Chest computed tomography of suspected COVID-19 pneumonia in the Emergency Department: comparative analysis between patients with different vaccination status

Luca Alessandro Carbonaro; Francesca Braga; Pietro Gemma; Eleonora Carlicchi; Annamaria Pata; Martina Conca; Francesco Rizzetto; Angelo Vanzulli

doi:10.5114/pjr.2023.125010

Chest computed tomography of suspected COVID-19 pneumonia in the Emergency Department: comparative analysis between patients with different vaccination status

Pol J Radiol. 2023 Feb 6:88:e80-e88. doi: 10.5114/pjr.2023.125010. eCollection 2023.

Authors

Luca Alessandro Carbonaro^{1

2}, Francesca Braga³, Pietro Gemma^{1

4}, Eleonora Carlicchi^{1

4}, Annamaria Pata^{1

4}, Martina Conca^{1

4}, Francesco Rizzetto^{1

4}, Angelo Vanzulli^{1

2}

Affiliations

¹ Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
² Department of Oncology and Haemato-oncology, University of Milan, Milan, Italy.
³ Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy.
⁴ Postgraduation School of Diagnostic and Interventional Radiology, University of Milan, Milan, Italy.

Abstract

Purpose: To identify differences in chest computed tomography (CT) of the symptomatic coronavirus disease 2019 (COVID-19) population according to the patients' severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination status (non-vaccinated, vaccinated with incomplete or complete vaccination cycle).

Material and methods: CT examinations performed in the Emergency Department (ED) in May-November 2021 for suspected COVID-19 pneumonia with a positive SARS-CoV-2 test were retrospectively included. Personal data were compared for vaccination status. One 13-year experienced radiologist and two 4th-year radiology residents independently evaluated chest CT scans according to CO-RADS and ACR COVID classifications. In possible COVID-19 pneumonia cases, defined as CO-RADS 3 to 5 (ACR indeterminate and typical) by each reader, high involvement CT score (≥ 25%) and CT patterns (presence of ground glass opacities, consolidations, crazy paving areas) were compared for vaccination status.

Results: 184 patients with known vaccination status were included in the analysis: 111 non-vaccinated (60%) for SARS-CoV-2 infection, 21 (11%) with an incomplete vaccination cycle, and 52 (28%) with a complete vaccination cycle (6 different vaccine types). Multivariate logistic regression showed that the only factor predicting the absence of pneumonia (CO-RADS 1 and ACR negative cases) for the 3 readers was a complete vaccination cycle (OR = 12.8-13.1compared to non-vaccinated patients, p ≤ 0.032). Neither CT score nor CT patterns of possible COVID-19 pneumonia showed any statistically significant correlation with vaccination status for the 3 readers.

Conclusions: Symptomatic SARS-CoV-2-infected patients with a complete vaccination cycle had much higher odds of showing a negative CT chest examination in ED compared to non-vaccinated patients. Neither CT involvement nor CT patterns of interstitial pneumonia showed differences across different vaccination status.

Keywords: COVID-19; SARS-CoV-2; computed tomography; pneumonia; vaccination.