Computed Tomography for COVID-19 Diagnosis

NCT ID: NCT04355507

Last Updated: 2020-12-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

10735 participants

Study Classification

OBSERVATIONAL

Study Start Date

2020-03-01

Study Completion Date

2020-10-16

Brief Summary

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The purpose of this study is to build a large dataset of Computed Tomography (CT) images for identification of accurate CT criteria and development of deep learning-based solutions for diagnosis, quantification and prognostic estimation.

Detailed Description

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The outbreak of the novel coronavirus SARS-CoV-2, initially epicentred in China and responsible for COVID-19 pneumonia has now spread to France, with 7730 confirmed cases and 175 deaths as on March 17th. Diagnosis relies on the identification of viral RNA by reverse-transcription polymerase chain reaction (RT-PCR), but its positivity can be delayed. A series based on 1014 chinese patients reported higher sensitivity for CT, with a mean interval time between the initial negative to positive RT-PCR results of 5.1 ± 1.5 days (PMID: 32101510). Moreover, obtaining RT-PCR results requires several hours, which is problematic for patients triage.

Chest CT can allow early depiction of COVID-19, especially when performed more than 3 days after symptoms onset. It is important to distinguish between COVID-19 and bacterial causes of pulmonary infection, which requires expertise in thoracic imaging. Thus, it is important to identify reliable CT diagnostic criteria based on visual assessment, and also develop deep-learning based solutions for early positive diagnosis which could be used by less experienced readers, in a context of large epidemic.

Several risk factors for poor outcome are already identified, such as older age, comorbidities, or an elevated d-dimer level at presentation (PMID: 32171076). Extensive CT abnormalities are linked to poor outcome, but some patients secondarily worsen despite non extensive abnormalities at first assessment, highlighting the need for worsening prediction based on initial imaging findings. Lastly, there is currently no drug with a proven efficacy for patients with acute respiratory distress syndrome, who for management relies on mechanical ventilation and supportive care. Some hypothesized that Remdesivir, an antiviral therapy could be effective (PMID: 32147516), with ongoing randomized trials conducted in China and the US. Automated tools allowing quantifying the disease extent on CT would be desirable in order to evaluate the efficacy of new treatments.

Building a large dataset of CT images is needed for identification of accurate CT criteria and development of deep learning-based solutions for diagnosis, quantification and prognostic estimation.

The aim of this project is three fold: (i) create a multi-centric open database repository on CT scans relative to COVID-19, (ii) create a multi-expert annotation protocol with different level of annotations depicting the severity of the disease, (iii) allow the development of non-proprietary computer aided solutions (academia \& industry) for automatic quantification of the diseases and prognosis through the use of the latest advances in the field of artificial intelligence.

For patients, the validation of reliable diagnostic criteria will allow early detection of the disease, and better distinction with other potential cause of acute respiratory symptoms, requiring a specific treatment, such as bacterial bronchopneumonia. It will contribute to a standardization of care as well as an equal access to diagnosis and treatment for the ensemble of the population.

Public health benefit will be an access to CT diagnosis of COVID-19 independently from the availability of local expertise in thoracic imaging. The possibility to anticipate the need for ventilation, based on the developed CT severity scores, will also positively impact the management of patients in particular in the context of a massive flow of patients as expected at the epidemic peak. This project will allow evaluating the proportion of patients likely to present respiratory sequelae, based on the severity and extent of lung abnormalities at the acute phase of the disease.

The availability of automated quantification tools will help evaluating treatment efficacy if new therapeutic approaches are developed.

Lastly, the developed tools for early diagnosis, evaluation of severity and prediction of outcomes could prove useful if other viral pandemic occurs in the future. Indeed SARS-Cov2 outbreak has been preceded by SARS and MERS outbreaks due to other coronavirus.

Conditions

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COVID-19

Keywords

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Computed Tomography (CT) COVID-19 Artificial intelligence Deep Learning

Study Design

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Observational Model Type

COHORT

Study Time Perspective

RETROSPECTIVE

Study Groups

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Patients with suspicions of COVID-19 pneumonia

Patients with suspicions of COVID-19 pneumonia

Chest computed tomography (CT)

Intervention Type DIAGNOSTIC_TEST

Chest computed tomography (CT) examination

Reverse-transcription polymerase chain reaction (RT-PCR)

Intervention Type DIAGNOSTIC_TEST

Identification of viral RNA by reverse-transcription polymerase chain reaction

Interventions

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Chest computed tomography (CT)

Chest computed tomography (CT) examination

Intervention Type DIAGNOSTIC_TEST

Reverse-transcription polymerase chain reaction (RT-PCR)

Identification of viral RNA by reverse-transcription polymerase chain reaction

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

* Age\>18 years
* CT examination performed for suspicion or follow-up of COVID-19
* Non opposition for use of data

Exclusion Criteria

* Unavailability of RT-PCR results for SARS-Cov-2
* Failure of CT image anonymized export
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Institut National de la Santé Et de la Recherche Médicale, France

OTHER_GOV

Sponsor Role collaborator

GE Healthcare

INDUSTRY

Sponsor Role collaborator

Orange healthcare

UNKNOWN

Sponsor Role collaborator

TheraPanacea

UNKNOWN

Sponsor Role collaborator

Assistance Publique - Hôpitaux de Paris

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Marie-Pierre REVEL, MD,PhD

Role: PRINCIPAL_INVESTIGATOR

Assistance Publique - Hôpitaux de Paris

Locations

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Cochin Hospital

Paris, , France

Site Status

Countries

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France

References

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Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, Tao Q, Sun Z, Xia L. Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020 Aug;296(2):E32-E40. doi: 10.1148/radiol.2020200642. Epub 2020 Feb 26.

Reference Type BACKGROUND
PMID: 32101510 (View on PubMed)

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-1062. doi: 10.1016/S0140-6736(20)30566-3. Epub 2020 Mar 11.

Reference Type BACKGROUND
PMID: 32171076 (View on PubMed)

Ko WC, Rolain JM, Lee NY, Chen PL, Huang CT, Lee PI, Hsueh PR. Arguments in favour of remdesivir for treating SARS-CoV-2 infections. Int J Antimicrob Agents. 2020 Apr;55(4):105933. doi: 10.1016/j.ijantimicag.2020.105933. Epub 2020 Mar 6. No abstract available.

Reference Type BACKGROUND
PMID: 32147516 (View on PubMed)

Revel MP, Boussouar S, de Margerie-Mellon C, Saab I, Lapotre T, Mompoint D, Chassagnon G, Milon A, Lederlin M, Bennani S, Moliere S, Debray MP, Bompard F, Dangeard S, Hani C, Ohana M, Bommart S, Jalaber C, El Hajjam M, Petit I, Fournier L, Khalil A, Brillet PY, Bellin MF, Redheuil A, Rocher L, Bousson V, Rousset P, Gregory J, Deux JF, Dion E, Valeyre D, Porcher R, Jilet L, Abdoul H. Study of Thoracic CT in COVID-19: The STOIC Project. Radiology. 2021 Oct;301(1):E361-E370. doi: 10.1148/radiol.2021210384. Epub 2021 Jun 29.

Reference Type DERIVED
PMID: 34184935 (View on PubMed)

Other Identifiers

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APHP200434

Identifier Type: -

Identifier Source: org_study_id