• Steven Schalekamp, Chantal P Bleeker-Rovers, Beenen Ludo F M LFM 0000-0001-9204-1026 From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal Medicine, , Henriette M E Quarles van Ufford, Hester A Gietema, J Lauran Stöger, Vanessa Harris, Monique H E Reijers, Janette Rahamat-Langendoen, Daniel A Korevaar, Loek P Smits, Christine Korteweg, Tjalco F D van Rees Vellinga, Marieke Vermaat, Patricia M Stassen, Henk Scheper, Roos Wijnakker, Frank J Borm, Dofferhoff Anthonius S M ASM 0000-0001-5900-3829 From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal M, and Mathias Prokop.
• From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal Medicine, Division of Infectious Diseases, and Radboud Center for Infectious Diseases (C.P.B.R.), Department of Pulmonology (M.H.E.R.), and Department of Medical Microbiology and Radboud Center for Infectious Diseases (J.R.L.), Radboud University Medical Center, Geert Grooteplein zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology (L.F.M.B.), Department of Medicine, Division of Infectious Diseases, Department of Internal Medicine (V.H.), Department of Respiratory Medicine (D.A.K.), and Department of Internal Medicine (L.P.S.), Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Departments of Radiology and Nuclear Medicine (H.M.E.Q.v.U., T.v.R.V.) and Pulmonology (C.K.), Haaglanden Medical Center, The Hague, the Netherlands; Department of Radiology and Nuclear Medicine (H.A.G.) and Department of Internal Medicine (P.M.S.), Maastricht University Medical Center+, Maastricht, the Netherlands; Departments of Radiology (J.L.S.), Infectious Diseases (H.S., R.W.), and Pulmonology (F.J.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands (V.H.); Departments of Radiology (M.V.) and Internal Medicine (A.S.M.D.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; and GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.).
• Radiology. 2021 Feb 1; 298 (2): E98-E106.

AbstractBackground Clinicians need to rapidly and reliably diagnose coronavirus disease 2019 (COVID-19) for proper risk stratification, isolation strategies, and treatment decisions. Purpose To assess the real-life performance of radiologist emergency department chest CT interpretation for diagnosing COVID-19 during the acute phase of the pandemic, using the COVID-19 Reporting and Data System (CO-RADS). Materials and Methods This retrospective multicenter study included consecutive patients who presented to emergency departments in six medical centers between March and April 2020 with moderate to severe upper respiratory symptoms suspicious for COVID-19. As part of clinical practice, chest CT scans were obtained for primary work-up and scored using the five-point CO-RADS scheme for suspicion of COVID-19. CT was compared with severe acute respiratory syndrome coronavirus 2 reverse-transcription polymerase chain reaction (RT-PCR) assay and a clinical reference standard established by a multidisciplinary group of clinicians based on RT-PCR, COVID-19 contact history, oxygen therapy, timing of RT-PCR testing, and likely alternative diagnosis. Performance of CT was estimated using area under the receiver operating characteristic curve (AUC) analysis and diagnostic odds ratios against both reference standards. Subgroup analysis was performed on the basis of symptom duration grouped presentations of less than 48 hours, 48 hours through 7 days, and more than 7 days. Results A total of 1070 patients (median age, 66 years; interquartile range, 54-75 years; 626 men) were included, of whom 536 (50%) had a positive RT-PCR result and 137 (13%) of whom were considered to have a possible or probable COVID-19 diagnosis based on the clinical reference standard. Chest CT yielded an AUC of 0.87 (95% CI: 0.84, 0.89) compared with RT-PCR and 0.87 (95% CI: 0.85, 0.89) compared with the clinical reference standard. A CO-RADS score of 4 or greater yielded an odds ratio of 25.9 (95% CI: 18.7, 35.9) for a COVID-19 diagnosis with RT-PCR and an odds ratio of 30.6 (95% CI: 21.1, 44.4) with the clinical reference standard. For symptom duration of less than 48 hours, the AUC fell to 0.71 (95% CI: 0.62, 0.80; P < .001). Conclusion Chest CT analysis using the coronavirus disease 2019 (COVID-19) Reporting and Data System enables rapid and reliable diagnosis of COVID-19, particularly when symptom duration is greater than 48 hours. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Elicker in this issue.

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