Chest X-Ray findings and visual quantitative assessment of COVID-19 pneumonia

Abstract AimTo assess the most common chest X-Ray findings and distribution in patients with confirmed diagnosis of COVID-19; to verify the repeatability of a radiological severity score, based on visual quantitative assessment; to assess the evolution of chest X-Ray findings at follow-up; to evaluate chest X-Ray sensitivity.MethodsWe analysed chest X-Rays at baseline of 110 consecutive COVID-19 patients (79 males, 31 females; mean age: 64±16 years) with RT-PCR confirmation, who presented to our ED.Two radiologists evaluated the imaging findings and distribution.A severity score, based on the extension of lung abnormalities, was assigned by two other radiologists, independently, to the baseline and follow-up X-Rays, executed in 77/110 cases; interobserver agreement was calculated. Chest X-Ray sensitivity was assessed, with RT-PCR as gold standard.ResultsInterobserver agreement was excellent for baseline and follow-up X-Rays (Cohen's K=0.989, p<0.001, Cohen's K=0.985, p<0.001, respectively). The mean score at baseline was 2.87±1.7 for readers 1 and 2. We observed radiological worsening in 52/77 (67%) patients, with significantly higher scores at follow-up (mean score: 4.27±2.15 for reader 1 and 4.28±2.14 for reader 2, respectively); p<0.001.Ground glass opacities were the most common findings (97/110, 88%). Abnormalities showed bilateral involvement in 67/110 (61%), with prevalent peripheral distribution (48/110, 43.5%).The X-Ray sensitivity for the detection of COVID-19 infection was 91%.ConclusionChest X-Ray highlighted imaging findings in line with those previously reported for chest CT. The use of a radiological score can result in clearer communication with Clinicians and a more precise assessment of disease evolution.