Observer agreement and clinical significance of chest CT reporting in patients suspected of COVID-19

Abstract

Objectives:To assess inter-observer agreement and clinical significance of chest CT reporting in patients suspected of COVID-19.Methods: From 16th to 24th March 2020, 241 consecutive patients addressed to hospital for COVID-19 suspicion had both chest CT and SARS-CoV-2 RT-PCR. Eight observers (2 thoracic and 2 general senior radiologists, 2 junior radiologists and 2 emergency physicians) retrospectively categorized each CT into one out of 3 categories (evocative, compatible for COVID-19 pneumonia, and not evocative or normal). Observer agreement for categorization between all readers and pairs of readers with similar experience was evaluated with the Kappa coefficient. The results of a consensus categorization were correlated to RT-PCR.Results: Observer agreement across the 3 categories was good between all readers (κ value 0.68 95%CI 0.67-0.70) and good to very good between pairs of readers (0.64-0.85). It was very good (κ 0.81 95%CI 0.79-0.83), fair (κ 0.32 95%CI 0.29-0.34) and good (κ 0.74 95%CI 0.71-0.76) for the categories evocative, compatible and not evocative or normal, respectively. RT-PCR was positive in 97%, 50% and 27% of cases classified in the respective categories. Observer agreement was lower (p=0.045) and RT-PCR positive cases were less frequently categorized evocative in presence of an underlying pulmonary disease (p<0.001). Conclusion:Inter-observer agreement for chest CT reporting using categorization of findings is good in patients suspected of COVID-19. Among patients considered for hospitalization in an epidemic context, CT categorized evocative is highly predictive of COVID-19, whereas the predictive value of CT decreases between the categories compatible and not evocative. Keywords Coronavirus infectionsAll rights reserved. No reuse allowed without permission.(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

A tricompartmental model of lung oxygenation disruption to explain pulmonary and systemic pathology in severe COVID-19

“…Regardless of the presence of larger clots, whether embolic in origin or developing locally as a consequence of immunothrombosis, pulmonary infarction would account for the unusually high incidence of chest pain at presentation owing to involvement of the exquisitely pain-sensitive pleural surface. 14,17,35,36 However, considering the small size of the vessels supplying the area of lung occupied by ground glass opacities, visualisation of PIC-induced clots is limited by the resolution constraints of CT, although clots can be easily identified at post-mortem. Despite the spatial limitation of CTPA in detecting microemboli or microthrombi, magnetic resonance pulmonary perfusion and single-photon emission CT (SPECT) pulmonary perfusion could potentially show the small areas of hypoperfusion secondary to PIC (and at the same time could also confirm or exclude pulmonary embolism to large and medium-sized arteries).…”

Differentiation of Chest CT Findings Between Influenza Pneumonia and COVID-19: Interobserver Agreement Between Radiologists

“…Debray et al investigated the observer agreement between eight physicians out of two junior radiologists, two thoracic and two general senior radiologists and two emergency physicians. They found a good Kappa coefficient between all readers ( 31 ). Also, in another study by Byrne et al ( 32 ), they used the Radiological Society of North America (RSNA) expert consensus guidelines to assess the interobserver variability and agreement between chest radiologists diagnosing suspected COVID-19 pneumonia patients.…”

Diagnostic Performance of COVID-19 Reporting and Data System Classification Across Residents and Radiologists: A Retrospective Study

“…Therefore, the support of individuals with different experience levels becomes important. To our knowledge, there have been studies investigating interobserver agreement between residents and radiologists, [23][24][25][26] and CO-RADS classification was used in a few of these to evaluate the images. [10][11][12]24,26 In our study, the CO-RADS scores of both the residents and radiologists groups show significant differences in determining RT-PCR test results (P < 0.001), similar to a recently published studies.…”