Chest CT accuracy in diagnosing COVID-19 during the peak of the Italian epidemic: A retrospective correlation with RT-PCR testing and analysis of discordant cases

•In our experience chest CT had a significantly higher specificity and accuracy in detecting COVID-19 pneumonia than previously reported.•Chest CT and RT-PCR positive rates were 485/773 (62.7 %) and 462/773 (59.7 %), respectively.•CT sensitivity and specificity for COVID 19 with RT-PCR as reference were 90.7 % and 78.8 % respectively.•CT PPV, NPV and accuracy were 86.4 %, 85.1 % and 85.9 % respectively. The goal of this study was to assess chest computed tomography (CT) diagnostic accuracy in clinical practice using RT-PCR as standard of reference. From March 4th to April 9th 2020, during the peak of the Italian COVID-19 epidemic, we enrolled a series of 773 patients that performed both non-contrast chest CT and RT-PCR with a time interval no longer than a week due to suspected SARS-CoV-2 infection. The diagnostic performance of CT was evaluated according to sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy, considering RT-PCR as the reference standard. An analysis on the patients with discrepant CT scan and RT-PCR result and on the patient with both negative tests was performed. RT-PCR testing showed an overall positive rate of 59.8 %. CT sensitivity, specificity, PPV, NPV, and accuracy for SARS-CoV-2 infection were 90.7 % [95 % IC, 87.7%–93.2%], 78.8 % [95 % IC, 73.8−83.2%], 86.4 % [95 % IC, 76.1 %–88.9 %], 85.1 % [95 % IC, 81.0 %–88.4] and 85.9 % [95 % IC 83.2−88.3%], respectively. Twenty-five/66 (37.6 %) patients with positive CT and negative RT-PCR results and 12/245 (4.9 %) patients with both negative tests were nevertheless judged as positive cases by the clinicians based on clinical and epidemiological criteria and consequently treated. In our experience, in a context of high pre-test probability, CT scan shows good sensitivity and a consistently higher specificity for the diagnosis of COVID-19 pneumonia than what reported by previous studies, especially when clinical and epidemiological features are taken into account.