Comparison of the CO-RADS and the RSNA chest CT classification system concerning sensitivity and reliability for the diagnosis of COVID-19 pneumonia

Mohamed Abdel-Tawab,Ali M Hendi,Mohamed M A Zaitoun,Waleed S Abo Shanab,Hamdy M Ibrahim,Saeed Bakry Elsayed,Ibrahim A I Mohamed,Hamada M Khater,Sameh Abdelaziz Aly,Mohammad Abd Alkhalik Basha,Walid Mosallam,Nader E M Mahmoud,Sayed Hassan,Ahmed A El Sammak,Hala Y Yousef

doi:10.1186/s13244-021-00998-4

Abstract

BackgroundThe Radiological Society of North America (RSNA) recently published a chest CT classification system and Dutch Association for Radiology has announced Coronavirus disease 2019 (COVID-19) reporting and data system (CO-RADS) to provide guidelines to radiologists who interpret chest CT images of patients with suspected COVID-19 pneumonia. This study aimed to compare CO-RADS and RSNA classification with respect to their sensitivity and reliability for diagnosis of COVID-19 pneumonia.ResultsA retrospective study assessed consecutive CT chest imaging of 359 COVID-19-positive patients. Three experienced radiologists who were aware of the final diagnosis of all patients, independently categorized each patient according to CO-RADS and RSNA classification. RT-PCR test performed within one week of chest CT scan was used as a reference standard for calculating sensitivity of each system. Kappa statistics and intraclass correlation coefficient were used to assess reliability of each system. The study group included 359 patients (180 men, 179 women; mean age, 45 ± 16.9 years). Considering combination of CO-RADS 3, 4 and 5 and combination of typical and indeterminate RSNA categories as positive predictors for COVID-19 diagnosis, the overall sensitivity was the same for both classification systems (72.7%). Applying both systems in moderate and severe/critically ill patients resulted in a significant increase in sensitivity (94.7% and 97.8%, respectively). The overall inter-reviewer agreement was excellent for CO-RADS (κ = 0.801), and good for RSNA classification (κ = 0.781).ConclusionCO-RADS and RSNA chest CT classification systems are comparable in diagnosis of COVID-19 pneumonia with similar sensitivity and reliability.

Highlights

The Radiological Society of North America (RSNA) recently published a chest Computed tomography (CT) classification system and Dutch Association for Radiology has announced Coronavirus disease 2019 (COVID-19) reporting and data system (CO-RADS) to provide guidelines to radiologists who interpret chest CT images of patients with suspected COVID-19 pneumonia
The COVID-19 Reporting and Data System (CO-RADS) had a better inter-reviewer agreement that may be attributed to greater familiarity with the CO-RADS system among radiologists due to its resemblance to other RAD systems
Patient characteristics The final analysis included a total of 359 patients (180 men, 179 women; mean age, 45 ± 16.9 years; range, 1–90 years) who were COVID-19-positive confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR)

Summary

Introduction

The Radiological Society of North America (RSNA) recently published a chest CT classification system and Dutch Association for Radiology has announced Coronavirus disease 2019 (COVID-19) reporting and data system (CO-RADS) to provide guidelines to radiologists who interpret chest CT images of patients with suspected COVID-19 pneumonia. RT-PCR is reported to have a low sensitivity with a considerable number of false-negative results, possibly necessitating that multiple tests be performed even up to five times to exclude the disease, despite the shortage of test kits in many regions all over the world [4, 6]. It may take hours or even days for RT-PCR test results to be available [7, 8]

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