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Diagnostic Performance of CO-RADS and the RSNA Classification System in Evaluating COVID-19 at Chest CT: A
Robert M Kwee1, Hugo J A Adams1, Thomas C Kwee1
1Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands (R.M.K.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands. (H.J.A.A.); Department of Radiology, Nuclear Medicine and Molecular Imaging University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (T.C.K.).
Insights
Higher COVID-19 Reporting and Data System (CO-RADS) and Radiological Society of North America (RSNA) scores indicate increased likelihood of coronavirus disease 2019 (COVID-19) infection. This meta-analysis evaluated the diagnostic performance of these scoring systems.
Area of Science:
- Radiology
- Infectious Diseases
- Medical Imaging
Background:
- Accurate diagnosis of coronavirus disease 2019 (COVID-19) is crucial for patient management and public health.
- Chest computed tomography (CT) plays a role in diagnosing COVID-19, necessitating standardized interpretation methods.
- The COVID-19 Reporting and Data System (CO-RADS) and Radiological Society of North America (RSNA) classification systems were developed to standardize CT interpretations.
Purpose of the Study:
- To evaluate the diagnostic performance of CO-RADS and RSNA categorizations for COVID-19.
- To compare the effectiveness of these scoring systems in patients with suspected coronavirus disease 2019.
Main Methods:
- A systematic meta-analysis was conducted, including studies published in 2020 up to August 24.
- Nine studies comprising 3283 patients with suspected COVID-19 were analyzed.
- Study quality was assessed using the QUADAS-2 tool, and meta-analysis was performed using a random effects model.
Main Results:
- Higher CO-RADS categories showed increased pooled COVID-19 frequencies, ranging from 8.8% (category 1) to 89.6% (category 5).
- RSNA classification also demonstrated a correlation, with typical findings having a 92.5% pooled COVID-19 frequency.
- Pooled sensitivity and specificity values were calculated for various thresholds of both CO-RADS and RSNA classifications, indicating good diagnostic performance.
Conclusions:
- Both CO-RADS and RSNA classification systems are valuable tools for diagnosing COVID-19 based on chest CT findings.
- A higher categorization within either system correlates with a greater likelihood of COVID-19 infection.
- These systems aid in standardizing the interpretation of chest CT in suspected COVID-19 cases.
Purpose:
To determine the diagnostic performance of the COVID-19 Reporting and Data System (CO-RADS) and the Radiological Society of North America (RSNA) categorizations in patients with clinically suspected coronavirus disease 2019 (COVID-19) infection.
Materials And Methods:
In this meta-analysis, studies from 2020, up to August 24, 2020 were assessed for inclusion criteria of studies that used CO-RADS or the RSNA categories for scoring chest CT in patients with suspected COVID-19. A total of 186 studies were identified. After review of abstracts and text, a total of nine studies were included in this study. Patient information (n¸ age, sex), CO-RADS and RSNA scoring categories, and other study characteristics were extracted. Study quality was assessed with the QUADAS-2 tool. Meta-analysis was performed with a random effects model.
Results:
Nine studies (3283 patients) were included. Overall study quality was good, except for risk of non-performance of repeated reverse transcriptase polymerase chain reaction (RT-PCR) after negative initial RT-PCR and persistent clinical suspicion in four studies. Pooled COVID-19 frequencies in CO-RADS categories were: 1, 8.8%; 2, 11.1%; 3, 24.6%; 4, 61.9%; and 5, 89.6%. Pooled COVID-19 frequencies in RSNA classification categories were: negative 14.4%; atypical, 5.7%; indeterminate, 44.9%; and typical, 92.5%. Pooled pairs of sensitivity and specificity using CO-RADS thresholds were the following: at least 3, 92.5% (95% CI: 87.1, 95.7) and 69.2% (95%: CI: 60.8, 76.4); at least 4, 85.8% (95% CI: 78.7, 90.9) and 84.6% (95% CI: 79.5, 88.5); and 5, 70.4% (95% CI: 60.2, 78.9) and 93.1% (95% CI: 87.7, 96.2). Pooled pairs of sensitivity and specificity using RSNA classification thresholds for indeterminate were 90.2% (95% CI: 87.5, 92.3) and 75.1% (95% CI: 68.9, 80.4) and for typical were 65.2% (95% CI: 37.0, 85.7) and 94.9% (95% CI: 86.4, 98.2).
Conclusion:
COVID-19 infection frequency was higher in patients categorized with higher CORADS and RSNA classification categories.
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