Evaluation of Ultra-Low-Dose Chest Computed Tomography Images in Detecting Lung Lesions Related to COVID-19: A Prospective Study

Background: The present study aimed to evaluate the effectiveness of ultra-low-dose (ULD) chest computed tomography (CT) in comparison with the routine dose (RD) CT images in detecting lung lesions related to COVID-19. Methods: A prospective study was conducted during April-September 2020 at Shahid Faghihi Hospital affiliated with Shiraz University of Medical Sciences, Shiraz, Iran. In total, 273 volunteers with suspected COVID-19 participated in the study and successively underwent RD-CT and ULD-CT chest scans. Two expert radiologists qualitatively evaluated the images. Dose assessment was performed by determining volume CT dose index, dose length product, and size-specific dose estimate. Data analysis was performed using a ranking test and kappa coefficient (kappa). P<0.05 was considered statistically significant. Results: Lung lesions could be detected with both RD-CT and ULD-CT images in patients with suspected or confirmed COVID-19 (kappa=1.0, P=0.016). The estimated effective dose for the RD-CT protocol was 22-fold higher than in the ULD-CT protocol. In the case of the ULD-CT protocol, sensitivity, specificity, accuracy, and positive predictive value for the detection of consolidation were 60%, 83%, 80%, and 20%, respectively. Comparably, in the case of RD-CT, these percentages for the detection of ground-glass opacity (GGO) were 62%, 66%, 66%, and 18%, respectively. Assuming the result of real-time polymerase chain reaction as true-positive, analysis of the receiver-operating characteristic curve for GGO detected using the ULD-CT protocol showed a maximum area under the curve of 0.78. Conclusion: ULD-CT, with 94% dose reduction, can be an alternative to RD-CT to detect lung lesions for COVID-19 diagnosis and follow-up. An earlier preliminary report of a similar work with a lower sample size was submitted to the arXive as a preprint. The preprint is cited as: https://arxiv.org/abs/2005.03347