TY - JOUR
T1 - CO-RADS
T2 - A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19 Definition and Evaluation
AU - Prokop, Mathias
AU - van Everdingen, Wouter
AU - Vellinga, Tjalco van Rees
AU - van Ufford, Henriette Quarles
AU - Stoger, Lauran
AU - Beenen, Ludo
AU - Geurts, Bram
AU - Gietema, Hester
AU - Krdzalic, Jasenko
AU - Schaefer-Prokop, Cornelia
AU - van Ginneken, Bram
AU - Brink, Monique
AU - COVID-19 Standardized Reporting Working Group of the Dutch Radiological Society
N1 - Publisher Copyright:
© RSNA, 2020.
PY - 2020/8
Y1 - 2020/8
N2 - Background: A categorical CT assessment scheme for suspicion of pulmonary involvement of coronavirus disease 2019 (COVID-19) provides a basis for gathering scientific evidence and improved communication with referring physicians.Purpose: To introduce the COVID-19 Reporting and Data System (CO-RADS) for use in the standardized assessment of pulmonary involvement of COVID-19 on unenhanced chest CT images and to report its initial inter observer agreement and performance.Materials and Methods: The Dutch Radiological Society developed CO-RADS based on other efforts for standardization, such as the Lung Imaging Reporting and Data System or Breast Imaging Reporting and Data System. CO-RADS assesses the suspicion for pulmonary involvement of COVID-19 on a scale from 1 (very low) to 5 (very high). The system is meant to be used in patients with moderate to severe symptoms of COVID-19. The system was evaluated by using 105 chest CT scans of patients admitted to the hospital with clinical suspicion of COVID-19 and in whom reverse transcription-polymerase chain reaction (RT-PCR) was performed (mean, 62 years +/- 16 [standard deviation]; 61 men, 53 with positive RT-PCR results). Eight observers used CO-RADS to assess the scans. Fleiss kappa value was calculated, and scores of individual observers were compared with the median of the remaining seven observers. The resulting area under the receiver operating characteristics curve (AUC) was compared with results from RT-PCR and clinical diagnosis of COVID-19.Results: There was absolute agreement among observers in 573 (68.2%) of 840 observations. Fleiss kappa value was 0.47 (95% confidence interval [CI]: 0.45, 0.47), with the highest kappa value for CO-RADS categories 1 (0.58, 95% CI: 0.54, 0.62) and 5 (0.68, 95% CI: 0.65, 0.72). The average AUC was 0.91 (95% CI: 0.85, 0.97) for predicting RT-PCR outcome and 0.95 (95% CI: 0.91, 0.99) for clinical diagnosis. The false-negative rate for CO-RADS 1 was nine of 161 cases (5.6%; 95% CI: 1.0%, 10%), and the false-positiverate for CO-RADS category 5 was one of 286 (0.3%; 95% CI: 0%, 1.0%).Conclusion: The coronavirus disease 2019 (COVID-19) Reporting and Data System (CO-RADS) is a categorical assessment scheme for pulmonary involvement of COVID-19 at unenhanced chest CT that performs very well in predicting COVID-19 in patients with moderate to severe symptoms and has substantial intero bserver agreement, especially for categories 1 and 5. (C) RSNA, 2020
AB - Background: A categorical CT assessment scheme for suspicion of pulmonary involvement of coronavirus disease 2019 (COVID-19) provides a basis for gathering scientific evidence and improved communication with referring physicians.Purpose: To introduce the COVID-19 Reporting and Data System (CO-RADS) for use in the standardized assessment of pulmonary involvement of COVID-19 on unenhanced chest CT images and to report its initial inter observer agreement and performance.Materials and Methods: The Dutch Radiological Society developed CO-RADS based on other efforts for standardization, such as the Lung Imaging Reporting and Data System or Breast Imaging Reporting and Data System. CO-RADS assesses the suspicion for pulmonary involvement of COVID-19 on a scale from 1 (very low) to 5 (very high). The system is meant to be used in patients with moderate to severe symptoms of COVID-19. The system was evaluated by using 105 chest CT scans of patients admitted to the hospital with clinical suspicion of COVID-19 and in whom reverse transcription-polymerase chain reaction (RT-PCR) was performed (mean, 62 years +/- 16 [standard deviation]; 61 men, 53 with positive RT-PCR results). Eight observers used CO-RADS to assess the scans. Fleiss kappa value was calculated, and scores of individual observers were compared with the median of the remaining seven observers. The resulting area under the receiver operating characteristics curve (AUC) was compared with results from RT-PCR and clinical diagnosis of COVID-19.Results: There was absolute agreement among observers in 573 (68.2%) of 840 observations. Fleiss kappa value was 0.47 (95% confidence interval [CI]: 0.45, 0.47), with the highest kappa value for CO-RADS categories 1 (0.58, 95% CI: 0.54, 0.62) and 5 (0.68, 95% CI: 0.65, 0.72). The average AUC was 0.91 (95% CI: 0.85, 0.97) for predicting RT-PCR outcome and 0.95 (95% CI: 0.91, 0.99) for clinical diagnosis. The false-negative rate for CO-RADS 1 was nine of 161 cases (5.6%; 95% CI: 1.0%, 10%), and the false-positiverate for CO-RADS category 5 was one of 286 (0.3%; 95% CI: 0%, 1.0%).Conclusion: The coronavirus disease 2019 (COVID-19) Reporting and Data System (CO-RADS) is a categorical assessment scheme for pulmonary involvement of COVID-19 at unenhanced chest CT that performs very well in predicting COVID-19 in patients with moderate to severe symptoms and has substantial intero bserver agreement, especially for categories 1 and 5. (C) RSNA, 2020
U2 - 10.1148/radiol.2020201473
DO - 10.1148/radiol.2020201473
M3 - Article
C2 - 32339082
SN - 0033-8419
VL - 296
SP - E97-E104
JO - Radiology
JF - Radiology
IS - 2
ER -