Department of Radiology, Hôpital Bichat Claude-Bernard, APHP, 46 rue Henri Huchard, 75018, Paris, France.
Inserm UMR1152, Physiopathology and Epidemiology of Respiratory Diseases, Paris, France.
Eur Radiol. 2021 Feb;31(2):1081-1089. doi: 10.1007/s00330-020-07126-8. Epub 2020 Aug 29.
To assess interobserver agreement and clinical significance of chest CT reporting in patients suspected of COVID-19.
From 16 to 24 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 4 categories (evocative, compatible for COVID-19 pneumonia, not evocative, and 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.
Observer agreement across the 4 categories was good between all readers (κ value 0.61 95% CI 0.60-0.63) and moderate to good between pairs of readers (0.54-0.75). It was very good (κ 0.81 95% CI 0.79-0.83), fair (κ 0.32 95% CI 0.29-0.34), moderate (κ 0.56 95% CI 0.54-0.58), and moderate (0.58 95% CI 0.56-0.61) for the categories evocative, compatible, not evocative, and normal, respectively. RT-PCR was positive in 97%, 50%, 31%, and 11% of cases in the respective categories. Observer agreement was lower (p < 0.001) and RT-PCR positive cases less frequently categorized evocative in the presence of an underlying pulmonary disease (p < 0.001).
Interobserver 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.
• In patients suspected of COVID-19, interobserver agreement for chest CT reporting into categories is good, and very good to categorize CT "evocative." • Chest CT can participate in estimating the likelihood of COVID-19 in patients presenting to hospital during the outbreak, CT categorized "evocative" being highly predictive of the disease whereas almost a third of patients with CT "not evocative" had a positive RT-PCR in our study. • Observer agreement is lower and CTs of positive RT-PCR cases less frequently "evocative" in presence of an underlying pulmonary disease.
评估疑似 COVID-19 患者的胸部 CT 报告的观察者间一致性和临床意义。
2020 年 3 月 16 日至 24 日，241 例连续疑似 COVID-19 的患者均进行了胸部 CT 和 SARS-CoV-2 RT-PCR 检查。8 名观察者（2 名胸部和 2 名普通高级放射科医生、2 名初级放射科医生和 2 名急诊医生）回顾性地将每例 CT 分为 4 类之一（提示性、提示 COVID-19 肺炎、非提示性和正常）。用 Kappa 系数评估所有读者和具有相似经验的读者之间的分类观察者间一致性。共识分类的结果与 RT-PCR 相关。
所有读者之间的 4 类分类观察者间一致性良好（κ 值 0.61，95%CI 0.60-0.63），具有相似经验的读者之间的观察者间一致性为中度至良好（0.54-0.75）。在提示性（κ 值 0.81，95%CI 0.79-0.83）、公平（κ 值 0.32，95%CI 0.29-0.34）、中度（κ 值 0.56，95%CI 0.54-0.58）和中度（κ 值 0.58，95%CI 0.56-0.61）类别中，观察者间一致性非常好，提示性（κ 值 0.81，95%CI 0.79-0.83）、公平（κ 值 0.32，95%CI 0.29-0.34）、中度（κ 值 0.56，95%CI 0.54-0.58）和中度（κ 值 0.58，95%CI 0.56-0.61）。各自类别中阳性病例分别为 97%、50%、31%和 11%。在存在肺部基础疾病的情况下，观察者间一致性（p<0.001）和 RT-PCR 阳性病例分类为提示性（p<0.001）的频率较低。
在疑似 COVID-19 的患者中，使用分类发现进行胸部 CT 报告的观察者间一致性良好。在考虑因疫情住院的患者中，CT 分类提示性高度提示 COVID-19，而在提示性和非提示性之间，CT 的预测值降低。
在疑似 COVID-19 的患者中，对胸部 CT 进行分类报告的观察者间一致性较好，且对 CT“提示性”的分类极好到极好。
在疫情爆发期间，胸部 CT 有助于评估患者患 COVID-19 的可能性，我们的研究中，CT 分类“提示性”高度提示该疾病，而近三分之一 CT“非提示性”的患者 RT-PCR 阳性。
在存在肺部基础疾病的情况下，观察者间一致性降低，RT-PCR 阳性病例的 CT 提示性分类不那么频繁。
