Proposed reporting language for CT findings related to COVID-19

Routine screening CT for diagnosis or exclusion of COVID-19 is currently not recommended by most professional organizations or the US Centers for Disease Control and Prevention
COVID-19 pneumonia imaging classification	Rationale	CT findings	Suggested reporting language
Typical appearance	Commonly reported imaging features of greater specificity for COVID-19 pneumonia.	Peripheral, bilateral, GGO with or without consolidation or visible intralobular lines ("crazy-paving") Multifocal GGO of rounded morphology with or without consolidation or visible intralobular lines ("crazy-paving") Reverse halo sign or other findings of organizing pneumonia (seen later in the disease)	"Commonly reported imaging features of (COVID-19) pneumonia are present. Other processes such as influenza pneumonia and organizing pneumonia, as can be seen with drug toxicity and connective tissue disease, can cause a similar imaging pattern."
Indeterminate appearance	Nonspecific imaging features of COVID-19 pneumonia.	Absence of typical features AND Presence of: Multifocal, diffuse, perihilar, or unilateral GGO with or without consolidation lacking a specific distribution and are non-rounded or non-peripheral. Few very small GGO with a non-rounded and non-peripheral distribution.	"Imaging features can be seen with (COVID-19) pneumonia, though are nonspecific and can occur with a variety of infectious and noninfectious processes."
Atypical appearance	Uncommonly or not reported features of COVID-19 pneumonia.	Absence of typical or indeterminate features AND Presence of: Isolated lobar or segmental consolidation without GGO Discrete small nodules (centrilobular, "tree-in-bud") Lung cavitation Smooth interlobular septal thickening with pleural effusion	"Imaging features are atypical or uncommonly reported for (COVID-19) pneumonia. Alternative diagnoses should be considered."
Negative for pneumonia	No features of pneumonia.	No CT features to suggest pneumonia.	"No CT findings present to indicate pneumonia. (NOTE: CT may be negative in the early stages of COVID-19.)"
NOTES: Inclusion in a report of items noted in parenthesis in the Suggested reporting language column may depend upon clinical suspicion, local prevalence, patient status as a PUI, and local procedures regarding reporting. CT is not a substitute for RT-PCR, consider testing according to local recommendations and procedures for and availability of RT-PCR.

Proposed reporting language for CT findings related to COVID-19, including rationale, CT findings, and suggested reporting language for each category. Associated CT findings for each category are based upon available literature at the time of writing in March 2020, noting the retrospective nature of many reports, including biases related to patient selection in cohort studies, examination timing, and other potential confounders.

COVID-19: coronavirus disease 2019; CT: computed tomography; GGO: ground-glass opacity; PUI: person under investigation; RT-PCR: reverse transcription polymerase chain reaction.

From: Simpson S, Kay FU, Abbara S, et al. Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. Radiology: Cardiothoracic Imaging 2020. Copyright © 2020 Radiological Society of North America. Available at: https://pubs.rsna.org/doi/10.1148/ryct.2020200152 (Accessed on April 6, 2020). Reproduced under the terms of the Creative Commons Attribution License.

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Proposed reporting language for CT findings related to COVID-19