Congruence of radiological scoring systems used in COVID-19 pneumonia and effect of comorbid diseases on radiological features

Radiological appearances in COVID-19



COVID-19, pneumonia, radiological appearance, scoring systems, comorbid diseases


Background/Aim: Several scoring systems have been developed to standardize radiological findings in patients with COVID-19 pneumonia. The most commonly used scoring systems in the radiological examination of COVID-19 are those of the North American Radiology Association (RSNA), British Thoracic Society (BTS), and COVID-19 Reporting and Data System (CO-RADS). However, the compatibility between these radiological scoring systems has not been evaluated before. Therefore, this study evaluated the radiological features of COVID-19 pneumonia and congruence between radiological scoring systems and determined the effect of comorbidities and demographic characteristics on radiological features and thoracic computed tomography (TCT) findings in the context of COVID-19.

Methods: A retrospective cohort study was performed on patients attending our unit with a suspicion of COVID-19 who also had a positive real-time transcriptase-polymerase chain reaction (RT-PCR) test. All TCT images were subjected to the RSNA, BTS, and CO-RADS scoring systems. Demographic data such as age and gender, and comorbid conditions were recorded.

Results: TCT showed peripheral, posterior, and bilateral involvement in 97.7%, 97.7%, and 87.6% of the patients, respectively. The most common TCT finding was ground glass appearance, which was found in 95.5% of the patients. The Charlson Comorbidity Index (CCI) score was found to have an impact on RSNA and BTS criteria (P=0.011 and P=0.014), while age, gender, and the presence of comorbidities such as cardiovascular disease (CVD), diabetes mellitus (DM), and chronic pulmonary disease (CPD) did not have such an effect (P>0.05 for all). On the other hand, CCI scores and the presence of CPD had an association with CO-RADS, but there was no effect of age, gender, DM, and CVD (P=0.915 and P=0.730).

Conclusion: TCT plays an important role in early management, isolation, and follow-up of patients with COVID-19 pneumonia. The radiological scoring systems were found to exhibit good compatibility, but comorbid conditions could have an impact on the assessment. Therefore, we conclude that these radiological assessment criteria are useful in the management and monitoring of such patients.


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Ölmez H, Tosun M, Ünver E, Özer D, Karavas E, Arslan YK. Congruence of radiological scoring systems used in COVID-19 pneumonia and effect of comorbid diseases on radiological features: Radiological appearances in COVID-19. J Surg Med [Internet]. 2023 Jan. 22 [cited 2024 Feb. 25];7(1):101-6. Available from: