CO-RADS (COVID-19 Reporting and Data System)

COVID-19, which first started spreading in December 2019 and was declared a pandemic in March 2020, is still spreading in 2021. While there are still many challenges to deal with today, there are also many learnings since the beginning of the pandemic that can be applied to better diagnose and treat the condition. The diagnosis of active infection is based on the results on an RT-PCR (real-time reverse-transcriptase polymerase chain reaction) test. Antibody tests are also used to the detection of SARS-CoV-2 antibodies in the patient’s blood. Additionally, a chest CT scan or a chest HRCT scan may be ordered as a diagnostic tool or to understand the progression of the disease through the damage caused to the lungs.

CO-RADS stands for COVID-19 Reporting and Data System and was specifically developed by Dutch researchers to better deal with COVID-19. It is a system that aims to standardize the assessment of pulmonary involvement in COVID-19 cases. It is not the only system of this kind, another one being the RSNA (Radiological Society of North America) chest CT classification system for reporting COVID-19 pneumonia. There are 7 CO-RADS categories from 0 to 6. The categorization is done based on non-enhanced CT scan results as well as symptom presentation when RT-PCR results are unavailable. CT scan results come in much faster than RT-PCR results, which can be life-saving in situations where the patient’s condition is serious and their COVID-19 status is not established.

Features of COVID-19
CO-RADS Categories

Doctors for CO-RADS

Features of COVID-19

As per research studies, typical features of COVID-19 seen on CT scans:

Ground-glass opacities or areas
Crazy paving (described as visible intralobular lines)
Patterns compatible with pneumonia
Thickened vessels within abnormalities

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CO-RADS Categories

Following are each of the categories are what they mean for the patient:

CO-RADS Category 0

CO-RADS category 0 is assigned when the CT scan was incomplete or not technically sufficient enough for assigning any of the other scores. Ideally, the scan should be repeated for an accurate score.

CO-RADS Category 1

In category 1, the level of suspicion of pulmonary involvement is considered to be very low. In cases assigned category 1, either the CT scan results were normal or they showed abnormalities that could be attributed to non-infectious diseases such as mild to severe emphysema, perifissural nodules, lung tumors or fibrosis.

CO-RADS Category 2

In category 2, the level of suspicion of pulmonary involvement with COVID-19 is considered to be low. In cases assigned this category, the CT results could indicate another infection besides COVID-19, like bronchitis, infectious bronchiolitis, bronchopneumonia, lobar pneumonia and pulmonary abscess.

CO-RADS Category 3

In category 3, the level of suspicion of pulmonary involvement with COVID-19 is considered to be unsure, as the CT results, which may show ground-glass opacities (typical for COVID-19 affected lungs), could indicate pulmonary involvement by COVID-19 but also other conditions, such as other viral pneumonia or non-infectious diseases of the lungs.

CO-RADS Category 4

In category 4, the level of suspicion on pulmonary involvement with COVID-19 is considered to be high due to the abnormalities shown in the images. If assigned this category, it would mean that the CT results are typical for a COVID-19 positive patient but there is a slight overlap still with other types of viral pneumonia as there are some classic features that are placed atypically on the images - this is what differentiates it from Category 5.

(Read more: Lung infections)

CO-RADS Category 5

In category 5, the level of suspicion of pulmonary involvement with COVID-19 becomes very high. Ground glass opacities are noted in the CT scans, with or without consolidation, closer to the visceral pleura (a membrane surrounding the lungs) than in the categories before this. There are three different patterns that may be noted on the images, which confirm the stage of the disease.

CO-RADS Category 6

Category 6 is for confirmed cases of COVID-19 infection through an RT-PCR test.

(Read more: COVID-19 and pregnancy)