Initial chest CT findings in COVID-19: correlation with clinical features.
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ABSTRACT:
SUBMITTER: Shen ZJ
PROVIDER: S-EPMC7237343 | biostudies-literature | 2020 Aug.
REPOSITORIES: biostudies-literature
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Initial chest CT findings in COVID-19: correlation with clinical features.
Shen Zhu-Jing ZJ Lu Nan N Gao Lu-Lu LL Lv Jian J Luo Hua-Fu HF Jiang Ji-Feng JF Xu Chao C Li Shi-Ya SY Mao Ju-Jiang JJ Li Kai K Xu Xiao-Pei XP Lin Bin B
Journal of Zhejiang University. Science. B 20200801 8
In December 2019, coronavirus disease 2019 (COVID-19), a new de novo infectious disease, was first identified in Wuhan, China and quickly spread across China and around the world. The etiology was a novel betacoronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Lu et al., 2020). On Mar. 11, 2020, World Health Organization (WHO) characterized COVID-19 as a global pandemic. As of Mar. 22, 2020, over 292 000 confirmed COVID-19 cases have been reported globally. To date, CO ...[more]
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Project description:PurposeTo analyze the initial CT features of different clinical categories of COVID-19.Material and methodsA total of 86 patients with COVID-19 were analyzed, including the clinical, laboratory and imaging features. The following imaging features were analyzed, the lesion amount, location, density, lung nodule, halo sign, reversed-halo sign, distribution pattern, inner structures and changes of adjacent structures. Chi-square test, Fisher's exact test, or Mann-Whitney U test was used for the enumeration data. Binary logistic regression analysis was performed to draw a regression equation to estimate the likelihood of severe and critical category. The forward conditional method was employed for variable selection.ResultsSignificant statistical differences were found in age (p = 0.001) and sex (p = 0.028) between mild and moderate and severe and critical category. No significant difference was found in clinical symptoms and WBC count between the two groups. The majority of cases (91.8%) showed multifocal lesions. The presence of GGO was higher in severe and critical category than in the mild and moderate category. (57.8% vs.31.7%, p = 0.015). Lymphocyte count was important indicator for the severe and critical category.ConclusionThe initial CT features of the different clinical category overlapped. Combining with laboratory test, especially the lymphocyte count, could help to predict the severity of COVID-19.Supplementary informationThe online version contains supplementary material available at 10.1007/s42058-021-00056-4.
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Project description:Background The standard for diagnosis of SARS-CoV-2 virus is reverse transcription polymerase chain reaction (RT-PCR) test, but chest CT may play a complimentary role in the early detection of COVID-19 pneumonia. Purpose To investigate CT features of patients with COVID-19 in Rome, Italy, and to compare the accuracy of CT with RT-PCR. Methods In this prospective study from March 4, 2020, until March 19, 2020, consecutive patients with suspected COVID-19 infection and respiratory symptoms were enrolled. Exclusion criteria were: chest CT with contrast medium performed for vascular indications, patients who refused chest CT or hospitalization, and severe CT motion artifact. All patients underwent RT-PCR and chest CT. Diagnostic performance of CT was calculated using RT-PCR as reference. Chest CT features were calculated in a subgroup of RT-PCR-positive and CT-positive patients. CT features of hospitalized patients and patient in home isolation were compared by using Pearson chi squared test. Results Our study population comprised 158 consecutive study participants (83 male and 75 female, mean age 57 y ±17). Fever was observed in 97/158 (61%), cough in 88/158 (56%), dyspnea in 52/158 (33%), lymphocytopenia in 95/158 (60%), increased C-reactive protein level in 139/158 (88%), and elevated lactate dehydrogenase in 128/158 (81%) study participants. Sensitivity, specificity, and accuracy of CT were 97% (60/62)[95% IC, 88-99%], 56% (54/96)[95% IC,45-66%] and 72% (114/158)[95% IC 64-78%], respectively. In the subgroup of RT-PCR-positive and CT-positive patients, ground-glass opacities (GGO) were present in 58/58 (100%), multilobe and posterior involvement were both present in 54/58 (93%), bilateral pneumonia in 53/58 (91%), and subsegmental vessel enlargement (> 3 mm) in 52/58 (89%) of study participants. Conclusion The typical pattern of COVID-19 pneumonia in Rome, Italy, was peripherally ground-glass opacities with multilobe and posterior involvement, bilateral distribution, and subsegmental vessel enlargement (> 3 mm). Chest CT sensitivity was high (97%) but with lower specificity (56%).
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Project description:Since December 2019, the novel coronavirus disease (COVID-19) has spread rapidly throughout China. This article reviews the chest CT features of COVID-19 and analyzes the role of chest CT in this health emergency.
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Project description:COVID-19 (coronavirus disease 2019) is a recently emerged pulmonary infection caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2). It started in Wuhan, China, in December 2019 and led to a highly contagious disease. Since then COVID-19 continues to spread, causing exponential morbidity and mortality and threatening economies worldwide. While the primary diagnostic test for COVID-19 is the reverse transcriptase-polymerase chain reaction (RT-PCR) assay, chest CT has proven to be a diagnostic tool of high sensitivity. A variety of conditions demonstrates CT features that are difficult to differentiate from COVID-19 rendering CT to be of low specificity. Radiologists and physicians should be aware of imaging patterns of these conditions to prevent an erroneous diagnosis that could adversely influence management and patients' outcome. Our purpose is to provide a practical review of the conditions that mimic COVID-19. A brief description of the forementioned clinical conditions with their CT features will be included.
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Project description:PurposeTo assess the spectrum of computed tomography angiogram (CTA) abdominal and pelvic findings in critically ill COVID-19 patients and investigate correlation with CT chest scores.MethodsAn IRB approved retrospective study of CTA of the chest, abdomen and pelvis between dates March 1st to September 15th, 2020 was performed in the hospitalized COVID-19 positive patients. CTA studies of solely the chest were excluded. Medical record review was performed to note patient demographics, CTA scan details and coagulation profile. CTA findings were reviewed to record vascular and non-vascular findings. CT chest was reviewed to calculate CT chest score. Logistic regression analyses were performed to correlate CT chest scores with odds of vascular and other abdomen-pelvis findings. A p < 0.05 was considered statistically significant.ResultsA total of 45 consecutive hospitalized COVID-19 positive patients with 61 years mean age and M:F (2:1) gender ratio were evaluated, out of which majority 68.9% (n = 31) had CTA chest, abdomen and pelvis. The most common vascular findings were hematoma 46.7% (n = 21), active extravasation 24.4% (n = 11) and vascular occlusion 17.8% (n = 8). Higher CT chest scores were significantly associated with hematoma/extravasation (OR 1.19, 95% CI 1.07-1.34, p < 0.01). The most common non-vascular abdomen-pelvis findings were seen in organs gallbladder 20% (n = 9), liver 20% (n = 9) followed by kidney 15.6% (n = 7). Higher CT chest scores were significantly associated with bowel findings (OR 1.28, 95% CI 1.01-1.63, p < 0.05) and cholestasis (OR 13.3, 95% CI 1.28-138.9, p < 0.05).ConclusionPatients with moderate to severe COVID-19 pneumonia have significantly higher rate of vascular complications in the abdomen and pelvis.
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Project description: Not available
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Project description:ObjectivesGround-glass opacity and consolidation are recognized typical features of Coronavirus disease-19 (COVID-19) pneumonia on Chest CT, yet ancillary findings have not been fully described. We aimed to describe ancillary findings of COVID-19 pneumonia on CT, to define their prevalence, and investigate their association with clinical data.MethodsWe retrospectively reviewed our CT chest cases with coupled reverse transcriptase polymerase chain reaction (rt-PCR). Patients with negative rt-PCR or without admission chest CT were excluded. Ancillary findings included: vessel enlargement, subpleural curvilinear lines, dependent subpleural atelectasis, centrilobular solid nodules, pleural and/or pericardial effusions, enlarged mediastinal lymph nodes. Continuous data were expressed as median and 95% confidence interval (95% CI) and tested by Mann-Whitney U test.ResultsAncillary findings were represented by 106/252 (42.1%, 36.1 to 48.2) vessel enlargement, 50/252 (19.8%, 15.4 to 25.2) subpleural curvilinear lines, 26/252 (10.1%, 7.1 to 14.7) dependent subpleural atelectasis, 15/252 (5.9%, 3.6 to 9.6) pleural effusion, 15/252 (5.9%, 3.6 to 9.6) mediastinal lymph nodes enlargement, 13/252 (5.2%, 3 to 8.6) centrilobular solid nodules, and 6/252 (2.4%, 1.1 to 5.1) pericardial effusion. Air space disease was more extensive in patients with vessel enlargement or centrilobular solid nodules (p < 0.001). Vessel enlargement was associated with longer history of fever (p = 0.035) and lower admission oxygen saturation (p = 0.014); dependent subpleural atelectasis with lower oxygen saturation (p < 0.001) and higher respiratory rate (p < 0.001); mediastinal lymph nodes with shorter history of cough (p = 0.046); centrilobular solid nodules with lower prevalence of cough (p = 0.023), lower oxygen saturation (p < 0.001), and higher respiratory rate (p = 0.032), and pericardial effusion with shorter history of cough (p = 0.015). Ancillary findings associated with longer hospital stay were subpleural curvilinear lines (p = 0.02), whereas centrilobular solid nodules were associated with higher rate of intensive care unit admission (p = 0.01).ConclusionTypical high-resolution CT findings of COVID-19 pneumonia are frequently associated with ancillary findings that variably associate with disease extent, clinical parameters, and disease severity.Advances in knowledgeAncillary findings might reflect the broad range of heterogeneous mechanisms in severe acute respiratory syndrome from viral pneumonia, and potentially help disease phenotyping.
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| S-EPMC7645347 | biostudies-literature
Project description:ObjectivesThe aim of this study was to investigate the chest computed tomography (CT) findings in patients with confirmed coronavirus disease 2019 (COVID-19) and to evaluate its relationship with clinical features.Materials and methodsStudy sample consisted of 80 patients diagnosed as COVID-19 from January to February 2020. The chest CT images and clinical data were reviewed, and the relationship between them was analyzed.ResultsTotally, 80 patients diagnosed with COVID-19 were included. With regards to the clinical manifestations, 58 (73%) of the 80 patients had cough, and 61 (76%) of the 80 patients had high temperature levels. The most frequent CT abnormalities observed were ground glass opacity (73/80 cases, 91%), consolidation (50/80 cases, 63%), and interlobular septal thickening (47/80, 59%). Most of the lesions were multiple, with an average of 12 ± 6 lung segments involved. The most common involved lung segments were the dorsal segment of the right lower lobe (69/80, 86%), the posterior basal segment of the right lower lobe (68/80, 85%), the lateral basal segment of the right lower lobe (64/80, 80%), the dorsal segment of the left lower lobe (61/80, 76%), and the posterior basal segment of the left lower lobe (65/80, 81%). The average pulmonary inflammation index value was (34% ± 20%) for all the patients. Correlation analysis showed that the pulmonary inflammation index value was significantly correlated with the values of lymphocyte count, monocyte count, C-reactive protein, procalcitonin, days from illness onset, and body temperature (P < 0.05).ConclusionsThe common chest CT findings of COVID-19 are multiple ground glass opacity, consolidation, and interlobular septal thickening in both lungs, which are mostly distributed under the pleura. There are significant correlations between the degree of pulmonary inflammation and the main clinical symptoms and laboratory results. Computed tomography plays an important role in the diagnosis and evaluation of this emerging global health emergency.
| S-EPMC7147284 | biostudies-literature