Chest CT texture-based radiomics analysis in differentiating COVID-19 from other interstitial pneumonia

• Published in: Radiologia medica Vol. 126; no. 11; pp. 1415 - 1424
• Main Authors: Caruso, Damiano, Pucciarelli, Francesco, Zerunian, Marta, Ganeshan, Balaji, De Santis, Domenico, Polici, Michela, Rucci, Carlotta, Polidori, Tiziano, Guido, Gisella, Bracci, Benedetta, Benvenga, Antonella, Barbato, Luca, Laghi, Andrea
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01-11-2021; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Chest; Chest Radiology; Coronaviruses; COVID-19; COVID-19 - diagnostic imaging; Diagnosis, Differential; Diagnostic Radiology; Emergency medical services; Etiology; Evaluation; Feature extraction; Female; Humans; Image filters; Imaging; Interventional Radiology; Kurtosis; Lung Diseases, Interstitial - diagnostic imaging; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Pilot Projects; Pneumonia; Polymerase chain reaction; Radiology; Radiomics; Retrospective Studies; Texture; Tomography, X-Ray Computed; Ultrasound; Viral diseases; Young Adult; COVID-19; Diagnostic tool; Texture analysis; Computed tomography
• ISSN: 0033-8362; 1826-6983
• DOI: 10.1007/s11547-021-01402-3

Purpose
To evaluate the potential role of texture-based radiomics analysis in differentiating Coronavirus Disease-19 (COVID-19) pneumonia from pneumonia of other etiology on Chest CT.
Materials and methods
One hundred and twenty consecutive patients admitted to Emergency Department, from March 8, 2020, to April 25, 2020, with suspicious of COVID-19 that underwent Chest CT, were retrospectively analyzed. All patients presented CT findings indicative for interstitial pneumonia. Sixty patients with positive COVID-19 real-time reverse transcription polymerase chain reaction (RT-PCR) and 60 patients with negative COVID-19 RT-PCR were enrolled.
CT texture analysis (CTTA) was manually performed using dedicated software by two radiologists in consensus and textural features on filtered and unfiltered images were extracted as follows: mean intensity, standard deviation (SD), entropy, mean of positive pixels (MPP), skewness, and kurtosis. Nonparametric Mann–Whitney test assessed CTTA ability to differentiate positive from negative COVID-19 patients. Diagnostic criteria were obtained from receiver operating characteristic (ROC) curves.
Results
Unfiltered CTTA showed lower values of mean intensity, MPP, and kurtosis in COVID-19 positive patients compared to negative patients (
p
 = 0.041, 0.004, and 0.002, respectively). On filtered images, fine and medium texture scales were significant differentiators; fine texture scale being most significant where COVID-19 positive patients had lower SD (
p
 = 0.004) and MPP (
p
 = 0.004) compared to COVID-19 negative patients. A combination of the significant texture features could identify the patients with positive COVID-19 from negative COVID-19 with a sensitivity of 60% and specificity of 80% (
p
 = 0.001).
Conclusions
Preliminary evaluation suggests potential role of CTTA in distinguishing COVID-19 pneumonia from other interstitial pneumonia on Chest CT.