Diagnostic accuracy and interobserver variability of CO-RADS in patients with suspected coronavirus disease-2019: a mult
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Diagnostic accuracy and interobserver variability of CO-RADS in patients with suspected coronavirus disease-2019: a multireader validation study Davide Bellini 1,2 & Nicola Panvini 1 & Marco Rengo 1 & Simone Vicini 1 & Miriam Lichtner 3 & Tiziana Tieghi 3 & Dea Ippoliti 1 & Federica Giulio 1 & Elena Orlando 1 & Mario Iozzino 2 & Maria Grazia Ciolfi 2 & Sarah Montechiarello 2 & Ugo d’Ambrosio 2 & Emanuele d’Adamo 2 & Chiara Gambaretto 2 & Stefano Panno 2 & Vanessa Caldon 2 & Cesare Ambrogi 2 & Iacopo Carbone 1 Received: 7 June 2020 / Revised: 10 August 2020 / Accepted: 8 September 2020 # European Society of Radiology 2020
Abstract Objective To conduct a multireader validation study to evaluate the interobserver variability and the diagnostic accuracy for the lung involvement by COVID-19 of COVID-19 Reporting and Data System (CO-RADS) score. Methods This retrospective study included consecutive symptomatic patients who underwent chest CT and reverse transcriptasepolymerase chain reaction (RT-PCR) from March 2020 to May 2020 for suspected COVID-19. Twelve readers with different levels of expertise independently scored each CT using the CO-RADS scheme for detecting pulmonary involvement by COVID19. Receiver operating characteristic (ROC) curves were computed to investigate diagnostic yield. Fleiss’ kappa statistics was used to evaluate interreader agreement. Results A total of 572 patients (mean age, 63 ± 20 [standard deviation]; 329 men; 142 patients with COVID-19 and 430 patients without COVID-19) were evaluated. There was a moderate agreement for CO-RADS rating among all readers (Fleiss’ K = 0.43 [95% CI 0.42– 0.44]) with a substantial agreement for CO-RADS 1 category (Fleiss’ K = 0.61 [95% CI 0.60–0.62]) and moderate agreement for CORADS 5 category (Fleiss’ K = 0.60 [95% CI 0.58–0.61]). ROC analysis showed the CO-RADS score ≥ 4 as the optimal threshold, with a cumulative area under the curve of 0.72 (95% CI 66–78%), sensitivity 61% (95% CI 52–69%), and specificity 81% (95% CI 77–84%). Conclusion CO-RADS showed high diagnostic accuracy and moderate interrater agreement across readers with different levels of expertise. Specificity is higher than previously thought and that could lead to reconsider the role of CT in this clinical setting. Key Points • COVID-19 Reporting and Data System (CO-RADS) demonstrated a good diagnostic accuracy for lung involvement by COVID19 with an average AUC of 0.72 (95% CI 67–75%). • When a threshold of ≥ 4 was used, sensitivity and specificity were 61% (95% CI 52–69%) and 81% (95% CI 76–84%), respectively. • There was an overall moderate agreement for CO-RADS rating across readers with different levels of expertise (Fleiss’ K = 0.43 [95% CI 0.42–0.44]). Keywords COVID-19 . Severe acute respiratory syndrome coronavirus 2 . Tomography, X-ray computed . ROC curve . Sensitivity and specificity Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00330-020-07273-y) contains supplementary material, which is available to authorized users. * Davi
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