Abstract
Purpose:To assess the interobserver variability between chest radiologists in the interpretation of the Radiological Society of North America (RSNA) expert consensus statement reporting guidelines in patients with suspected coronavirus disease 2019 (COVID-19) pneumonia in a setting with limited reverse transcription polymerase chain reaction testing availability.Methods:Chest computed tomography (CT) studies in 303 consecutive patients with suspected COVID-19 were reviewed by 3 fellowship-trained chest radiologists. Cases were assigned an impression of typical, indeterminate, atypical, or negative for COVID-19 pneumonia according to the RSNA expert consensus statement reporting guidelines, and interobserver analysis was performed. Objective CT features associated with COVID-19 pneumonia and distribution of findings were recorded.Results:The Fleiss kappa for all observers was almost perfect for typical (0.815), atypical (0.806), and negative (0.962) COVID-19 appearances (P < .0001) and substantial (0.636) for indeterminate COVID-19 appearance (P < .0001). Using Cramer V analysis, there were very strong correlations between all radiologists’ interpretations, statistically significant for all (typical, indeterminate, atypical, and negative) COVID-19 appearances (P < .001). Objective CT imaging findings were recorded in similar percentages of typical cases by all observers.Conclusion:The RSNA expert consensus statement on reporting chest CT findings related to COVID-19 demonstrates substantial to almost perfect interobserver agreement among chest radiologists in a relatively large cohort of patients with clinically suspected COVID-19. It therefore serves as a reliable reference framework for radiologists to accurately communicate their level of suspicion based on the presence of evidence-based objective findings.
Highlights
Coronavirus disease 2019 (COVID-19) is a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2
COVID-19 may result in a wide spectrum of computed tomography (CT) imaging findings, which in isolation or combination can be of variable significance
The Radiological Society of North America (RSNA) expert consensus statement on reporting chest CT findings related to COVID-19 was published to facilitate reporting of CT imaging studies acquired during the COVID-19 pandemic.[10]
Summary
Coronavirus disease 2019 (COVID-19) is a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2. It was first identified in the human population in December 20191 and spread rapidly around the world reaching pandemic status in March 2020.2 Reverse transcription polymerase chain reaction (RT-PCR) of respiratory specimens is the most widely used method for diagnosing COVID-19.3,4 in many clinical settings, RT-PCR testing may not be readily available, be limited to hospitalized patients, or may be initially falsely negative.[5] patients with mild respiratory symptoms may be reluctant to travel to a PCR testing site or hospital.[5]. Several retrospective studies have shown that CT has greater sensitivity (86%-98%) and lower false-negative rate than RT-PCR.[6,7,8,9] The sensitivity of nasopharyngeal swabs ranges from 42% to 71%,6,10 with false negatives observed more frequently early in the course of the disease.[11,12]
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Schedule a callMore From: Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes
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