Structured report improves radiology residents' performance in reporting chest high-resolution computed tomography: a study in patients with connective tissue disease.

PURPOSE To evaluate the performance of radiology residents (RRs) when using a dedicated structured report (SR) template for chest HRCT in patients with suspected connective tissue disease-interstitial lung disease (CTD-ILD), compared to the traditional narrative report (NR). METHODS We retrospectively evaluated 50 HRCT exams in patients with suspected CTD-ILD. A chest-devoted radiologist reported all the HRCT exams as the reference standard, pointing out pulmonary fibrosis findings (i.e., honeycombing, traction bronchiectasis, reticulation, and volume loss), presence and pattern of ILD, and possible other diagnoses. We divided four RRs into two groups according to their expertise level. In each group, RRs reported all HRCT examinations alternatively with NR or SR, noting each report's reporting time. The Cohen's Kappa, Wilcoxon, and McNemar tests were used for statistical analysis. RESULTS Regarding the pulmonary fibrosis findings, we found higher agreement between RRs and the reference standard reader when using SR than NR, regardless of their expertise level, except for volume loss.RRs' accuracy for "other diagnosis" was higher when using SR than NR, moving from 0.48 to 0.66 in the novel group (p = 0.035) and from 0.44 to 0.80 in the expertise group (p < 0.001). No differences in accuracy were found between ILD presence and ILD pattern. The reporting time was significantly lower (p = 0.001) when using SR than NR. CONCLUSION SR is of value in increasing the reporting of critical chest HRCT findings in the complex CTD-ILD scenario and should be used early and systematically during the residency.

Chest high-resolution computed tomography in patients with connective tissue disease: pulmonary conditions beyond "the usual suspects".

The term "connective tissue diseases" (CTDs) refers to a heterogeneous group of autoimmune disorders, including systemic sclerosis, rheumatoid arthritis, Sjögren's syndrome, systemic lupus erythematosus, polymyositis, dermatomyositis, antisynthetase syndrome, and mixed connective tissue disease. Chest high-resolution computed tomography (HRCT) is the imaging method of choice for evaluating patients with known or suspected CTD-related interstitial lung disease (CTD-ILD), a complication accounting for substantial morbidity and mortality. While specific HRCT patterns and signs of CTD-ILD have been extensively described (hence the designation "the usual suspects"), the knowledge of various, less frequent conditions involving the lungs in patients with CTD would help the radiologist produce a clinically valuable report, thus potentially influencing patient management. This paper aims to provide an up-to-date review of various unusual pulmonary CTD-related conditions the radiologist should be aware of; namely, acute exacerbation of CTD-ILD, CTD-related interstitial lung abnormalities, lung amyloidosis, MALT lymphoma, antisynthetase syndrome, pleuroparenchymal fibroelastosis-like lesion, drug-induced ILD, combined pulmonary fibrosis and emphysema, and pulmonary hypertension. For each condition, the chest HRCT appearance and the key histopathological and clinical features are resumed, helping the radiologist participate actively in the multidisciplinary discussion of complex clinical cases.

Inter-reader agreement of high-resolution computed tomography findings in patients with COVID-19 pneumonia: A multi-reader study.

PURPOSE: To investigate the inter-reader agreement in assessing high-resolution computed tomography (HRCT) features of coronavirus disease 2019 (COVID-19) pneumonia. METHOD: Seventy-seven consecutive patients (mean age, 64 ± 15 years) with mild COVID-19 pneumonia that underwent HRCT were retrospectively included. Three radiologists [two devoted to thoracic imaging (R1, R2), and one generalist (R3)] on a per-examination basis independently assessed ground-glass opacity (GGO), consolidation, and crazy-paving pattern. The extent of each feature (total feature score, TFS) was semi-quantitatively assessed, and each TFS summed up to obtain total lung score (TLS). Presence of organizing pneumonia (OP) pattern was also recorded. The inter-reader agreement was calculated with Cohen's Kappa (k) and Free-Marginal Multirater k. Multivariable analysis was run to determine whether imaging features were predictive of short-term evolution to severe disease (need for ventilation). RESULTS: Most features showed substantial inter-reader agreement, including TLS > 6 (k = 0.69), which was an independent predictor of short-term occurrence of severe disease, regardless of the reader (OR 9-53.19). Consolidation TFS > 2 and OP pattern showed substantial and moderate agreement, respectively, only when comparing R1 and R2. Consolidation TFS > 2 and OP pattern were independent predictors of severe disease for R2 (OR 4.87) and R1 (OR 6), respectively. CONCLUSIONS: The inter-reader agreement for most HRCT features of COVID-19 pneumonia ranges moderate-to-substantial, though it depends on readers' experience in the case of consolidation and OP pattern.