Diagnostic Performance and Reproducibility of the Radiological Society of North America Expert Consensus Statement on COVID-19 Pneumonia

Abstract

Aim: To investigate the interobserver and intraobserver agreement and performance of the Radiological Society of North America Expert agreement declaration in assessing chest computed tomography (CT) findings related to new COVID-19 pneumonia. Materials and Methods: In this retrospective study, conducted from March 15 to April 1, 2020, 113 patients with suspected COVID-19 infection were enrolled. All patients underwent investigation using real-time reverse transcription polymerase chain reaction (RT-PCR) and chest CT scans. Chest CT features were categorized by three radiologists following the North American Consensus Statement. Characteristic and indeterminate features were considered as Group A, while atypical and negative features were considered as Group B. The interobserver and intraobserver agreement of the imaging features were evaluated, along with the sensitivity and specificity of the consensus statement. Results: The study population comprised 113 consecutive patients. Out of the 113 patients, 61 tested positive for RT-PCR. Group A (categories 3 and 4) consisted of 89 patients, while Group B (categories 1 and 2) included 24 patients. The ICC score for intraobserver and interobserver agreement was 0.996 (95% CI) and 0.971 (95% CI), respectively. Using RT-PCR as a reference standard, the sensitivity, specificity, negative predictive value, and positive predictive value of CT findings (group A, B) for COVID-19 pneumonia were 82%, 25%, 56.1%, and 54.1%, respectively. Conclusion: The expert agreement declaration on reporting new COVID-19 pneumonia tomography findings is a well-designed, reliable, and reproducible standardized CT reporting language. It demonstrates excellent intra- and interobserver agreement.

Keywords

• Coronavirus disease-2019
• Pneumonia
• Computed Tomography
• Real-Time Reverse Transcription Polymerase Chain Reaction

COVID-19 Pnömonisine İlişkin Kuzey Amerika Radyoloji Derneği Uzman Konsensusunun Tanısal Performansı

Abstract

Amaç: COVID-19 pnömonisinde gözlenen toraks bilgisayarlı tomografi (BT) bulgularının değerlendirilmesinde Kuzey Amerika Radyoloji Derneği Uzman Anlaşması beyanının gözlemciler arası ve gözlemci içi uyumunu ve performansını araştırmayı amaçladık. Gereç ve Yöntemler: 15 Mart - 1 Nisan 2020 tarihleri arasında yürütülen bu retrospektif çalışmaya COVID-19 enfeksiyonu şüphesi olan 113 hasta dahil edildi. Tüm hastalara real time reverse transkriptaz polimeraz zincir reaksiyonu (RT-PCR) ve toraks BT incelemesi yapıldı. Toraks BT özellikleri Kuzey Amerika Uzlaşı Beyannamesine göre üç radyolog tarafından kategorize edildi. Karakteristik ve intermediate özellikler A grubu olarak kabul edildi. Atipik ve negatif özellikler B grubu olarak kabul edildi. Görüntüleme özelliklerinin gözlemciler arası ve gözlemci içi uyumu konsensüs ifadesinin duyarlılığı ve özgüllüğü ile birlikte değerlendirildi. Bulgular: Çalışma popülasyonu 113 ardışık hastadan oluşmaktadır. 113 hastanın 61’i RT-PCR pozitifti. Grup A (kategori 3+4) 89 hastadan ve grup B (kategori 1+2) 24 hastadan oluşuyordu. Gözlemci içi ve gözlemciler arası uyum için skoru sırasıyla 0.996 (%95 CI) ve 0.971 (%95 CI) idi. Referans standart olarak RT-PCR kullanıldığında, BT bulgularının (grup A, B) COVID-19 pnömonisi için duyarlılık, özgüllük, negatif ve pozitif prediktif değerleri sırasıyla %82, %25, %56.1 ve %54.1 idi. Sonuç: Yeni COVID-19 pnömonisi tomografi bulgularının raporlanmasına ilişkin uzman anlaşması beyanı, iyi tasarlanmış, güvenilir ve tekrarlanabilir standart raporlama dilidir ve gözlemciler arası ve gözlemci içi mükemmel bir uyum gösterir.

Keywords

• Koronavirüs Hastalığı-2019
• Pnömoni
• Bilgisayarlı Tomografi
• Polimeraz Zincir Reaksiyonu

References

1. Rubin GD, Ryerson CJ, Haramati LB, Sverzellati N, Kanne JP, Raoof S et al. The role of chest imaging in patient management during the COVID-19 Pandemic: A Multinational Consensus Statement from the Fleischner Society. Radiology. 2020 J2020;296(1):172-180. doi: 10.1148/radiol.2020201365
2. Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19). Radiology. 2020;295(3):715-721. doi: 10.1148/ radiol.2020200370.
3. Bai HX, Hsieh B, Xiong Z, Halsey K, Choi JW, Tran TML, et al. Performance of radiologists in differentiating COVID-19 from Non-COVID-19 Viral pneumonia at Chest CT. Radiology. 2020;296(2):46-54. doi: 10.1148/radiol.2020200823
4. Pan Y, Guan H, Zhou S, Wang Y, Li Q, Zhu T, et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol. 2020;30(6):3306-3309. doi: 10.1007/ s00330-020-06731-x.
5. Simpson S, Kay FU, Abbara S, Bhalla S , Chung JH, Chung M, et al. Radiological Society of North America expert consensus statement on reporting chest CT findings related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA - Secondary Publication. J Thorac Imaging. 2020;35(4):219-227. doi: 10.1097/RTI.0000000000000524.
6. Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, et al. Zhongnan Hospital of Wuhan University novel coronavirus management and research team, evidence-based medicine chapter of China International Exchange and Promotive Association for Medical and Health Care (CPAM). A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res. 2020;7(1):4. doi: 10.1186/s40779-020-0233-6.
7. Li Y, Xia L. Coronavirus Disease 2019 (COVID-19): Role of chest CT in diagnosis and management. Am J Roentgenol 2020; 214(6):1280-1286.
8. Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of Chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology 2020; 296:32–40.

9. Bao C, Liu X, Zhang H, Li Y, Liu J. COVID-19 computed tomography findings: a systematic review and meta-analysis. J Am Coll Radiol 2020; 17(6):701-709.
10. Wen Z, Chi Y, Zhang L, Liu H, Du K, Li Z, et al. Coronavirus Disease 2019: Initial detection on chest CT in a retrospective multicenter study of 103 chinese subjects. Radiology Cardiothoracic Imaging 2020; 2(2):e200092.
11. Inui S, Fujikawa A, Jitsu M, Kunishima N, Watanabe S, Suzuki Y, et al. Chest CT findings in cases from the cruise ship “diamond princess” with coronavirus disease 2019 (COVID-19). Radiology Cardiothoracic Imaging 2020; 2(2):e200110.
12. Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, Ji W. Sensitivity of Chest CT for COVID19: Comparison to RT-PCR. Radiology 2020; 296:115-117.
13. Byrne D,O’Neill SB, Muller NL, Muller IS, Walsh JP, et al. RSNA Expert consensus statement on reporting chest CT findings related to COVID-19: Interobserver agreement between chest radiologists. Canadian Association of Radiologists’ Journal. 2020; 0846537120938328.