COVID-19 pneumonia and its lookalikes: How radiologists perform in differentiating atypical pneumonias

•Radiologists can differentiate COVID-19 from other atypical pneumonias on chest CT.•Radiologists performed worse in the early and late CT stage of COVID 19 pneumonia.•PJP-, CMV- and HSV1-pneumonia were most similar to COVID-19 pneumonia on chest CT. To examine the performance of radiologists in dif...

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Published in:European journal of radiology 2021-11, Vol.144, p.110002-110002, Article 110002
Main Authors: Giannakis, Athanasios, Móré, Dorottya, Erdmann, Stella, Kintzelé, Laurent, Fischer, Ralph Michael, Vogel, Monika Nadja, Mangold, David Lukas, von Stackelberg, Oyunbileg, Schnitzler, Paul, Zimmermann, Stefan, Heussel, Claus Peter, Kauczor, Hans-Ulrich, Hellbach, Katharina
Format: Article
Language:English
Subjects:
Atypical
Bacteria
COVID-19
Fungal
Humans
Influenza, Human
Lung
Radiologists
Retrospective Studies
SARS-CoV-2
Viral
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Summary:•Radiologists can differentiate COVID-19 from other atypical pneumonias on chest CT.•Radiologists performed worse in the early and late CT stage of COVID 19 pneumonia.•PJP-, CMV- and HSV1-pneumonia were most similar to COVID-19 pneumonia on chest CT. To examine the performance of radiologists in differentiating COVID-19 from non-COVID-19 atypical pneumonia and to perform an analysis of CT patterns in a study cohort including viral, fungal and atypical bacterial pathogens. Patients with positive RT-PCR tests for COVID-19 pneumonia (n = 90) and non-COVID-19 atypical pneumonia (n = 294) were retrospectively included. Five radiologists, blinded to the pathogen test results, assessed the CT scans and classified them as COVID-19 or non-COVID-19 pneumonia. For both groups specific CT features were recorded and a multivariate logistic regression model was used to calculate their ability to predict COVID-19 pneumonia. The radiologists differentiated between COVID-19 and non-COVID-19 pneumonia with an overall accuracy, sensitivity, and specificity of 88% ± 4 (SD), 79% ± 6 (SD), and 90% ± 6 (SD), respectively. The percentage of correct ratings was lower in the early and late stage of COVID-19 pneumonia compared to the progressive and peak stage (68 and 71% vs 85 and 89%). The variables associated with the most increased risk of COVID-19 pneumonia were band like subpleural opacities (OR 5.55, p 
ISSN:0720-048X
1872-7727
DOI:10.1016/j.ejrad.2021.110002