Department of Radiology, Hôpital Foch, 40 rue Worth, 92150, Suresnes, France.
Department of Clinical Research and Innovation, Hôpital Foch, 40 rue Worth, 92150, Suresnes, France.
Eur Radiol. 2021 Apr;31(4):1969-1977. doi: 10.1007/s00330-020-07346-y. Epub 2020 Oct 3.
To assess inter-reader agreements and diagnostic accuracy of chest CT to identify COVID-19 pneumonia in patients with intermediate clinical probability during an acute disease outbreak.
From March 20 to April 8, 319 patients (mean age 62.3 years old) consecutive patients with an intermediate clinical probability of COVID-19 pneumonia underwent a chest CT scan. Two independent chest radiologists blinded to clinical information and RT-PCR results retrospectively reviewed and classified images on a 1-5 confidence level scale for COVID-19 pneumonia. Agreements between radiologists were assessed with kappa statistics. Diagnostic accuracy of chest CT compared with RT-PCR assay and patient outcomes was measured using receiver operating characteristics (ROC). Positive predictive value (PPV) and negative predictive value (NPV) for COVID-19 pneumonia were calculated.
Inter-observer agreement for highly probable (kappa: 0.83 [p < .001]) and highly probable or probable (kappa: 0.82 [p < .001]) diagnosis of COVID-19 pneumonia was very good. RT-PCR tests performed in 307 patients were positive in 174 and negative in 133. The areas under the curve (AUC) were 0.94 and 0.92 respectively. With a disease prevalence of 61.2%, PPV were 95.9% and 94.3%, and NPV 84.4% and 77.1%.
During acute COVID-19 outbreak, chest CT scan may be used for triage of patients with intermediate clinical probability with very good inter-observer agreements and diagnostic accuracy.
• Concordances between two chest radiologists to diagnose or exclude a COVID-19 pneumonia in 319 consecutive patients with intermediate clinical probability were very good (kappa: 0.82; p < .001). • When compared with RT-PCR results and patient outcomes, the diagnostic accuracy of CT to identify COVID-19 pneumonia was high for both radiologists (AUC: 0.94 and 0.92). • With a disease prevalence of 61.2% in the studied population, the positive predictive values of CT for diagnosing COVID-19 pneumonia were 95.9% and 94.3% with negative predictive values of 84.4% and 77.1%.
评估胸部 CT 对急性疾病爆发期间具有中度临床可能性的 COVID-19 肺炎患者的的读者间一致性和诊断准确性。
2020 年 3 月 20 日至 4 月 8 日，连续 319 例（平均年龄 62.3 岁）具有中度 COVID-19 肺炎临床可能性的患者接受了胸部 CT 扫描。两位独立的胸部放射科医生在不了解临床信息和 RT-PCR 结果的情况下，使用 1-5 置信度等级量表回顾性地对图像进行分类，以评估 COVID-19 肺炎。使用 Kappa 统计评估放射科医生之间的一致性。使用受试者工作特征（ROC）比较胸部 CT 与 RT-PCR 检测以及患者结局的诊断准确性。计算 COVID-19 肺炎的阳性预测值（PPV）和阴性预测值（NPV）。
对高度可能（kappa：0.83 [p < .001]）和高度可能或可能（kappa：0.82 [p < .001]）COVID-19 肺炎诊断的观察者间一致性非常好。对 307 例患者进行的 RT-PCR 检测中，174 例为阳性，133 例为阴性。曲线下面积（AUC）分别为 0.94 和 0.92。在疾病流行率为 61.2%的情况下，PPV 分别为 95.9%和 94.3%，NPV 分别为 84.4%和 77.1%。
在急性 COVID-19 爆发期间，胸部 CT 扫描可用于对具有中度临床可能性的患者进行分诊，具有非常好的观察者间一致性和诊断准确性。
两名胸部放射科医生对 319 例连续中度临床可能性的 COVID-19 肺炎患者进行诊断或排除的一致性非常好（kappa：0.82；p < .001）。
与 RT-PCR 结果和患者结局相比，CT 识别 COVID-19 肺炎的诊断准确性对于两位放射科医生均较高（AUC：0.94 和 0.92）。
在研究人群中疾病流行率为 61.2%的情况下，CT 诊断 COVID-19 肺炎的阳性预测值分别为 95.9%和 94.3%，阴性预测值分别为 84.4%和 77.1%。
