Abstract
Objectives:Both Reporting and Data System (CO-RADS) and CT-involvement scores (CTIS) have been proposed for evaluation of COVID-19 on chest CT. The purpose of this single-center, retrospective study was to evaluate both scoring systems to diagnose COVID-19 infection in a high-prevalence area.Materials and Methods:Chest CT datasets (n = 200) and available reverse transcription polymerase chain reaction (RT-PCR) on nasopharyngeal swab were included. CT scans were assigned to four ‘imaging groups’ after scoring for both CO-RADS and CTIS. Diagnostic accuracy of chest CT was calculated respectively using RT-PCR and clinical diagnosis as gold standards: False-negatives and false-positives of chest CT regarding RT-PCR were studied in more depth using the medical files.Results:The ‘imaging group’ including CO-RADS 4/5 scores reached the highest diagnostic values for COVID-19 considering either the initial RT-PCR or the final clinical diagnosis as the standard of reference: accuracies of 172/200 (86%) to 181/200 (90.5%), sensitivities of 60/80 (88.2%) to 70/79 (88.6%), specificities of 112/132 (84.9%) to 111/121 (91.7%), negative predictive values (NPV) of 112/120 (93.3%) to 111/120 (92.5%), respectively. False-negative CTs regarding RT-PCR were mainly explained by imaging very early in the disease course (5 out of 8 cases) or COVID-19 infection with no/minor respiratory symptoms (3 out of 8 cases).Conclusion:Assessing chest CT using CO-RADS is a valuable diagnostic approach for COVID-19 infection in a high-prevalence area, with a higher accuracy than CTIS.
Highlights
Coronavirus disease 19 (COVID-19) swiftly spread from Wuhan, China, to other Asian countries, Europe, Northern America, and globally [1, 2]
The radiological community recognized the potential of chest CT to diagnose COVID-19, as COVID-19 infection with pulmonary involvement resulted in typical changes of lung parenchyma such as ground glass opacities with a peripherally distribution in multiple lobes. [9,10,11]
The primary goal of this single-center, retrospective study is to evaluate the accuracy of chest CT to detect COVID-19 using respectively COVID-19 Reporting and Data System (CO-RADS) and CT involvement scores (CTIS) and to see if these scores can be used for the diagnosis of COVID-19 infection
Summary
Coronavirus disease 19 (COVID-19) swiftly spread from Wuhan, China, to other Asian countries, Europe, Northern America, and globally [1, 2]. A reverse transcription polymerase chain reaction (RT-PCR) lab test on nasopharyngeal swab was quickly developed and gained widespread use [3, 4]. This test was reported to have very high specificity but relatively lower sensitivity, with clinical case review resulting in 11–25% false negative results [5,6,7,8]. The Dutch Radiological Society developed the COVID-19 Reporting and Data System (CO-RADS), which is a categorical assessment scheme on chest CT, from 1 (very low) to 5 (very high) of the likelihood for COVID-19 infection in patients with moderate to severe symptoms [12]. The primary goal of this single-center, retrospective study is to evaluate the accuracy of chest CT to detect COVID-19 using respectively CO-RADS and CTIS and to see if these scores can be used for the diagnosis of COVID-19 infection
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