Department of Radiology and Interventional Therapy, Vivantes Klinikum Neukölln, Berlin, Germany.
Department of Pulmonary Medicine and Infectious Diseases, Vivantes Klinikum Neukölln, Berlin, Germany.
Br J Radiol. 2021 Jan 1;94(1117):20200574. doi: 10.1259/bjr.20200574. Epub 2020 Nov 27.
Although chest CT has been widely used in patients with COVID-19, its role for early diagnosis of COVID-19 is unclear. We report the diagnostic performance of chest CT using structured reporting in a routine clinical setting during the early phase of the epidemic in Germany.
Patients with clinical suspicion of COVID-19 and moderate-to-severe symptoms were included in this retrospective study. CTs were performed and reported before RT-PCR results (reference standard) became available. A structured reporting system was used that concluded in a recently described five-grade score ("CO-RADS"), indicating the level of suspicion for pulmonary involvement of COVID-19 from 1 = very low to 5 = very high. Structured reporting was performed by three Radiologists in consensus.
In 96 consecutive patients (50 male, mean age 64), RT-PCR was positive in 20 (21%) cases. CT features significantly more common in RT-PCR-positive patients were ground-glass opacities as dominant feature, crazy paving, hazy margins of opacities, and multifocal bilateral distribution ( < 0.05). Using a cut-off point between CO-RADS 3 and 4, sensitivity was 90%, specificity 91%, positive predictive value 72%, negative predictive value 97%, and accuracy 91%. ROC analysis showed an AUC of 0.938.
Structured reporting of chest CT with a five-grade scale provided accurate diagnosis of COVID-19. Its use was feasible and helpful in clinical routine.
Chest CT with structured reporting may be a provisional diagnostic alternative to RT-PCR testing for early diagnosis of COVID-19, especially when RT-PCR results are delayed or test capacities are limited.
尽管胸部 CT 已广泛用于 COVID-19 患者，但在 COVID-19 的早期诊断中的作用尚不清楚。我们报告了在德国疫情早期的常规临床环境中使用结构化报告的胸部 CT 的诊断性能。
本回顾性研究纳入了临床疑似 COVID-19 且症状中度至重度的患者。在获得 RT-PCR 结果（参考标准）之前进行 CT 检查和报告。使用了一种结构化报告系统，该系统得出了最近描述的五级评分（“CO-RADS”），表示对 COVID-19 肺部受累的怀疑程度从 1=非常低到 5=非常高。结构化报告由三位放射科医生共识完成。
在 96 例连续患者（50 例男性，平均年龄 64 岁）中，20 例（21%）患者的 RT-PCR 结果为阳性。在 RT-PCR 阳性患者中，更常见的 CT 特征是磨玻璃影为主、铺路石征、模糊的密度影边界和多灶性双侧分布（<0.05）。使用 CO-RADS 3 与 4 之间的截断值，敏感性为 90%，特异性为 91%，阳性预测值为 72%，阴性预测值为 97%，准确性为 91%。ROC 分析显示 AUC 为 0.938。
使用五级评分的胸部 CT 结构化报告可准确诊断 COVID-19。它在临床常规中具有可行性和帮助。
结构化报告的胸部 CT 可能是 RT-PCR 检测 COVID-19 的早期诊断的一种替代方法，特别是在 RT-PCR 结果延迟或检测能力有限时。
