCR). The patients were divided into positive or negative depending upon their test results. A high- resolution computed tomography scan was followed in every patient and the results were compared with the RT-PCR findings. The sensitivity and Specificity of the CT scan test were assessed. Results of RT-PCR were kept hidden at the time of reporting for illuminating biases in the study. The low-dose non-contrast based high-resolution chest CT scanning images comprising of spiral- acquisition with 1 pitch and a rotation 0.35second and having an auto kVp as well as mA choice with an average dosage length of the product to be 149 mGy cm was used. Images having a 1.25 mm thickness of the slice were rebuilt through deep learning-image reconstruction (DLIR). It was customized at a medium level and also stored in the PACS system. Data were analyzed using SPSS version 26.0. RESULTS The mean age of the patients was 59±6.5 years. There were 60 male and 40 female patients. Around 58% of the patients were found as positive on PCR while 42% were negative (Table 1). The values of the CT scan showed a higher number of positive results for coronavirus than RT-PCR results. There were 75% of the cases were positive for novel coronavirus while only 25% were negative (Fig. 1). The diagnostic efficiency of the CT scan of Covid 19 patients presented a sensitivity of upto 100% with a confidence interval of 95% (Table 2). The CT scan reports in various patients presented with multiple focal-ground glass opacities which were associated with linear inter as well as intra-lobular thickening of septa presented n the upper lobular region. Other cases showed bilateral, predominant consolidation patterns in lower lobes. Presentation of subpleural ground glass was also common in the lower as well as upper lobes. Patients also presented CT imaging with diffuse consolidations (Fig 2).