Universidade Federal do Rio Grande do Sul, Program in Pneumology Sciences, Porto Alegre, RS, Brazil; Hospital Moinhos de Vento, Department of Radiology, Porto Alegre, RS, Brazil.
Hospital Moinhos de Vento, Department of Radiology, Porto Alegre, RS, Brazil.
Braz J Infect Dis. 2020 Nov-Dec;24(6):524-533. doi: 10.1016/j.bjid.2020.10.002. Epub 2020 Oct 31.
COVID-19 is a new disease and the most common complication is pneumonia. The Radiological Society of North America (RSNA) proposed an expert consensus for imaging classification for COVID-19 pneumonia.
To evaluate sensitivity, specificity, accuracy, and reproducibility of chest CT standards in the beginning of the Brazilian COVID-19 outbreak.
Cross-sectional study performed from March 1st to April 14th, 2020. Patients with suspected COVID-19 pneumonia submitted to RT-PCR test and chest computed tomography (CT) were included. Two thoracic radiologists blinded for RT-PCR and clinical and laboratory results classified every patient scan according to the RSNA expert consensus. A third thoracic radiologist also evaluated in case of discordance, and consensus was reached among the three radiologists. A typical appearance was considered a positive chest CT for COVID-19 pneumonia. Sensitivity, specificity, positive and negative predictive values were calculated. Cohen's kappa coefficient was used to evaluate intra- and inter-rater agreements.
A total of 159 patients were included (mean age 57.9 ± 18.0 years; 88 [55.3%] males): 86 (54.1%) COVID-19 and 73 (45.9%) non-COVID-19 patients. Eighty (50.3%) patients had a positive CT for COVID-19 pneumonia. Sensitivity and specificity of typical appearance were 88.3% (95%CI, 79.9-93.5) and 94.5% (95%CI, 86.7-97.8), respectively. Intra- and inter-rater agreement were assessed (Cohen's kappa = 0.924, P = 0.06; Cohen's kappa=0.772, P = 0.05, respectively).
Chest CT categorical classification of COVID-19 findings is reproducible and demonstrates high level of agreement with clinical and RT-PCR diagnosis of COVID-19. In RT-PCR scarcity scenarios or in equivocal cases, it may be useful for attending physicians in the evaluation of suspected COVID-19 pneumonia patients attended at the emergency unit.
COVID-19 是一种新疾病，最常见的并发症是肺炎。北美放射学会（RSNA）提出了一种用于 COVID-19 肺炎影像学分类的专家共识。
评估巴西 COVID-19 爆发初期胸部 CT 标准的敏感性、特异性、准确性和可重复性。
这是一项在 2020 年 3 月 1 日至 4 月 14 日进行的横断面研究。纳入了疑似 COVID-19 肺炎并接受 RT-PCR 检测和胸部计算机断层扫描（CT）的患者。两位胸部放射科医生对 RT-PCR 和临床及实验室结果进行盲法，并根据 RSNA 专家共识对每位患者的扫描进行分类。第三位胸部放射科医生在存在分歧时进行评估，并在三位放射科医生之间达成共识。出现典型表现被认为是 COVID-19 肺炎的阳性胸部 CT。计算了敏感性、特异性、阳性和阴性预测值。使用 Cohen's kappa 系数评估内部和外部评估者之间的一致性。
共纳入 159 例患者（平均年龄 57.9±18.0 岁；88 [55.3%] 为男性）：86 例（54.1%）COVID-19 患者和 73 例（45.9%）非 COVID-19 患者。80 例（50.3%）患者的 CT 对 COVID-19 肺炎呈阳性。典型表现的敏感性和特异性分别为 88.3%（95%CI，79.9-93.5）和 94.5%（95%CI，86.7-97.8）。评估了内部和外部评估者之间的一致性（Cohen's kappa=0.924，P=0.06；Cohen's kappa=0.772，P=0.05）。
COVID-19 胸部 CT 分类发现具有可重复性，并与 COVID-19 的临床和 RT-PCR 诊断具有高度一致性。在 RT-PCR 稀缺的情况下或在不确定的情况下，对于在急诊就诊的疑似 COVID-19 肺炎患者的评估，它可能对主治医生有用。
