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Research Article
COVID-19 Pneumonia: Inter-Observer Agreement and Diagnostic Accuracy of Chest CT in Patients with Intermediate Clinical Probability
Anne-Laure BRUN
Hopital Foch
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4447-7850
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Objectives
To assess inter-reader agreements and diagnostic accuracy of chest CT to identify COVID-19 pneumonia in patients with intermediate clinical probability during an acute disease outbreak.
Methods:
From March 20 to April 8, consecutive patients with intermediate clinical probability of COVID-19 pneumonia underwent a chest CT scan. Two independent chest radiologists blinded to clinical information and RT-PCR results retrospectively reviewed and classified images on a 1-5 confidence level scale for COVID-19 pneumonia. Agreements between radiologists were assessed with kappa statistics. Diagnostic accuracy of chest CT compared to RT-PCR assay and patient outcomes was measured using receiver operating characteristics (ROC). Positive predictive value (PPV) and negative predictive value (NPV) for COVID-19 pneumonia were calculated.
Results:
319 patients with a mean age of 62.3 yo were included. Inter-observer agreement for highly probable (kappa: 0.83 [p < .001]) and highly probable or probable (kappa: 0.82 [p < .001]) diagnosis of COVID-19 pneumonia was very good. RT-PCR tests performed in 307 patients were positive in 173 and negative in 134. Sixteen patients with negative RT-PCR tests and probable or highly probable CT patterns according to both radiologists were reclassified COVID-19 positive after clinical discussion. The areas under the curve (AUC) were 0.94 and 0.92 respectively. With a disease prevalence of 61.6%, PPV were 96.6 % and 94.4%, and NPV 84.3% and 78.2%.
Conclusion :
During acute COVID-19 outbreak, chest CT scan may be used for triage of patients with intermediate clinical probability with very good inter-observer agreements and diagnostic accuracy.
Keywords
Coronarovirus disease 2019 pneumonia, chest CT imaging, reverse transcription polymerase chain reaction, intermediate clinical probability, inter-reader variability, diagnostic accuracy, receiver operating characteristics, positive predictive value.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Due to technical limitations, Tables 1-3 are provided in the Supplementary Files section.
This is a list of supplementary files associated with this preprint. Click to download.
- table1.jpg
Concordances between radiologists’ ranking (1-5 scale) in 319 patients (%). Kappa value: 0.61 (p< .001). R1: radiologist 1; R2: radiologist 2
- Table2.jpg
Radiologist’ rankings (1-5 scale) for the diagnosis of COVID-19 pneumonia and reverse transcription polymerase chain (RT-PCR) results in 307 patients
- Table3.jpg
Sensitivity, Specificity, Positive predictive value (PPV) and Negative predictive value (NPV) of chest CT for diagnosing COVID-19 pneumonia compared to reverse transcription polymerase chain (RT-PCR) and patient outcomes
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This is a preprint. It has not completed peer review.
Research Article
COVID-19 Pneumonia: Inter-Observer Agreement and Diagnostic Accuracy of Chest CT in Patients with Intermediate Clinical Probability
Anne-Laure BRUN
Hopital Foch
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4447-7850
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 22 Jun, 2020
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Objectives
To assess inter-reader agreements and diagnostic accuracy of chest CT to identify COVID-19 pneumonia in patients with intermediate clinical probability during an acute disease outbreak.
Methods:
From March 20 to April 8, consecutive patients with intermediate clinical probability of COVID-19 pneumonia underwent a chest CT scan. Two independent chest radiologists blinded to clinical information and RT-PCR results retrospectively reviewed and classified images on a 1-5 confidence level scale for COVID-19 pneumonia. Agreements between radiologists were assessed with kappa statistics. Diagnostic accuracy of chest CT compared to RT-PCR assay and patient outcomes was measured using receiver operating characteristics (ROC). Positive predictive value (PPV) and negative predictive value (NPV) for COVID-19 pneumonia were calculated.
Results:
319 patients with a mean age of 62.3 yo were included. Inter-observer agreement for highly probable (kappa: 0.83 [p < .001]) and highly probable or probable (kappa: 0.82 [p < .001]) diagnosis of COVID-19 pneumonia was very good. RT-PCR tests performed in 307 patients were positive in 173 and negative in 134. Sixteen patients with negative RT-PCR tests and probable or highly probable CT patterns according to both radiologists were reclassified COVID-19 positive after clinical discussion. The areas under the curve (AUC) were 0.94 and 0.92 respectively. With a disease prevalence of 61.6%, PPV were 96.6 % and 94.4%, and NPV 84.3% and 78.2%.
Conclusion :
During acute COVID-19 outbreak, chest CT scan may be used for triage of patients with intermediate clinical probability with very good inter-observer agreements and diagnostic accuracy.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Due to technical limitations, Tables 1-3 are provided in the Supplementary Files section.