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. 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.

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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.