Avaliação dos achados de tomografia computadorizada em pacientes imunocompetentes com covid-19 comparado a outras pneumonias virais : revisão sistemática e meta-análise

Abstract

Background: Some authors have proposed the use of chest computed tomography (CT) to screen patients with suspected COVID-19; however, the imaging findings are nonspecific and could correspond to any other etiologic agent of viral pneumonia. The goal of this study was to carry out a systematic review and meta-analysis to compare the CT findings of COVID-19 compared to other viral pneumonia. Methods: The Cochrane, EMBASE, and MEDLINE databases were searched through April 04, 2020 for eligible studies. Eligibility criteria included studies with immunocompetent patients presenting with viral pneumonia and a positive respiratory tract sample for coronavirus or other viral etiology (non-COVID). Exclusion criteria included studies not published in English or with less than 10 subjects, inclusion of patients <16 years of age, and lack of confirmatory laboratory diagnosis for viral etiology. Pooled prevalence of findings were calculated and described with 95% confidence intervals. Results: A total of 2263 studies were identified, but only 33 met the inclusion criteria. The main CT finding for both COVID-19 and non-COVID viral pneumonia were a predominantly ground-glass opacity (GGO) pattern (COVID-19, 0.42, 95% CI 0.28- 0.55; non-COVID, 0.25; 95% CI 0.17-0.32) or a mixed pattern of GGO and consolidation (COVID-19, 0.37, 95% CI 0.17-0.56; non-COVID 0.46, 95% CI 0.35- 0.58). Distribution of lung opacities were predominantly bilateral and involved the lower lungs for both etiologies. COVID-19 had a higher prevalence of peripheral distribution, upper and middle lobe involvement compared to other viral pneumonia. Conclusion: Despite the higher prevalence of peripheral distribution, involvement of upper and middle lobes, COVID-19 and non-COVID viral pneumonia had overlapping CT findings.