Radiological Society of North America Chest CT Classification System for Reporting COVID-19 Pneumonia: Interobserver Variability and Correlation with Reverse-Transcription Polymerase Chain Reaction

Purpose To evaluate the Radiological Society of North America (RSNA) chest CT classification system for reporting coronavirus disease 2019 (COVID-19) pneumonia. Materials and Methods Chest CT scans of consecutive patients suspected of having COVID-19 were retrospectively and independently evaluated by two chest radiologists and a 5th-year radiology resident using the RSNA chest CT classification system for reporting COVID-19 pneumonia. Interobserver agreement was evaluated by calculating weighted κ coefficients. The proportion of patients with real-time reverse-transcription polymerase chain reaction (RT-PCR)–confirmed COVID-19 in each of the four chest CT categories (typical, indeterminate, atypical, and negative features for COVID-19) was calculated. Results In total, 96 patients (61 men; median age, 70 years [range, 29–94]) were included, of whom 45 had RT-PCR–confirmed COVID-19. The number of patients assigned to chest CT categories typical, indeterminate, atypical, and negative by the three readers ranged from 18 to 29, 26 to 43, 19 to 31, and 5 to 8, respectively. The κ coefficient among the chest radiologists was 0.663 (95% confidence interval [CI]: 0.565, 0.761). κ coefficients among the chest radiologists and the 5th-year radiology resident were 0.570 (95% CI: 0.443, 0.696) and 0.564 (95% CI: 0.451, 0.678), respectively. The proportion of patients with RT-PCR–confirmed COVID-19 in the chest CT categories typical, indeterminate, atypical, and negative for the three readers ranged from 76.9% to 96.6%, 51.2% to 64.1%, 2.8% to 5.3%, and 20% to 25%, respectively. Conclusion The RSNA chest CT classification system for reporting COVID-19 pneumonia has moderate-to-substantial interobserver agreement. However, the proportion of RT-PCR–confirmed COVID-19 cases in the categories atypical appearance and negative for pneumonia is nonnegligible. Supplemental material is available for this article.