Diagnostic Performance of CO-RADS and the RSNA Classification System in Evaluating COVID-19 at Chest CT: A Meta-Analysis
Robert M. Kwee, Hugo J.A. Adams, Thomas C. Kwee
Abstract
Purpose To determine the diagnostic performance of the COVID-19 Reporting and Data System (CO-RADS) and the Radiological Society of North America (RSNA) categorizations in patients with clinically suspected coronavirus disease 2019 (COVID-19) infection. Materials and Methods In this meta-analysis, studies from 2020, up to August 24, 2020, were assessed for inclusion criteria of studies that used CO-RADS or the RSNA categories for scoring chest CT in patients suspected of having COVID-19. A total of 186 studies were identified. After review of abstracts and text, a total of nine studies were included in this study. Patient information (n¸ age, sex), CO-RADS and RSNA scoring categories, and other study characteristics were extracted. Study quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Meta-analysis was performed with a random effects model. Results Nine studies (3283 patients) were included. Overall study quality was good, except for risk of nonperformance of repeated reverse-transcriptase polymerase chain reaction (RT-PCR) testing after negative initial RT-PCR testing and persistent clinical suspicion in four studies. Pooled COVID-19 frequencies in CO-RADS categories were: 1, 8.8%; 2, 11.1%; 3, 24.6%; 4, 61.9%; and 5, 89.6%. Pooled COVID-19 frequencies in RSNA classification categories were: negative, 14.4%; atypical, 5.7%; indeterminate, 44.9%; and typical, 92.5%. Pooled pairs of sensitivity and specificity using CO-RADS thresholds were the following: at least 3, 92.5% (95% CI: 87.1, 95.7) and 69.2% (95%: CI: 60.8, 76.4); at least 4, 85.8% (95% CI: 78.7, 90.9) and 84.6% (95% CI: 79.5, 88.5); and 5, 70.4% (95% CI: 60.2, 78.9) and 93.1% (95% CI: 87.7, 96.2). Pooled pairs of sensitivity and specificity using RSNA classification thresholds for indeterminate were 90.2% (95% CI: 87.5, 92.3) and 75.1% (95% CI: 68.9, 80.4) and for typical were 65.2% (95% CI: 37.0, 85.7) and 94.9% (95% CI: 86.4, 98.2). Conclusion COVID-19 infection frequency was higher in patients categorized with higher CO-RADS and RSNA classification categories. Supplemental material is available for this article. Keywords: CT, Lung, Meta-Analysis, Thorax © RSNA, 2021