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 Jan;36(1):31-36.
doi: 10.1097/RTI.0000000000000563.

Performance of Chest Computed Tomography in Differentiating Coronavirus Disease 2019 From Other Viral Infections Using a Standardized Classification

Gustavo Borges da Silva Teles  1   2 , Eduardo Kaiser Ururahy Nunes Fonseca  1   3 , Patricia Yokoo  1 , Murilo Marques Almeida Silva  1 , Elaine Yanata  1 , Hamilton Shoji  1   4 , Rodrigo Bastos Duarte Passos  1 , Rodrigo Caruso Chate  1   3 , Gilberto Szarf  1   5
Affiliations

Performance of Chest Computed Tomography in Differentiating Coronavirus Disease 2019 From Other Viral Infections Using a Standardized Classification

Gustavo Borges da Silva Teles et al. J Thorac Imaging. 2021 Jan.

Abstract

Background: An expert consensus recently proposed a standardized coronavirus disease 2019 (COVID-19) reporting language for computed tomography (CT) findings of COVID-19 pneumonia.

Purpose: The purpose of the study was to evaluate the performance of CT in differentiating COVID-19 from other viral infections using a standardized reporting classification.

Methods: A total of 175 consecutive patients were retrospectively identified from a single tertiary-care medical center from March 15 to March 24, 2020, including 87 with positive reverse transcription-polymerase chain reaction (RT-PCR) test for COVID-19 and 88 with negative COVID-19 RT-PCR test, but positive respiratory pathogen panel. Two thoracic radiologists, who were blinded to RT-PCR and respiratory pathogen panel results, reviewed chest CT images independently and classified the imaging findings under 4 categories: "typical" appearance, "indeterminate," "atypical," and "negative" for pneumonia. The final classification was based on consensus between the readers.

Results: Patients with COVID-19 were older than patients with other viral infections (P=0.038). The inter-rater agreement of CT categories between the readers ranged from good to excellent, κ=0.80 (0.73 to 0.87). Final CT categories were statistically different among COVID-19 and non-COVID-19 groups (P<0.001). CT "typical" appearance was more prevalent in the COVID-19 group (64/87, 73.6%) than in the non-COVID-19 group (2/88, 2.3%). When considering CT "typical" appearance as a positive test, a sensitivity of 73.6% (95% confidence interval [CI]: 63%-82.4%), specificity of 97.7% (95% CI: 92%-99.7%), positive predictive value of 97% (95% CI: 89.5%-99.6%), and negative predictive value of 78.9% (95% CI: 70%-86.1%) were observed.

Conclusion: The standardized chest CT classification demonstrated high specificity and positive predictive value in differentiating COVID-19 from other viral infections when presenting a "typical" appearance in a high pretest probability environment. Good to excellent inter-rater agreement was found regarding the CT standardized categories between the readers.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Center for Disease Control and Prevention. Interim Guidelines of Collecting, Handling and Testing Clinical Specimens from Persons Under Investigation (PUIs) for Coronavirus Disease 2019 (COVID-19). 2020. Available at: https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specim... . Accessed April 14, 2020.
    1. Ai T, Yang Z, Hou H, et al. Correlation of chest CT and RT-PCR testing for coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology. 2020;296:E32–E40.
    1. Wen Z, Chi Y, Zhang L, et al. Coronavirus disease 2019: initial detection on chest CT in a retrospective multicenter study of 103 Chinese subjects. Radiol Cardiothorac Imaging. 2020;2:e200092.
    1. Fang Y, Zhang H, Xie J, et al. Sensitivity of chest CT for COVID-19: comparison to RT-PCR. Radiology. 2020;296:E115–E117.
    1. Xie X, Zhong Z, Zhao W, et al. Chest CT for typical coronavirus disease 2019 (COVID-19) Pneumonia: relationship to negative RT-PCR testing. Radiology. 2020;296:E41–E45.