Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland.
Clinical Research Centre, School of Medicine, University College, Dublin, Ireland.
Eur J Radiol. 2021 Jan;134:109414. doi: 10.1016/j.ejrad.2020.109414. Epub 2020 Nov 11.
To date, the majority of chest imaging studies in COVID-19 pneumonia have focused on CT. Evidence for the utility of chest radiographs (CXRs) in this population is less robust. Our objectives were to develop a systematic approach for reporting likelihood of COVID-19 pneumonia on CXRs, to measure the interobserver variability of this approach and to evaluate the diagnostic performance of CXRs compared to real-time reverse transcription polymerase chain reaction (RT-PCR).
Retrospective review of patients suspected of having COVID-19 pneumonia who attended our emergency department and underwent both CXR and a RT-PCR were included. Two radiologists reviewed the CXRs, blind to the RT-PCR, and classified them according to a structured reporting template with five categories (Characteristic, High Suspicion, Indeterminate, Unlikely and Normal) which we devised. For analysis of diagnostic accuracy, Characteristic and High Suspicion CXRs were considered positive and the remaining categories negative. Concordance between the two assessors was also measured.
Of 582 patients (51 +/- 20 years), 143/582 (24.6 %) had a positive RT-PCR. The absolute concordance between the two assessors was 71.1 % (414/582) with a Fleiss-Cohen-weighted Cohen's κ of 0.81 (95 % confidence interval, 0.78-0.85). A patient with a positive CXR had an 88 % (95 % CI 80-96 %) probability of having a positive RT-PCR during a period of high incidence, early in the COVID-19 pandemic.
Using a structured approach, a positive CXR had a high likelihood of predicting a positive RT-PCR, with good interrater reliability. CXRs can be useful in identifying new cases of COVID-19.
迄今为止，大多数 COVID-19 肺炎的胸部影像学研究都集中在 CT 上。在该人群中，胸部 X 线摄影（CXR）的效用证据不太可靠。我们的目标是制定一种用于报告 CXR 上 COVID-19 肺炎可能性的系统方法，测量该方法的观察者间变异性，并评估 CXR 与实时逆转录聚合酶链反应（RT-PCR）相比的诊断性能。
回顾性分析了我院急诊科疑似患有 COVID-19 肺炎并同时接受 CXR 和 RT-PCR 的患者。两名放射科医生对 CXR 进行了盲法评估，并根据我们设计的五个类别（特征、高度怀疑、不确定、不太可能和正常）的结构化报告模板进行了分类。为了分析诊断准确性，将特征和高度怀疑的 CXR 视为阳性，其余类别视为阴性。还测量了两位评估者之间的一致性。
在 582 名患者（51±20 岁）中，143/582（24.6%）的 RT-PCR 为阳性。两位评估者之间的绝对一致性为 71.1%（414/582），Fleiss-Cohen 加权 Cohen's κ 值为 0.81（95%置信区间，0.78-0.85）。在 COVID-19 大流行早期高发期间，CXR 阳性患者 RT-PCR 阳性的概率为 88%（95%CI 80-96%）。
使用结构化方法，CXR 阳性具有高度预测 RT-PCR 阳性的可能性，且观察者间可靠性良好。CXR 可用于识别新的 COVID-19 病例。
