For each patient, three readers recorded the presence of GGO, consolidation, and crazy-paving pattern, as defined by the glossary of terms for thoracic imaging from Fleischner Society [20]. Readers included two radiologists devoted to thoracic imaging, namely reader 1 (R1) and reader 2 (R2), with 10 and 3 years of experience, respectively, and one generalist radiologist (R3) with 20 years of experience in body imaging. Readers also assessed whether GGO and/or consolidation presented with an OP pattern, i.e., whether they showed triangular or polygonal shape, or were associated with perilobular pattern, bronchial dilatation, reverse halo sign, linear and band-like opacities, and signs of fibrosis [21]. On a per-examination basis, six lung zones were identified (3 per lung), i.e., two upper zones (above the carina), two middle zones (from the carina to the inferior pulmonary veins), and two lower zones (below the inferior pulmonary veins). Readers then assessed the zonal extent of GGO, consolidation, and crazy-paving pattern, using a previously reported semi-quantitative score [11, 22]. Score was 0 if the feature was not present, 1 if it was present with a <25% zonal involvement, 2 for a ≥25% to <50% involvement, 3 for a ≥50% to <75% involvement, and 4 for ≥75% involvement. Therefore, the per-patient total score for each pulmonary feature (TFS) ranged from 0 (i.e., a certain feature was scored 0 in each of the six lung zones) to 24 (i.e., a certain feature was scored 4 in each of the six lung zones). TLS was defined as the summing up of the GGO, consolidation, and crazy-paving pattern TFSs.

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