COVID-19 clinico-radiological mismatch: a proposal for a novel combined morphologic/volumetric CT severity score with blinded validation

Abstract Background Some COVID-19 patients with similar quantitative CT measurements had variable clinical presentation and outcome. The absence of reasonable explanations, such as pre-existing comorbidities or vascular complications, adds to the confusion. authors believed that neglecting impact certain severe morphologic features could be an alternative radiological explanation. This study aims optimize initial staging propose a new combined morphologic/volumetric severity index (CTSI) solve this clinico-radiological mismatch. Results multi-center included two major steps. first step entailed standardized analyses optimized CTSI. was conducted retrospectively during period from June till September 2020. It 379 acutely symptomatic patients. They were clinically classified according their oxygen saturation respiratory therapeutic requirements into three groups: group A (mild 298/79%), B (borderline 57/15%), C (severe/critical 24/6%). volumetric assessment HRCT analyzed severity, by consultant radiologists in consensus. 25 point-CTSI has been created, combining eight morphological patterns [M1:M8; 8 points] four grades scores [S1:S4; 17 points]. addition M5 pattern (air bubble sign), M6 (early fibrosis architectural distortion), M7 (crazy-paving) proved increase severity. second blinded/independent validation analysis for proposed prospectively on other 132 October 2020 independently performed radiologists. Validation results reached 80.2% sensitivity, 91.8% specificity, AUROC-curve = 0.8356, 90.9% accuracy. Conclusion CTSI accepted is patients, using instead alone. mismatch among complications.