Diagnosis of the coronavirus disease 2019 with chest computed tomography: A retrospective inter-observer agreement study between radiologists and clinicians

Abstract

Background: Effective triage and early detection are very important for the control and treatment of coronavirus disease 2019. For this purpose, reverse transcription polymerase chain reaction and chest computed tomography are used in emergency departments. Objective: The aim of the study was to examine the diagnostic performance of computed tomography and to compare the inter-observer agreement among radiologists and between clinicians, in a coronavirus disease 2019 pneumonia high-prevalence area. Methods: After exclusions, 534 patients were retrospectively included in this study. Reverse transcription polymerase chain reaction was considered as gold standard for diagnosis. All computed tomography images were independently reviewed by two radiologists who were blinded to reverse transcription polymerase chain reaction results and other clinical information. Each computed tomography scan was scored in four categories as typical, intermediate, atypical, and negative, regarding coronavirus disease 2019 pneumonia according to Radiological Society of North America guideline. As for the evaluation of the diagnostic performance, typical and intermediate appearances were accepted as positive for coronavirus disease 2019. In addition, the computed tomography scans were scored by two clinicians as coronavirus disease 2019 positive and negative. Results: The study group included 534 patients after the exclusion criteria. As a result of the repeated reverse transcription polymerase chain reaction tests, 396 (74%) patients were diagnosed with coronavirus disease 2019, 138 (26%) patients had a negative result and were evaluated as a control group. When the reverse transcription polymerase chain reaction results were referenced as the gold standard; the accuracy rates of radiologists and clinicians (R1, R2, C1, and C2) in the diagnosis of coronavirus disease 2019 were 78%, 79%, 73%, and 71%, their sensitivity rates were 83%, 83%, 74%, and 75%, and the negative predictive values were 57%, 58%, 49%, and 46%, respectively. Inter-observer agreements among the reviewers ranged from good to excellent. Conclusions: Radiological Society of North America guideline related to coronavirus disease 2019 has excellent inter-observer agreement among chest radiologists. In this study, radiologists and clinicians have presented similar and good diagnostic performances in the evaluation of coronavirus disease 2019–suspected patients with chest computed tomography in high-epidemic area.

Evaluation of Performance Between Thoracic Computed Tomography and Reverse Transcription- Polymerase Chain Reaction Test in Coronavirus Disease-19 Management

“…The optimum approach to the diagnosis of COVID-19 is the RT-PCR test (2,11), although the large number of samples being collected daily leads to delays in results, as a significant disadvantage of the approach. Furthermore, challenging for clinicians is the prevalence of false negative results as a result of the inappropriate collection and storage of samples (3,5,12). In countries such as ours with large populations, the use of thoracic CT to distinguish between those who should be hospitalized and those who should be discharged, as well as the appropriate treatment method, has increased to overcome the delays associated with the RT-PCR test.…”

“…The specificity of the test is high, while the reported sensitivity ranges from 60-70% to 95-97%. The appropriate collection of the sample from the patient and storage conditions affect the sensitivity of the test, and results may take up to 8-24 h to be delivered (2,3,5).…”

Diagnostic performance of standardized typical CT findings for COVID-19: a systematic review and meta-analysis

“…There were 18 studies from developing countries (4 studies from lower-middle-income and 14 studies from upper-middle-income countries) [ 18 , 19 , 22 , 23 , 30 – 32 , 35 , 37 , 38 , 43 – 45 , 47 , 48 , 50 , 51 , 58 ] and 24 studies from developed countries (high income) [ 9 , 20 , 21 , 24 – 29 , 33 , 34 , 36 , 39 – 42 , 46 , 49 , 52 – 57 ]. The included studies were predominantly from Europe (24 studies) [ 9 , 20 , 21 , 23 – 27 , 29 , 31 , 32 , 34 , 35 , 37 , 38 , 41 , 42 , 47 – 49 , 52 , 55 – 57 ], followed by the Americas (10 studies), Asia (seven studies), and Africa (one study). Nineteen studies for assessing the interobserver agreement are summarized in Additional file 1 : Table 1 .…”

Emergency medicine during COVID‐19: Global challenges and Asian solutions

“…Accurate diagnosis is another key element of ED response. While reverse transcription polymerase chain reaction test remains the gold standard of diagnosis, Cengel et al 12 showed that in high‐prevalence areas, computed tomography of thorax had an acceptable accuracy of diagnosing COVID‐19 infection and good inter‐observer agreement between radiologists and clinicians. In an observational study conducted on 42 COVID‐19 patients in the intensive care unit (ICU), Li et al 13 demonstrated that point‐of‐care lung ultrasound had a superior diagnostic performance in detecting adult respiratory distress syndrome compared with chest X‐ray, making it a useful bedside tool for physicians in the care of critically ill COVID‐19 patients.…”