Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb;72(1):159-166.
doi: 10.1177/0846537120938328. Epub 2020 Jul 2.

RSNA Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19: Interobserver Agreement Between Chest Radiologists

Danielle Byrne  1   2 , Siobhan B O' Neill  1   2 , Nestor L Müller  1   2 , C Isabela Silva Müller  3 , John P Walsh  1   2 , Sabeena Jalal  1 , William Parker  1   2 , Ana-Maria Bilawich  1   2 , Savvas Nicolaou  1   2
Affiliations

RSNA Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19: Interobserver Agreement Between Chest Radiologists

Danielle Byrne et al. Can Assoc Radiol J. 2021 Feb.

Abstract
in English, French

Purpose: To assess the interobserver variability between chest radiologists in the interpretation of the Radiological Society of North America (RSNA) expert consensus statement reporting guidelines in patients with suspected coronavirus disease 2019 (COVID-19) pneumonia in a setting with limited reverse transcription polymerase chain reaction testing availability.

Methods: Chest computed tomography (CT) studies in 303 consecutive patients with suspected COVID-19 were reviewed by 3 fellowship-trained chest radiologists. Cases were assigned an impression of typical, indeterminate, atypical, or negative for COVID-19 pneumonia according to the RSNA expert consensus statement reporting guidelines, and interobserver analysis was performed. Objective CT features associated with COVID-19 pneumonia and distribution of findings were recorded.

Results: The Fleiss kappa for all observers was almost perfect for typical (0.815), atypical (0.806), and negative (0.962) COVID-19 appearances (P < .0001) and substantial (0.636) for indeterminate COVID-19 appearance (P < .0001). Using Cramer V analysis, there were very strong correlations between all radiologists' interpretations, statistically significant for all (typical, indeterminate, atypical, and negative) COVID-19 appearances (P < .001). Objective CT imaging findings were recorded in similar percentages of typical cases by all observers.

Conclusion: The RSNA expert consensus statement on reporting chest CT findings related to COVID-19 demonstrates substantial to almost perfect interobserver agreement among chest radiologists in a relatively large cohort of patients with clinically suspected COVID-19. It therefore serves as a reliable reference framework for radiologists to accurately communicate their level of suspicion based on the presence of evidence-based objective findings.

Objectif:: Évaluer la variabilité inter-observateurs entre radiologistes thoraciques concernant les lignes directrices de la déclaration de consensus d’experts de la Radiological Society of North America (RSNA) pour le signalement des patients ayant une pneumonie COVID-19 suspectée dans un établissement où la disponibilité des tests de dépistage par rt-PCR est limitée.

Méthodes:: Des études de tomodensitométries (TDM) thoraciques effectuées chez 303 patients consécutifs suspects de COVID-19 ont été analysées par 3 radiologistes thoraciques formés dans le cadre d’un fellowship. Chaque cas a été classé selon sa forme (typique, indéterminé, atypique ou négatif) pour la pneumonie COVID-19 en suivant les lignes directrices pour leur signalement tirées de la déclaration de consensus d’experts de la RSNA; une analyse inter-observateurs a ensuite été effectuée. Les caractéristiques objectives des TDM associées à la pneumonie COVID-19 et la répartition des constatations ont été consignées.

Résultats:: Le kappa de Fleiss pour tous les observateurs a été presque parfait pour toutes les formes typiques (0,815), atypiques (0,806) et négatives (0,962) de COVID-19 (P < 0,0001) et substantiel (0,636) pour les formes indéterminées de COVID-19 (P < 0,0001). L’analyse V de Cramer a montré de très fortes corrélations entre toutes les interprétations des radiologistes, avec une signification statistique pour toutes les formes (typiques, indéterminées, atypiques et négatives) de COVID-19 (P < 0,001). Les constatations objectives à l’imagerie par TDM ont été consignées avec des pourcentages semblables de cas typiques par tous les observateurs.

Conclusion:: La déclaration de consensus d’experts de la RSNA pour le signalement des constatations à la TDM thoracique en rapport avec la COVID-19 démontre une concordance substantielle à presque parfaite entre les radiologistes thoraciques dans une cohorte relativement importante de patients ayant une infection COVID-19 suspectée cliniquement. Il s’agit donc d’un cadre de référence fiable permettant aux radiologistes de communiquer avec exactitude leur niveau de soupçon en se basant sur la présence d’éléments objectifs reposant sur des données probantes.

Keywords: 2019n-CoV; COVID-19; CT; lung diseases; pneumonia.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Bilateral posterior and peripheral predominant ground-glass opacities in (A) (short arrows), with a slightly more rounded appearance in (B) (short arrows).
Figure 2.
Figure 2.
Examples of bilateral peripheral posterior predominant consolidation with perilobular morphology consistent with organizing pneumonia reaction pattern. Examples of perilobular arcades are demonstrated in (A) (short arrows) and areas of subpleural sparing in (B) (arrowheads). Magnified image of perilobular arcades demonstrated in (C).
Figure 3.
Figure 3.
Examples of rounded peribronchovascular ground-glass opacities, slightly ill-defined in (A) and (B) (short arrows) and more confluent and well demarcated in (C) (long arrows).
Figure 4.
Figure 4.
Spectrum of ground-glass opacities with peripheral predominance in (A) and (B) (short arrows).
Figure 5.
Figure 5.
Spectrum of organizing pneumonia reaction pattern (short arrows) ranging from mild in (A), with peripheral crescentic, perilobular consolidation and central ground glass consistent with the “reverse halo” sign (long arrow) demonstrated in the left lower lobe in (B) and parenchymal distortion demonstrated in (C) and (D).
Figure 6.
Figure 6.
Examples of peripheral predominant ground-glass opacities with superimposed intralobular and interlobular septal thickening (short arrows) consistent with crazy paving (A-C). D, Magnified image of the left lung in (C) more clearly demonstrates intralobular and interlobular septal thickening (long arrow) superimposed on peripheral ground-glass opacification (arrowhead).
See this image and copyright information in PMC

References

    1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. - PMC - PubMed
    1. World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19—11 March 2020. Published 2020 https://www.who.int/dg/speeches/detail/who-director-general-s-opening-re.... Accessed May 14, 2020.
    1. World Health Organization. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). February 16-24, 2020 ed: World Health Organization; 2020.
    1. World Health Organization. Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases. 2020. Accessed May 14, 2020.
    1. Udugama B, Kadhiresan P, Kozlowski HN, et al. Diagnosing COVID-19: the disease and tools for detection. ACS Nano. 2020;14(4):3822–3835. - PubMed