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      RSNA Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19: Interobserver Agreement Between Chest Radiologists

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          Abstract

          Purpose:

          To assess the interobserver variability between chest radiologists in the interpretation of the Radiological Society of North America (RSNA) expert consensus statement reporting guidelines in patients with suspected coronavirus disease 2019 (COVID-19) pneumonia in a setting with limited reverse transcription polymerase chain reaction testing availability.

          Methods:

          Chest computed tomography (CT) studies in 303 consecutive patients with suspected COVID-19 were reviewed by 3 fellowship-trained chest radiologists. Cases were assigned an impression of typical, indeterminate, atypical, or negative for COVID-19 pneumonia according to the RSNA expert consensus statement reporting guidelines, and interobserver analysis was performed. Objective CT features associated with COVID-19 pneumonia and distribution of findings were recorded.

          Results:

          The Fleiss kappa for all observers was almost perfect for typical (0.815), atypical (0.806), and negative (0.962) COVID-19 appearances ( P < .0001) and substantial (0.636) for indeterminate COVID-19 appearance ( P < .0001). Using Cramer V analysis, there were very strong correlations between all radiologists’ interpretations, statistically significant for all (typical, indeterminate, atypical, and negative) COVID-19 appearances ( P < .001). Objective CT imaging findings were recorded in similar percentages of typical cases by all observers.

          Conclusion:

          The RSNA expert consensus statement on reporting chest CT findings related to COVID-19 demonstrates substantial to almost perfect interobserver agreement among chest radiologists in a relatively large cohort of patients with clinically suspected COVID-19. It therefore serves as a reliable reference framework for radiologists to accurately communicate their level of suspicion based on the presence of evidence-based objective findings.

          Translated abstract

          Objectif:

          Évaluer la variabilité inter-observateurs entre radiologistes thoraciques concernant les lignes directrices de la déclaration de consensus d’experts de la Radiological Society of North America (RSNA) pour le signalement des patients ayant une pneumonie COVID-19 suspectée dans un établissement où la disponibilité des tests de dépistage par rt-PCR est limitée.

          Méthodes:

          Des études de tomodensitométries (TDM) thoraciques effectuées chez 303 patients consécutifs suspects de COVID-19 ont été analysées par 3 radiologistes thoraciques formés dans le cadre d’un fellowship. Chaque cas a été classé selon sa forme (typique, indéterminé, atypique ou négatif) pour la pneumonie COVID-19 en suivant les lignes directrices pour leur signalement tirées de la déclaration de consensus d’experts de la RSNA; une analyse inter-observateurs a ensuite été effectuée. Les caractéristiques objectives des TDM associées à la pneumonie COVID-19 et la répartition des constatations ont été consignées.

          Résultats:

          Le kappa de Fleiss pour tous les observateurs a été presque parfait pour toutes les formes typiques (0,815), atypiques (0,806) et négatives (0,962) de COVID-19 ( P < 0,0001) et substantiel (0,636) pour les formes indéterminées de COVID-19 ( P < 0,0001). L’analyse V de Cramer a montré de très fortes corrélations entre toutes les interprétations des radiologistes, avec une signification statistique pour toutes les formes (typiques, indéterminées, atypiques et négatives) de COVID-19 ( P < 0,001). Les constatations objectives à l’imagerie par TDM ont été consignées avec des pourcentages semblables de cas typiques par tous les observateurs.

          Conclusion:

          La déclaration de consensus d’experts de la RSNA pour le signalement des constatations à la TDM thoracique en rapport avec la COVID-19 démontre une concordance substantielle à presque parfaite entre les radiologistes thoraciques dans une cohorte relativement importante de patients ayant une infection COVID-19 suspectée cliniquement. Il s’agit donc d’un cadre de référence fiable permettant aux radiologistes de communiquer avec exactitude leur niveau de soupçon en se basant sur la présence d’éléments objectifs reposant sur des données probantes.

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          Most cited references 4

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            Drug-induced lung disease: high-resolution CT and histological findings.

            To compare the parenchymal high-resolution computed tomography (HRCT) appearances with histological findings in patients with drug-induced lung disease and to determine the prognostic value of HRCT. Drug history, HRCT features, histological findings and outcome at 3 months in 20 patients with drug induced-lung disease were reviewed retrospectively. The HRCT images were assessed for the pattern and distribution of abnormalities and classified as most suggestive of interstitial pneumonitis/fibrosis, diffuse alveolar damage (DAD), organizing pneumonia (OP) reaction, or a hypersensitivity reaction. On histopathological examination there were eight cases of interstitial pneumonitis/fibrosis, five of DAD, five of OP reactions, one of hypersensitivity reaction and one of pulmonary eosinophilia. The most common abnormalities on HRCT were ground-glass opacities (n = 17), consolidation (n = 14), interlobular septal thickening (n = 15) and centrilobular nodules (n = 8). HRCT interpretation and histological diagnosis were concordant in only nine (45%) of 20 patients. The pattern, distribution, and extent of HRCT abnormalities were of limited prognostic value: all eight patients with histological findings of OP, hypersensitivity reaction, or eosinophilic infiltrate improved on follow-up compared to only five of 13 patients with interstitial pneumonitis/fibrosis or DAD. In many cases of drug-induced lung injury HRCT is of limited value in determining the histological pattern and prognosis. Copyright 2002 The Royal College of Radiologists.
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              Computed Tomographic Imaging of 3 Patients With Coronavirus Disease 2019 Pneumonia With Negative Virus Real-time Reverse-Transcription Polymerase Chain Reaction Test

              Abstract We reported computed tomographic (CT) imaging findings of 3 patients with coronavirus disease 2019 (COVID-19) pneumonia with initially negative results before CT examination and finally confirmed positive for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by real-time reverse-transcription polymerase chain reaction assay.
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                Author and article information

                Journal
                Can Assoc Radiol J
                Can Assoc Radiol J
                CAJ
                spcaj
                Canadian Association of Radiologists Journal
                SAGE Publications (Sage CA: Los Angeles, CA )
                0846-5371
                1488-2361
                2 July 2020
                Affiliations
                [1 ]Department of Radiology, Vancouver General Hospital, British Columbia, Canada
                [2 ]University of British Columbia, Vancouver, British Columbia, Canada
                [3 ]Department of Radiology, Delfin Clinic, Salvador, Bahia, Brazil
                Author notes
                Danielle Byrne, FFR (RCSI), Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada V5Z 1M9. Email: dbyrne.radiology@ 123456gmail.com
                Article
                10.1177_0846537120938328
                10.1177/0846537120938328
                7335944
                32615802
                © The Author(s) 2020

                This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

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                Custom metadata
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                pneumonia, lung diseases, ct, covid-19, 2019n-cov

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