Reporting of COVID-19 Chest CT Findings


In this 14-minute video presentation, Dr Jonathan Chung (@jonherochung) outlines the reporting language and categories recently proposed by the RSNA expert consensus statement for the reporting of COVID-19 chest CT findings. Jonathan is Professor of Radiology and Section Chief of Cardiothoracic Imaging at University of Chicago Medicine, and is Radiopaedia's Chest Imaging expert adviser.

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More Radiopaedia COVID-19 resources and initiatives:

The British Society of Thoracic Imaging (BSTI) have published a reporting proforma for the plain chest radiographic appearances of potential COVID-19 cases 168

  • classic/probable COVID-19
    • lower lobe and peripheral predominant multiple opacities that are bilateral (>> unilateral)
  • indeterminate for COVID-19
    • does not fit classic or non-COVID-19 descriptors
  • non-COVID-19
    • pneumothorax / lobar pneumonia / pleural effusion(s) / pulmonary edema / other
  • normal
    • COVID-19 not excluded

The Radiological Society of North America (RSNA) has released a consensus statement endorsed by the Society of Thoracic Radiology and the American College of Radiology (ACR) that classifies the CT appearance of COVID-19 into four categories for standardized reporting language 99:

  • typical appearance
    • peripheral, bilateral, GGO +/- consolidation or visible intralobular lines (“crazy paving” pattern)
    • multifocal GGO of rounded morphology +/- consolidation or visible intralobular lines (“crazy paving” pattern)
    • reverse halo sign or other findings of organizing pneumonia
  • indeterminate appearance
    • absence of typical CT findings and the presence of
      • multifocal, diffuse, perihilar, or unilateral GGO +/- consolidation lacking a specific distribution and are non-rounded or non-peripheral
      • few very small GGO with a non-rounded and non-peripheral distribution
  • atypical appearance
    • absence of typical or indeterminate features and the presence of
      • isolated lobar or segmental consolidation without GGO
      • discrete small nodules (e.g. centrilobular, tree-in-bud) 
      • lung cavitation
      • smoother interlobular septal thickening with pleural effusion
  • negative for pneumonia: no CT features to suggest pneumonia, in particular, absent GGO and consolidation

A study evaluating the RSNA chest CT classification system for COVID-19 against RT-PCR results found moderate interobserver agreement. Using a cohort of 96 patients, it reported that 76.9-96.6% of "typical" scans, 51.2-64.1% of "indeterminate" scans, 2.8-5.3% "atypical" scans and 20-25% of "negative" scans returned a RT-PCR confirming COVID-19 99,147.

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