Comparison of dark-field chest radiography and CT for the assessment of COVID-19 pneumonia

Background: Dark-field chest radiography allows the assessment of the structural integrity of the alveoli by exploiting the wave properties of x-rays. Purpose: To compare the qualitative and quantitative features of dark-field chest radiography in patients with COVID-19 pneumonia with conventional CT imaging. Materials and methods: In this prospective study conducted from May 2020 to December 2020, patients aged at least 18 years who underwent chest CT for clinically suspected COVID-19 infection were screened for participation. Inclusion criteria were a CO-RADS score ≥4, the ability to consent to the procedure and to stand upright without help. Participants were examined with a clinical dark-field chest radiography prototype. For comparison, a healthy control cohort of 40 subjects was evaluated. Using Spearman's correlation coefficient, correlation was tested between dark-field coefficient and CT-based COVID-19 index and visual total CT score as well as between the visual total dark-field score and the visual total CT score. Results: A total of 98 participants [mean age 58 ± 14 (standard deviation) years; 59 men] were studied. The areas of signal intensity reduction observed in dark-field images showed a strong correlation with infiltrates identified on CT scans. The dark-field coefficient had a negative correlation with both the quantitative CT-based COVID-19 index (r = −.34, p =.001) and the overall CT score used for visual grading of COVID-19 severity (r = −.44, p <.001). The total visual dark-field score for the presence of COVID-19 was positively correlated to the total CT score for visual COVID-19 severity grading (r =.85, p <.001). Conclusion: COVID-19 pneumonia-induced signal intensity losses in dark-field chest radiographs are consistent with CT-based findings, showing the technique's potential for COVID-19 assessment.