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Published on: December 19, 2020
Diagnostic Performance of the Radiological Society of North America Consensus Statement for Reporting COVID-19 Chest
Mohammed Hazem1,2, Sayed Ibrahim Ali3,4, Qasem M AlAlwan5
1Department of Surgery, Collage of Medicine, King Faisal University, P.O. Box 400, Al-Ahsa 31982, Saudi Arabia.
Insights
Chest CT scans using RSNA categories show high accuracy for diagnosing COVID-19, correlating well with RT-PCR tests. The typical, atypical, and negative categories are reliable, though the indeterminate category is less so.
Area of Science:
- Radiology
- Infectious Diseases
- Medical Diagnostics
Background:
- Coronavirus disease 2019 (COVID-19) is a significant global health concern requiring accurate diagnostic methods.
- Chest computed tomography (CT) is utilized for COVID-19 diagnosis, with reporting categories established by the Radiological Society of North America (RSNA).
- Limited studies have evaluated RSNA CT reporting performance in the Middle East region.
Purpose of the Study:
- To assess the diagnostic performance of RSNA-recommended chest CT reporting categories for COVID-19.
- To compare the diagnostic accuracy of chest CT categories against reverse transcription polymerase chain reaction (RT-PCR) in a Middle Eastern cohort.
- To analyze the sensitivity, specificity, and predictive values of each CT reporting category.
Main Methods:
- A retrospective study included 184 patients with probable COVID-19 infections between July 2021 and February 2022.
- Patients underwent both chest CT and RT-PCR examinations within 7 days.
- Diagnostic performance metrics (sensitivity, specificity, PPV, NPV, accuracy) were calculated for each RSNA CT category, using RT-PCR as the reference standard.
Main Results:
- RT-PCR confirmed COVID-19 in 60.33% of patients.
- The 'typical' CT category demonstrated high performance: 74.8% sensitivity, 93.2% specificity, 94.3% PPV, and 92.5% accuracy.
- The 'atypical' and 'negative' categories showed good positive predictive values (81.8% and 89.1%, respectively), while the 'indeterminate' category had a lower PPV (67.9%) and sensitivity (17.1%).
Conclusions:
- The RSNA chest CT reporting categories offer a robust diagnostic framework for COVID-19.
- The 'typical', 'atypical', and 'negative' CT categories demonstrate strong correlation with RT-PCR results.
- The diagnostic utility of the 'indeterminate' CT category is limited compared to other categories.
Abstract:
Coronavirus disease 2019 (COVID-19) is a highly contagious respiratory disease that leads to variable degrees of illness, and which may be fatal. We evaluated the diagnostic performance of each chest computed tomography (CT) reporting category recommended by the Expert Consensus of the Radiological Society of North America (RSNA) in comparison with that of reverse transcription polymerase chain reaction (RT-PCR). We aimed to add an analysis of this form of reporting in the Middle East, as few studies have been performed there. Between July 2021 and February 2022, 184 patients with a mean age of 55.56 ± 16.71 years and probable COVID-19 infections were included in this retrospective study. Approximately 64.67% (119 patients) were male, while 35.33% (65 patients) were female. Within 7 days, all patients underwent CT and RT-PCR examinations. According to a statement by the RSNA, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of each CT reporting category were calculated, and the RT-PCR results were used as a standard reference. The RT-PCR results confirmed a final diagnosis of COVID-19 infection in 60.33% of the patients. For COVID-19 diagnoses, the typical category (n = 88) had a sensitivity, specificity, PPV, and accuracy of 74.8%, 93.2%, 94.3%, and 92.5%, respectively. For non-COVID-19 diagnoses, the PPVs for the atypical (n = 22) and negative (n = 46) categories were 81.8% and 89.1%, respectively. The PPV for the indeterminate (n = 28) category was 67.9%, with a low sensitivity of 17.1%. However, the RSNA's four chest CT reporting categories provide a strong diagnostic foundation and are highly correlated with the RT-PCR results for the typical, atypical, and negative categories, but they are weaker for the indeterminate category.
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