Imadis Teleradiology, 48 Rue Quivogne, 69002, Lyon, France.
Centre Aquitain d'Imagerie, 64 rue de Canolle, 33000, Bordeaux, France.
Eur Radiol. 2021 May;31(5):2833-2844. doi: 10.1007/s00330-020-07345-z. Epub 2020 Oct 29.
To evaluate the accuracy of diagnoses of COVID-19 based on chest CT as well as inter-observer agreement between teleradiologists during on-call duty and senior radiologists in suspected COVID-19 patients.
From March 13, 2020, to April 14, 2020, consecutive suspected COVID-19 adult patients who underwent both an RT-PCR test and chest CT from 15 hospitals were included in this prospective study. Chest CTs were immediately interpreted by the on-call teleradiologist and were systematically blind reviewed by a senior radiologist. Readings were categorised using a five-point scale: (1) normal; (2) non-infectious findings; (3) infectious findings but not consistent with COVID-19 infection; (4) consistent with COVID-19 infection; and (5) typical appearance of COVID-19 infection. The diagnostic accuracy of chest CT and inter-observer agreement using the kappa coefficient were evaluated over the study period.
In total, 513 patients were enrolled, of whom 244/513 (47.6%) tested positive for RT-PCR. First readings were scored 4 or 5 in 225/244 (92%) RT-PCR+ patients, and between 1 and 3 in 201/269 (74.7%) RT-PCR- patients. The data were highly consistent (weighted kappa = 0.87) and correlated with RT-PCR (p < 0.001, AUC = 0.89, AUC = 0.93). The negative predictive value for scores of 4 or 5 was 0.91-0.92, and the PPV for a score of 5 was 0.89-0.96 at the first and second readings, respectively. Diagnostic accuracy was consistent over the study period, irrespective of a variable prevalence rate.
Chest CT demonstrated high diagnostic accuracy with strong inter-observer agreement between on-call teleradiologists with varying degrees of experience and senior radiologists over the study period.
• The accuracy of readings by on-call teleradiologists, relative to second readings by senior radiologists, demonstrated a sensitivity of 0.75-0.79, specificity of 0.92-0.97, NPV of 0.80-0.83, and PPV of 0.89-0.96, based on "typical appearance," as predictive of RT-PCR+. • Inter-observer agreement between the first reading in the emergency setting and the second reading by the senior emergency teleradiologist was excellent (weighted kappa = 0.87).
评估基于胸部 CT 的 COVID-19 诊断的准确性，以及在疑似 COVID-19 患者中，轮值的远程放射科医生与资深放射科医生之间的观察者间一致性。
从 2020 年 3 月 13 日至 2020 年 4 月 14 日，连续纳入了来自 15 家医院的接受了实时聚合酶链反应（RT-PCR）检测和胸部 CT 的连续疑似 COVID-19 成年患者。胸部 CT 由轮值的远程放射科医生立即解读，并由一名资深放射科医生进行系统的盲法审核。阅读结果使用五分制进行分类：（1）正常；（2）非传染性发现；（3）传染性发现，但与 COVID-19 感染不一致；（4）与 COVID-19 感染一致；（5）COVID-19 感染的典型表现。在整个研究期间，评估了胸部 CT 的诊断准确性和观察者间一致性（使用 Kappa 系数）。
共有 513 名患者入组，其中 244/513（47.6%）例 RT-PCR 检测阳性。244 例 RT-PCR+患者的首次读数均为 4 或 5 分，而 269 例 RT-PCR-患者的读数为 1 至 3 分。数据高度一致（加权 Kappa=0.87），与 RT-PCR 相关（p<0.001，AUC=0.89，AUC=0.93）。评分 4 或 5 的阴性预测值为 0.91-0.92，首次和第二次阅读评分 5 的阳性预测值分别为 0.89-0.96。在整个研究期间，诊断准确性是一致的，无论患病率如何变化。
在整个研究期间，经验程度不同的轮值远程放射科医生与资深放射科医生之间，胸部 CT 显示出较高的诊断准确性和较强的观察者间一致性。
轮值远程放射科医生的首次读数与资深放射科医生的第二次读数相比，在“典型表现”方面，对 RT-PCR+的预测具有 0.75-0.79 的敏感性、0.92-0.97 的特异性、0.80-0.83 的阴性预测值和 0.89-0.96 的阳性预测值。
轮值的远程放射科医生在急诊环境中的首次阅读与资深放射科医生的第二次阅读之间的观察者间一致性非常好（加权 Kappa=0.87）。
