Large-scale screening to distinguish between COVID-19 and community-acquired pneumonia using infection size-aware classification.

The worldwide spread of coronavirus disease (COVID-19) has become a threat to global public health. It is of great importance to rapidly and accurately screen and distinguish patients with COVID-19 from those with community-acquired pneumonia (CAP). In this study, a total of 1,658 patients with COVID-19 and 1,027 CAP patients underwent thin-section CT and were enrolled. All images were preprocessed to obtain the segmentations of infections and lung fields. A set of handcrafted location-specific features was proposed to best capture the COVID-19 distribution pattern, in comparison to the conventional CT severity score (CT-SS) and radiomics features. An infection size-aware random forest method (iSARF) was proposed for discriminating COVID-19 from CAP. Experimental results show that the proposed method yielded its best performance when using the handcrafted features, with a sensitivity of 90.7%, a specificity of 87.2%, and an accuracy of 89.4% over state-of-the-art classifiers. Additional tests on 734 subjects, with thick slice images, demonstrates great generalizability. It is anticipated that our proposed framework could assist clinical decision making.