Radiological Society of North America (RSNA) Expert Consensus Statement Related to Chest CT Findings in COVID-19 Versus CO-RADS: Comparison of Reporting System Performance Among Chest Radiologists and End-User Preference

Abstract

Purpose: The RSNA expert consensus statement and CO-RADS reporting system assist radiologists in describing lung imaging findings in a standardized manner in patients under investigation for COVID-19 pneumonia and provide clarity in communication with other healthcare providers. We aim to compare diagnostic performance and inter-/intra-observer among chest radiologists in the interpretation of RSNA and CO-RADS reporting systems and assess clinician preference. Methods: Chest CT scans of 279 patients with suspected COVID-19 who underwent RT-PCR testing were retrospectively and independently examined by 3 chest radiologists who assigned interpretation according to the RSNA and CO-RADS reporting systems. Inter-/intra-observer analysis was performed. Diagnostic accuracy of both reporting systems was calculated. 60 clinicians participated in a survey to assess end-user preference of the reporting systems. Results: Both systems demonstrated almost perfect inter-observer agreement (Fleiss kappa 0.871, P < 0.0001 for RSNA; 0.876, P < 0.0001 for CO-RADS impressions). Intra-observer agreement between the 2 scoring systems using the equivalent categories was almost perfect (Fleiss kappa 0.90-0.92, P < 0.001). Positive predictive values were high, 0.798-0.818 for RSNA and 0.891-0.903 CO-RADS. Negative predictive value were similar, 0.573-0.585 for RSNA and 0.573-0.58 for CO-RADS. Specificity differed between the 2 systems, 68-73% for CO-RADS and 52-58% for RSNA with superior specificity of CO-RADS. Of 60 survey participants, the majority preferred the RSNA reporting system rather than CO-RADS for all options provided (66.7-76.7%; P < 0.05). Conclusions: RSNA and CO-RADS reporting systems are consistent and reproducible with near perfect inter-/intra-observer agreement and excellent positive predictive value. End-users preferred the reporting language in the RSNA system.

Coronavirus Disease 2019 in Children

“…Given that chest CT findings of COVID-19 are not pathognomonic in children, it is use in this population has been questioned. The American College of Radiology currently recommends against using CT as a first line screening test to diagnose COVID-19 and states that chest CT should be reserved for symptomatic hospitalized adults and children with specific clinical indications (117). The International Expert Consensus Statement on Chest Imaging in Pediatric COVID-19 Patient Management does not recommend using CT as the initial diagnostic test in children with suspected disease (115).…”

Diagnostic performance of the RSNA-proposed classification for COVID-19 pneumonia versus pre-pandemic controls

“…The RSNA classification system for reporting COVID-19 pneumonia classified chest CT findings into four categories (negative, atypical, indeterminate, and typical; Table 2 ). Studies have shown its noteworthy diagnostic performance with specific diagnostic thresholds (indeterminate and typical), as well as moderate-to-substantial inter-reader agreement, mostly adopting the SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) test as the reference diagnostic standard 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 .…”

Radiological Imaging of Viral Pneumonia Cases Identified Before the COVİD-19 Pandemic Period and COVİD-19 Pneumonia Cases Comparison of Characteristics

“…5,6 It has been reported that CT cannot be used as a screening test, since the positive predictive value of thoracic CT in the diagnosis of COVID-19 is 92% high while the negative predictive value is 42% 7 and the absence of CT findings in the early phase of the disease should not exclude the possibility of COVID-19 disease. 2,8 Clinical It has been reported that the combination of repetitive RT-PCR test and thoracic CT examination is beneficial in cases with suspected COVID-19. 9…”