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

Abstract

Objective: To meta-analyze diagnostic performance measures of standardized typical CT findings for COVID-19 and examine these measures by region and national income.

Methods: MEDLINE and Embase were searched from January 2020 to April 2022 for diagnostic studies using the Radiological Society of North America (RSNA) classification or the COVID-19 Reporting and Data System (CO-RADS) for COVID-19. Patient and study characteristics were extracted. We pooled the diagnostic performance of typical CT findings in the RSNA and CO-RADS systems and interobserver agreement. Meta-regression was performed to examine the effect of potential explanatory factors on the diagnostic performance of the typical CT findings.

Results: We included 42 diagnostic performance studies with 6777 PCR-positive and 9955 PCR-negative patients from 18 developing and 24 developed countries covering the Americas, Europe, Asia, and Africa. The pooled sensitivity was 70% (95% confidence interval [CI]: 65%, 74%; I² = 92%), and the pooled specificity was 90% (95% CI 86%, 93%; I² = 94%) for the typical CT findings of COVID-19. The sensitivity and specificity of the typical CT findings did not differ significantly by national income and the region of the study (p > 0.1, respectively). The pooled interobserver agreement from 19 studies was 0.72 (95% CI 0.63, 0.81; I² = 99%) for the typical CT findings and 0.67 (95% CI 0.61, 0.74; I² = 99%) for the overall CT classifications.

Conclusion: The standardized typical CT findings for COVID-19 provided moderate sensitivity and high specificity globally, regardless of region and national income, and were highly reproducible between radiologists.

Critical relevance statement: Standardized typical CT findings for COVID-19 provided a reproducible high diagnostic accuracy globally.

Key points: Standardized typical CT findings for COVID-19 provide high sensitivity and specificity. Typical CT findings show high diagnosability regardless of region or income. The interobserver agreement for typical findings of COVID-19 is substantial.

Keywords: COVID-19; Lung; Meta-analysis; Pneumonia (viral); Tomography (X-Ray Computed).

Fig. 1

Flow diagram of study selection

Fig. 2

A Coupled forest plot for the diagnostic accuracy of typical CT findings. B Summary ROC curve in studies reporting both sensitivity and specificity

Fig. 3

Estimated predictive values of typical CT findings and rapid antigen test (RAT). The black lines indicate predictive values and 95% confidence intervals for RAT, and the blue lines indicate predictive values and 95% confidence intervals for typical CT findings. Square indicates summary points of sensitivity and specificity, and solid black curvilinear line passing through summary point is the estimated summary ROC curve. Black dashed line and blue dashed line represent 95% confidence region and prediction region respectively. *Proportion of prediction region to area under ROC curve = 35.8%