Chest CT in COVID-19 patients : a clinical need

Introduction: The COVID-19 pandemic caused by the coronavirus SARS-CoV-2 has resulted in a global healthcare crisis. The provision of computed tomography (CT) imaging services by radiology departments for COVID-19 patients poses multiple challenges. Consequently, it is important to explore the clinical need and indications for thoracic CT and whether they subsequently alter patient management. Methods: We report our experience in this single-centre retrospective cohort study of all confirmed COVID-19 cases admitted during the peak of the ‘Delta’ variant wave in Australia, and who underwent a chest CT. Clinical indication and patient management plan pre- and post-CT were ascertained. Results: A total of 92 out of 1403 patients who were admitted with COVID-19 underwent a thoracic CT (73 CT pulmonary angiogram (CTPA), 14 CT Chest and five high-resolution CT (HRCT) studies). 72.8% of studies were to evaluate for pulmonary emboli, 16.2% for assessment of COVID-19 pneumonia complications, 5.4% for tuberculosis and 6.5% for other indications. 21 (23%) of these studies resulted in a change in management with two patients having a major change in management (thrombolysis, CT-guided aspiration). Management was altered due to diagnosis of pulmonary embolism (PE), pneumonia, cryptogenic organising pneumonia and other reasons. Of 73 CTPA studies, 11 (15%) patients had evidence of PE. Conclusion: In our centre, thoracic CT in COVID-19 patients were predominantly for the evaluation of PE with other indications being for COVID-19 complications and other cardiopulmonary pathologies. 23% of studies subsequently altered patient management, suggesting there is good clinical need for CT chests for these indications.