Chest CT for Typical Coronavirus Disease 2019 (COVID-19) Pneumonia: Relationship to Negative RT-PCR Testing
Open accessAbstract
Some patients with positive chest CT findings may present with negative results of real-time reverse-transcription polymerase chain reaction (RT-PCR) tests for coronavirus disease 2019 (COVID-19). In this study, the authors present chest CT findings from five patients with COVID-19 infection who had initial negative RT-PCR results. All five patients had typical imaging findings, including ground-glass opacity (five patients) and/or mixed ground-glass opacity and mixed consolidation (two patients). After isolation for presumed COVID-19 pneumonia, all patients were eventually confirmed to have COVID-19 infection by means of repeated swab tests. A combination of repeated swab tests and CT scanning may be helpful for individuals with a high clinical suspicion of COVID-19 infection but negative findings at RT-PCR screening.
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There are currently a number of different ways to detect COVID-19, whereas computed tomography and X-rays remain the major surgical techniques.
“There are currently a number of different ways to detect COVID-19, whereas computed tomography and X-rays remain the major surgical techniques [80–82].”
From A comprehensive survey on federated learning techniques for healthcare informatics (2023) · cites this paper as [81]
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Rahimzadeh, M., Attar, A., & Sakhaei, S. M. (2021) · Biomedical Signal Processing and Control · doi:10.1016/j.bspc.2021.102588 · Cited by 315 · see citing works
COVID-19 Transmission, Current Treatment, and Future Therapeutic Strategies
Salian, V. S., Wright, J. A., Vedell, P. T., Nair, S. A., Li, C., Kandimalla, M., Tang, X., Carmona, E. M., Kalari, K. R., & Kandimalla, K. K. (2021) · Molecular Pharmaceutics · doi:10.1021/acs.molpharmaceut.0c00608 · Cited by 319 · see citing works
COVID‐19 and the clinical hematology laboratory
Frater, J. L., Zini, G., d’Onofrio, G., & Rogers, H. J. (2020) · International Journal of Laboratory Hematology · doi:10.1111/ijlh.13229 · Cited by 313 · see citing works
FALSE-NEGATIVE RESULTS OF INITIAL RT-PCR ASSAYS FOR COVID-19: A SYSTEMATIC REVIEWPreprint
Arévalo-Rodríguez, I., Buitrago‐García, D., Simancas‐Racines, D., Zambrano-Achig, P., del Campo, R., Ciapponi, A., Sued, O. G., Martínez-García, L., Rutjes, A. W., Low, N. N., et al. (2020) · medRxiv · doi:10.1101/2020.04.16.20066787 · Cited by 315 · see citing works
Baker, A. N., Richards, S., Guy, C. S., Congdon, T. R., Hasan, M., Zwetsloot, A. J., Gallo, A., Lewandowski, J. R., Stansfeld, P. J., Straube, A., et al. (2020) · ACS Central Science · doi:10.1021/acscentsci.0c00855 · Cited by 302 · see citing works
A Review on Deep Learning Techniques for the Diagnosis of Novel Coronavirus (COVID-19)
Islam, M. M., Karray, F. O., Alhajj, R., & Zeng, J. (2021) · IEEE Access · doi:10.1109/access.2021.3058537 · Cited by 292 · see citing works
“Furthermore, RT-PCR inspection also experiences high false negative rates [7].”
BackgroundHecht, J. L., Quade, B. J., Deshpande, V., Mino-Kenudson, M. A., Ting, D. T., Desai, N., Dygulska, B., Heyman, T., Salafia, C. M., Shen, D., et al. (2020) · Modern Pathology · doi:10.1038/s41379-020-0639-4 · Cited by 293 · see citing works
“8 As the epidemic evolves, we are starting to observe the varied presentations of COVID-19 pneumonia, with symptomatic patients showing con cordant CT and RT-PCR fi ndings.”
BackgroundKim, C., Kim, J.-Y., Lee, E. J., Kang, Y. M., Song, K.-H., Kim, E. S., Kim, E. J., Sheen, S., Lee, Y. R., Kang, B., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0264711 · Cited by 287 · see citing works
He, J., Luo, L., Luo, Z., Lyu, J., Ng, M., Shen, X., & Wen, Z. (2020) · Respiratory Medicine · doi:10.1016/j.rmed.2020.105980 · Cited by 281 · see citing works
Body Localization of ACE-2: On the Trail of the Keyhole of SARS-CoV-2
Salamanna, F., Maglio, M., Landini, M. P., & Fini, M. (2020) · Frontiers in Medicine · doi:10.3389/fmed.2020.594495 · Cited by 283 · see citing works
Federated learning for COVID-19 screening from Chest X-ray images
Feki, I., Ammar, S., Kessentini, Y., & Muhammad, K. (2021) · Applied Soft Computing · doi:10.1016/j.asoc.2021.107330 · Cited by 278 · see citing works
Routine blood tests as a potential diagnostic tool for COVID-19
Ferrari, D., Motta, A., Strollo, M., Banfi, G., & Locatelli, M. (2020) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm-2020-0398 · Cited by 273 · see citing works
Hosseini, E. S., Kashani, N. R., Nikzad, H., Azadbakht, J., Bafrani, H. H., & Kashani, H. H. (2020) · Virology · doi:10.1016/j.virol.2020.08.011 · Cited by 277 · see citing works
“Chest CT, Compared to RT-PCR, is a fast, sensitive, easy to perform and more accurate and reliable tool for screening and diagnosis of COVID-19 (Xie et al., 2020).”
Chest CT findings of COVID-19 pneumonia by duration of symptoms
Ding, X., Jia, X., Zhou, J., & Long, Q. (2020) · European Journal of Radiology · doi:10.1016/j.ejrad.2020.109009 · Cited by 270 · see citing works
“Reasons for false negative RT-PCR tests may include insufficient cellular material for detection and improper extraction of nucleic acid from clinical materials [5, 6].”
Perspectives on therapeutic neutralizing antibodies against the Novel Coronavirus SARS-CoV-2
Zhou, G., & Zhao, Q. (2020) · International Journal of Biological Sciences · doi:10.7150/ijbs.45123 · Cited by 262 · see citing works
“COVID-19 can be diagnosed by either clinical CT radiography or a laboratory real time Reverse Transcription-Polymerase Chain Reaction (RT-PCR) [4].”
BackgroundSerological Approaches for COVID-19: Epidemiologic Perspective on Surveillance and Control
Lee, C. Y., Lin, R. T. P., Rénia, L., & Ng, L. F. P. (2020) · Frontiers in Immunology · doi:10.3389/fimmu.2020.00879 · Cited by 256 · see citing works
“Apart from being costly and time consuming to perform, false negative results may arise due to improper handling of nucleic acid samples, inadequate and variable sampling resulting in insufficient viral genetic material at the point of detection (after 14 days pio), or biological variation on when viral RNA is detecta…”
BackgroundCOVID-19: Virology, biology and novel laboratory diagnosis
Mohamadian, M., Chiti, H., Shoghli, A., Biglari, S., Parsamanesh, N., & Esmaeilzadeh, A. (2021) · The Journal of Gene Medicine · doi:10.1002/jgm.3303 · Cited by 371 · see citing works
“Xie et al.(72) demonstrated that about 3% of patients have no”
BackgroundThe ensemble deep learning model for novel COVID-19 on CT images
Zhou, T., Lu, H., Yang, Z., Qiu, S., Huo, B., & Dong, Y. (2020) · Applied Soft Computing · doi:10.1016/j.asoc.2020.106885 · Cited by 255 · see citing works
“It can thus complement the nucleic acid reagent detection [7].”
Chest computed tomography in children with COVID-19 respiratory infection
Li, W., Cui, H., Li, K., Fang, Y., & Li, S. (2020) · Pediatric Radiology · doi:10.1007/s00247-020-04656-7 · Cited by 257 · see citing works
“It has been reported that the susceptible population to the virus is mainly older adults with low immunity, and there have been few reports of paediatric patients [7].”
BackgroundCOVID-19 in older people: a rapid clinical review
Lithander, F. E., Neumann, S., Tenison, E., Lloyd, K., Welsh, T. J., Rodrigues, J. C. L., Higgins, J. P. T., Scourfield, L., Christensen, H., Haunton, V. J., et al. (2020) · Age and Ageing · doi:10.1093/ageing/afaa093 · Cited by 244 · see citing works
“Initial PCR-negative suspected patients have subsequently become positive on repeat testing [42-45].”
BackgroundXiang, J., Yan, M., Li, H., Liu, T., Lin, C., Huang, S., & Shen, C. (2020) · medRxiv · doi:10.1101/2020.02.27.20028787 · Cited by 239 · see citing works
Deep Learning on Chest X-ray Images to Detect and Evaluate Pneumonia Cases at the Era of COVID-19
Hammoudi, K., Benhabiles, H., Melkemi, M., Dornaika, F., Arganda‐Carreras, I., Collard, D., & Scherpereel, A. (2021) · Journal of Medical Systems · doi:10.1007/s10916-021-01745-4 · Cited by 232 · see citing works
“To date (April 5th 2020), there have been 82,602 highly controversial confirmed cases in China, more than 500,000 confirmed cases in Europe and 1,226,644 confirmed cases all around the world 1 .”
BackgroundMethodInfluentialChest CT features of coronavirus disease 2019 (COVID-19) pneumonia: key points for radiologists
Carotti, M., Salaffi, F., Sarzi‐Puttini, P., Agostini, A., Borgheresi, A., Minorati, D., Galli, M., Marotto, D., & Giovagnoni, A. (2020) · La radiologia medica · doi:10.1007/s11547-020-01237-4 · Cited by 228 · see citing works
“The same authors also highlight the fact that follow-up chest CT scans were capable of detecting an improvement in the condition of 42% of patients before their RT-PCR findings were negative [17].”
BackgroundInfluentialOjha, V., Mani, A., Pandey, N. N., Sharma, S., & Kumar, S. (2020) · European Radiology · doi:10.1007/s00330-020-06975-7 · Cited by 227 · see citing works
“Xie et al [9] Feb-20 China 167 NP NP NP NP”
BackgroundInfluentialReview of COVID-19 testing and diagnostic methods
Filchakova, O., Dossym, D., Ilyas, A., Kuanysheva, T., Abdizhamil, A., & Bukasov, R. (2022) · Talanta · doi:10.1016/j.talanta.2022.123409 · Cited by 226 · see citing works
Effectiveness of COVID-19 diagnosis and management tools: A review
Alsharif, W. M., & Qurashi, A. A. (2020) · Radiography · doi:10.1016/j.radi.2020.09.010 · Cited by 228 · see citing works
Nicol, T., Lefeuvre, C., Serri, O., Pivert, A., Joubaud, F., Dubée, V., Kouatchet, A., Ducancelle, A., Lunel, F., & Guillou‐Guillemette, H. L. (2020) · Journal of Clinical Virology · doi:10.1016/j.jcv.2020.104511 · Cited by 218 · see citing works
“Chest computed tomography (CT) may be helpful for the diagnosis, complementary to RT-PCR, but it remains unspecific [7].”
Chest CT for detecting COVID-19: a systematic review and meta-analysis of diagnostic accuracy
Xu, B., Xing, Y., Peng, J., Zheng, Z., Tang, W., Sun, Y., Xu, C., & Peng, F. (2020) · European Radiology · doi:10.1007/s00330-020-06934-2 · Cited by 217 · see citing works
Shan, F., Gao, Y., Wang, J., Shi, W., Shi, N., Han, M., Xue, Z., Shen, D. G., & Shi, Y. (2020) · Medical Physics · doi:10.1002/mp.14609 · Cited by 206 · see citing works
“Each suspected case needs to be confirmed by real-time polymerase chain reaction (RT-PCR) assay of the sputum.(10)”
MethodDiagnosis of COVID-19 for controlling the pandemic: A review of the state-of-the-art
Taleghani, N., & Taghipour, F. (2020) · Biosensors and Bioelectronics · doi:10.1016/j.bios.2020.112830 · Cited by 203 · see citing works
“This was found to be the case even for asymptomatic individuals or patients with initial negative RT-PCR but clinical symptoms, thus showing that CT scans have higher sensitivity compared with RT-PCR (Ai et al., 2020; Fang et al., 2020; Xie et al., 2020).”
BackgroundResultPulmonary embolism in patients with COVID-19: Time to change the paradigm of computed tomography
Rotzinger, D. C., Beigelman‐Aubry, C., von Garnier, C., & Qanadli, S. D. (2020) · Thrombosis Research · doi:10.1016/j.thromres.2020.04.011 · Cited by 199 · see citing works
“To date, most, if not all the available literature regarding SARS-CoV-2 infection relies on non-contrast CT, which is considered the first-line imaging tool [1] and has even proven useful to diagnose COVID-19 pneumonia when initial polymerase chain reaction screening is negative [2].”
BackgroundGuillain-Barré syndrome following COVID-19: new infection, old complication?
Padroni, M., Mastrangelo, V., Asioli, G. M., Pavolucci, L., Abu‐Rumeileh, S., Piscaglia, M. G., Querzani, P., Callegarini, C., & Foschi, M. (2020) · Journal of Neurology · doi:10.1007/s00415-020-09849-6 · Cited by 199 · see citing works
“However, we could not rule out with certainty a COVID-19 parainfectious neurological syndrome, given the reported suboptimal sensitivity of the RT-PCR for swab due to laboratory error or insufficient viral material in the specimen [7].”
BackgroundLeong, S. X., Leong, Y. X., Tan, E. X., Sim, H. Y. F., Koh, C. S. L., Lee, Y. H., Chong, C., Ng, L. S., Chen, J. R. T., Pang, D. W. C., et al. (2022) · ACS Nano · doi:10.1021/acsnano.1c09371 · Cited by 199 · see citing works
Chu, J., Yang, N., Wei, Y., Yue, H., Zhang, F., Zhao, J., He, L., Sheng, G., Chen, P., Li, G., et al. (2020) · Journal of Medical Virology · doi:10.1002/jmv.25793 · Cited by 194 · see citing works
- Authors
- Xie, X., Zhong, Z., Zhao, W., Zheng, C., Wang, F., & Liu, J.
- Affiliations
- Central South University (CN)
- Corresponding author
- Liu, Jun
- Venue
- Radiology
- Published
- 2020-08
- Volume
- 296
- Issue
- 2
- Pages
- E41-E45
- ISSN
- 0033-8419 (ISSN-L)
- 1527-1315
- PMC
- PMC7233363
- OpenAlex
- W3006110666
- Cited by
- 1,960
- References
- 6
- Citations by year
- 2026: 16 · 2025: 24 · 2024: 75 · 2023: 136 · 2022: 282 · 2021: 575 · 2020: 850 · 2012: 1
- FWCI
- 60.46
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Radiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › COVID-19 diagnosis using AI
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 detection and testing
- Keywords
- COVID-19 pandemic, COVID-19 pneumonia, chest CT findings, ground-glass opacities, delayed diagnosis
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, COVID-19 Vaccines, COVID-19 Testing, Adult, Aged, False Negative Reactions, Female, Humans, Male, Middle Aged, Pneumonia, Viral, Radiographic Image Interpretation, Computer-Assisted, Tomography, X-Ray Computed, Reproducibility of Results, Coronavirus Infections, Clinical Laboratory Techniques, Reverse Transcriptase Polymerase Chain Reaction, Pandemics
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