True-Positive Rate of RSNA Typical Chest CT Findings for COVID-19 Pneumonia in an Increasingly Vaccinated Population.

Background RSNA COVID-19 chest CT consensus guidelines are widely used, but their true positive rate for COVID-19 pneumonia has not been assessed among vaccinated patients. Purpose To assess true positive rate of RSNA typical chest CT findings of COVID-19 among fully vaccinated subjects with PCR-confirmed COVID-19 infection compared with unvaccinated subjects. Materials and Methods Patients with COVID Typical chest CT findings and one positive or two negative PCR tests for COVID-19 within 7 days of their chest CT between January 2021 - January 2022 at a quaternary academic medical center were included. True positives were defined as chest CTs interpreted as COVID Typical and PCR-confirmed COVID-19 infection within 7 days. Logistic regression models were constructed to quantify the association between PCR results and vaccination status, vaccination status and COVID-19 variants, and vaccination status and months. Results 652 subjects (median age 59, [IQR, 48-72]); 371 [57%] men) with CT scans classified as COVID Typical were included. 483 (74%) were unvaccinated and 169 (26%) were fully vaccinated. The overall true positive rate of COVID Typical CTs was lower among vaccinated versus unvaccinated (70/169 [41%; 95% CI: 34, 49%] vs 352/483 [73%; 69, 77%]; OR (95% CI): 3.8 (2.6, 5.5); P < .001). Unvaccinated subjects were more likely to have true positive CTs compared with fully vaccinated subjects during the peaks of COVID-19 variants Alpha (OR, 16 [95% CI: 6.1, 42]; P < .001) and Delta (OR, 8.3 [95% CI: 4.2, 16]; P < .001), but no statistical differences were found during the peak of Omicron variant (OR, 1.7 [95% CI: 0.27, 11]; P = .56) Conclusion Fully vaccinated subjects with confirmed COVID-19 breakthrough infections had lower true positive rates of COVID Typical chest CT findings.