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      Artificial Intelligence Distinguishes COVID-19 from Community Acquired Pneumonia on Chest CT

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          Abstract

          Background

          Coronavirus disease has widely spread all over the world since the beginning of 2020. It is desirable to develop automatic and accurate detection of COVID-19 using chest CT.

          Purpose

          To develop a fully automatic framework to detect COVID-19 using chest CT and evaluate its performances.

          Materials and Methods

          In this retrospective and multi-center study, a deep learning model, COVID-19 detection neural network (COVNet), was developed to extract visual features from volumetric chest CT exams for the detection of COVID-19. Community acquired pneumonia (CAP) and other non-pneumonia CT exams were included to test the robustness of the model. The datasets were collected from 6 hospitals between August 2016 and February 2020. Diagnostic performance was assessed by the area under the receiver operating characteristic curve (AUC), sensitivity and specificity.

          Results

          The collected dataset consisted of 4356 chest CT exams from 3,322 patients. The average age is 49±15 years and there were slightly more male patients than female (1838 vs 1484; p-value=0.29). The per-exam sensitivity and specificity for detecting COVID-19 in the independent test set was 114 of 127 (90% [95% CI: 83%, 94%]) and 294 of 307 (96% [95% CI: 93%, 98%]), respectively, with an AUC of 0.96 (p-value<0.001). The per-exam sensitivity and specificity for detecting CAP in the independent test set was 87% (152 of 175) and 92% (239 of 259), respectively, with an AUC of 0.95 (95% CI: 0.93, 0.97).

          Conclusions

          A deep learning model can accurately detect COVID-19 and differentiate it from community acquired pneumonia and other lung diseases.

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          Most cited references12

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          Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

          In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
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            Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia

            Abstract Background The initial cases of novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) occurred in Wuhan, Hubei Province, China, in December 2019 and January 2020. We analyzed data on the first 425 confirmed cases in Wuhan to determine the epidemiologic characteristics of NCIP. Methods We collected information on demographic characteristics, exposure history, and illness timelines of laboratory-confirmed cases of NCIP that had been reported by January 22, 2020. We described characteristics of the cases and estimated the key epidemiologic time-delay distributions. In the early period of exponential growth, we estimated the epidemic doubling time and the basic reproductive number. Results Among the first 425 patients with confirmed NCIP, the median age was 59 years and 56% were male. The majority of cases (55%) with onset before January 1, 2020, were linked to the Huanan Seafood Wholesale Market, as compared with 8.6% of the subsequent cases. The mean incubation period was 5.2 days (95% confidence interval [CI], 4.1 to 7.0), with the 95th percentile of the distribution at 12.5 days. In its early stages, the epidemic doubled in size every 7.4 days. With a mean serial interval of 7.5 days (95% CI, 5.3 to 19), the basic reproductive number was estimated to be 2.2 (95% CI, 1.4 to 3.9). Conclusions On the basis of this information, there is evidence that human-to-human transmission has occurred among close contacts since the middle of December 2019. Considerable efforts to reduce transmission will be required to control outbreaks if similar dynamics apply elsewhere. Measures to prevent or reduce transmission should be implemented in populations at risk. (Funded by the Ministry of Science and Technology of China and others.)
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              Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases

              Background Chest CT is used for diagnosis of 2019 novel coronavirus disease (COVID-19), as an important complement to the reverse-transcription polymerase chain reaction (RT-PCR) tests. Purpose To investigate the diagnostic value and consistency of chest CT as compared with comparison to RT-PCR assay in COVID-19. Methods From January 6 to February 6, 2020, 1014 patients in Wuhan, China who underwent both chest CT and RT-PCR tests were included. With RT-PCR as reference standard, the performance of chest CT in diagnosing COVID-19 was assessed. Besides, for patients with multiple RT-PCR assays, the dynamic conversion of RT-PCR results (negative to positive, positive to negative, respectively) was analyzed as compared with serial chest CT scans for those with time-interval of 4 days or more. Results Of 1014 patients, 59% (601/1014) had positive RT-PCR results, and 88% (888/1014) had positive chest CT scans. The sensitivity of chest CT in suggesting COVID-19 was 97% (95%CI, 95-98%, 580/601 patients) based on positive RT-PCR results. In patients with negative RT-PCR results, 75% (308/413) had positive chest CT findings; of 308, 48% were considered as highly likely cases, with 33% as probable cases. By analysis of serial RT-PCR assays and CT scans, the mean interval time between the initial negative to positive RT-PCR results was 5.1 ± 1.5 days; the initial positive to subsequent negative RT-PCR result was 6.9 ± 2.3 days). 60% to 93% of cases had initial positive CT consistent with COVID-19 prior (or parallel) to the initial positive RT-PCR results. 42% (24/57) cases showed improvement in follow-up chest CT scans before the RT-PCR results turning negative. Conclusion Chest CT has a high sensitivity for diagnosis of COVID-19. Chest CT may be considered as a primary tool for the current COVID-19 detection in epidemic areas. A translation of this abstract in Farsi is available in the supplement. - ترجمه چکیده این مقاله به فارسی، در ضمیمه موجود است.
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                Author and article information

                Contributors
                Journal
                Radiology
                Radiology
                Radiology
                Radiology
                Radiological Society of North America
                0033-8419
                1527-1315
                19 March 2020
                : 200905
                Affiliations
                [1]From the Department of Radiology, Wuhan Huangpi People's Hospital, Wuhan, Hubei, China 430301 (L. L., Z. X., X. F., S. Z., J.X.), Jianghan University Affiliated Huangpi People's Hospital, Wuhan, Hubei, China 430301 (L. L.), Department of Radiology, Wuhan Pulmonary Hospital, Wuhan, Hubei, China 430030 (L. Q.), Keya Medical Technology Co., Ltd, Shenzhen, Guangdong, China 518116 (Y. Y., X. W., B. K., J. B., Y. L., Z. F, Q. S., K. C.), Department of Radiology, Liaocheng People’s Hospital, Shandong, China, 252000 (D. L.), Department of CT, The Third Medical Center of Chinese PLA General Hospital, Beijing, China 100039 (G. W.), and Department of Radiology, Shenzhen Second People’s Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China 518035 (Q. X., J. X.).
                Author notes
                Address correspondence to J.X. xiajun@ 123456email.szu.edu.cn

                Author contributions: Guarantors of integrity of entire study, L.L., L.Q., Y.Y., J.X.; study concepts/study design or data acquisition or data analysis/interpretation, L.L., L.Q., Z.X., Y.Y., X.W., B.K., J.B., Y.L., Z.F., Q.S., K.C., D.L., G.W., Q.X., X.F., S.Z., J.X., J.X.; manuscript drafting or manuscript revision for important intellectual content, L.L., L.Q., Z.X., Y.Y., X.W., B.K., J.B., Y.L., Z.F., Q.S., K.C., D.L., G.W., Q.X., X.F., S.Z., J.X., J.X.; approval of final version of submitted manuscript, L.L., L.Q., Z.X., Y.Y., X.W., B.K., J.B., Y.L., Z.F., Q.S., K.C., D.L., G.W., Q.X., X.F., S.Z., J.X., J.X.; literature research, Y.Y., X.W., B.K., J.B., Y.L., J.X; clinical studies, L.L., L.Q., D.L., G.W., J.X.; experimental studies, Y.Y., X.W., B.K., J.B., Y.L., Z.F., statistical analysis, Y.Y., X.W., B.K., Y.L.; and manuscript editing, L.L., L.Q., Y.Y., X.W., B.K., J.B., Y.L., Q.S., J.X.

                Author information
                https://orcid.org/0000-0001-9903-8049
                https://orcid.org/0000-0003-0966-3006
                https://orcid.org/0000-0003-3610-0436
                https://orcid.org/0000-0001-9913-134X
                https://orcid.org/0000-0002-7528-2407
                https://orcid.org/0000-0003-2108-5341
                https://orcid.org/0000-0002-9134-1024
                https://orcid.org/0000-0002-6793-6212
                https://orcid.org/0000-0002-2874-6619
                https://orcid.org/0000-0001-9805-1946
                https://orcid.org/0000-0003-2361-151X
                https://orcid.org/0000-0002-3496-2174
                https://orcid.org/0000-0002-5342-3870
                https://orcid.org/0000-0001-7748-9586
                https://orcid.org/0000-0003-3174-4267
                https://orcid.org/0000-0001-6677-1519
                https://orcid.org/0000-0002-9663-6577
                https://orcid.org/0000-0002-5689-0343
                Article
                200905
                10.1148/radiol.2020200905
                7233473
                32191588
                5f74f569-ffdf-4b64-ac39-fa4a06d1299a
                2020 by the Radiological Society of North America, Inc.

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                Categories
                Original Research
                Thoracic Imaging

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