BACKGROUND: The recent outbreak of pneumonia cases in Wuhan, PR China, was caused by a novel beta coronavirus, the 2019 novel coronavirus (COVID-19).
PURPOSE: To summarize chest computed tomography (CT) manifestations of the early stage of COVID-19 infection and provide a piece of reliable imaging evidence for initial screening and diagnosis.
MATERIAL AND METHODS: From 10 January 2020 to 10 February 2020, we continuously observed chest CT imaging of 14 patients with clinically suspected new coronavirus infection in the two weeks after onset of symptoms. Ground-glass opacity (GGO), consolidation, reticular pattern, and ground-glass mimic nodules in each patient's chest CT image were recorded.
RESULTS: We enrolled 14 patients, of which nine patients had the infection confirmed by reverse transcription polymerase chain reaction (RT-PCR). Five patients were highly suspected of infection. All cases had epidemiological evidence. GGO was a dominant imaging manifestation in the initial days of infection. GGO performance accounts for 40% in 1- 2 days, 90% in 3- 6 days, and 85% in 7- 10 days. With disease progression, consolidation appeared on follow-up CT. Consolidation performance accounts for 0% in 1- 2 days, 40% in 3- 6 days, and 71% in 7- 10 days. The lesions are mostly near the pleura. The number of lesions and the extent of the lesions increased as the disease progressed.
CONCLUSION: Patients with novel coronavirus pneumonia have characteristic CT features in the initial stage of infection, which can be used as an essential supplement for nucleic acid examination.
PURPOSE: To explore the clinical and dynamic computed tomography features of coronavirus disease 2019.
METHODS: We enrolled 24 patients with coronavirus disease 2019 treated at a regional center in Dezhou, China, from January 22 to February 5, 2020, and analyzed data retrospectively.
RESULTS: Nineteen cases had close contact with people with coronavirus disease 2019, and five patients denied a travel history in Wuhan City or contact with patients having coronavirus disease 2019. Symptoms were fever, cough, chest tightness, dyspnea, fatigue, and muscle pain. Chest computed tomography showed multiple ground-glass opacities distributed along peribronchial bundles and subpleural areas, often accompanied by bronchiectasis, vascular thickening, and interlobular septal thickening after coronavirus disease 2019 progression.
CONCLUSIONS: Coronavirus disease 2019 has certain clinical characteristics and typical computed tomography features.
OBJECTIVES: To investigate CT images of 100 confirmed COVID-19 pneumonia patients to describe the lesion distribution, CT signs, and evolution during different courses.
METHODS: A retrospective study of 100 COVID-19 pneumonia patients without ARDS was performed, and CT scans were reviewed. A COVID-19 pneumonia course diagram was drawn. Mann-Whitney U test was used to compare the lesion distribution and CT scores, χ2 test was used to compare the CT findings between different stages.
RESULTS: A total of 272 CT scans from 100 patients (mean age, 52.3 years ± 13.1) were investigated. Four patients with lung abnormalities on CT first showed negative RT-PCR result and turned positive afterwards. One hundred sixty-nine (62.1%) showed predominantly peripheral distribution. The CT scores of the upper zone (3.4 ± 3.6) were significantly lower than those of the middle (5.0 ± 3.9) and lower (4.8 ± 3.6) zones (p < 0.001). The CT scores of the anterior zones (4.9 ± 4.7) were significantly lower than those of the posterior zones (8.4 ± 6.2) (p < 0.001). In the early rapid progressive stage (1~7 days), ground glass opacity (GGO) plus reticular pattern (58.1%), GGO plus consolidation (43.0%), and GGO (41.9%) were all common. In the advanced stage (8~14 days), GGO plus consolidation (79.8%) and repairing CT signs (subpleural line, bronchus distortion, and fibrotic strips) showed a significant increase (p < 0.05). In the absorption stage, GGO plus consolidation (9.1%) sharply decreased (p < 0.05).
CONCLUSION: CT imaging of COVID-19 pneumonia showed a predominantly peripheral, middle and lower, and posterior distribution. The early rapid progressive stage is 1~7 days from symptom onset, the advanced stage with peak levels of abnormalities on CT is 8~14 days, and the abnormalities started to improve after 14 days.
KEY POINTS: • The course of COVID-19 pneumonia consists of three stages: 1~7 days is the early rapid progressive stage, 8~14 days is the advanced stage, and after 14 days, the abnormalities started to decrease. • In the early rapid progressive stage, GGO plus a reticular pattern, GGO plus consolidation, and GGO were all common signs; in the advanced stage, signs of progression and absorption coexisted; lung abnormalities showed an asynchronous process with parts with absorption and parts progressing. • Lung abnormalities mainly showed predominantly peripheral, middle, and lower distribution.
AIM: To report the epidemiological, clinical, and radiological characteristics of patients with COVID-19 in Xiaogan, Hubei, China.
MATERIALS AND METHODS: The complete clinical and imaging data of 114 confirmed COVID-19 patients treated in Xiaogan Hospital were analysed retrospectively. Data were gathered regarding the presence of chest computed tomography (CT) abnormalities; the distribution, morphology, density, location, and stage of abnormal shadows on chest CT; and observing the correlation between the severity of chest infection and lymphocyte ratio and blood oxygen saturation (SPO2) in patients.
RESULTS: Chest CT revealed abnormal lung shadows in 110 patients. Regarding lesion distribution, multi-lobe lesions in both lungs were present in most patients (80 cases; 72.7%). Lesions most frequently involved both the peripheral zone and the central zone (62 cases; 56.4%). Regarding lesion morphology, 56 cases (50.1%) demonstrated patchy shadows that were partially fused into large areas. Thirty cases showed ground-glass opacity (27.3%), 30 cases showed the consolidation change (27.3%), and the remaining 50 cases showed both types of changes (45.4%). The progressing stage was the most common stage (54 cases; 49.1%). CT results showed a negative correlation with SPO2 and lymphocyte numbers (p<0.05), with r-values of -0.446 and -0.780, respectively.
CONCLUSION: Spiral CT is a sensitive examination method, which can be applied to make an early diagnosis and for evaluation of progression, with a diagnostic sensitivity and accuracy better than that of nucleic acid detection.
OBJECTIVE: The purpose of this study was to investigate chest computed tomography (CT) findings in children with coronavirus disease-19 (COVID-19) pneumonia in our hospital.
METHODS: This study included 22 pediatric patients with confirmed COVID-19 from January to March 2020. The chest CT images and clinical data were reviewed.
RESULTS: The most prevalent presenting symptoms were fever (64%) and cough (59%), and a mildly elevated mean (SD) C-reactive protein (CRP) level of 11.22(11.06) and erythrocyte sedimentation rate of 18.8 (15.17) were detected. The major CT abnormalities observed were mixed ground-glass opacity and consolidation lesions (36%), consolidations (32%), and ground-glass opacities (14%). Peripheral distribution (45%) of lung lesions was predominant. Most of the lesions were multilobar (68%), with an average of three lung segments involved.
CONCLUSION: Children with COVID-19 had relatively milder symptoms and less severe lung inflammation than adults. Chest CT plays an important role in the management of children with COVID-19 pneumonia.
OBJECTIVES: To explore the relationship between the imaging manifestations and clinical classification of COVID-19.
METHODS: We conducted a retrospective single-center study on patients with COVID-19 from Jan. 18, 2020 to Feb. 7, 2020 in Zhuhai, China. Patients were divided into 3 types based on Chinese guideline: mild (patients with minimal symptoms and negative CT findings), common, and severe-critical (patients with positive CT findings and different extent of clinical manifestations). CT visual quantitative evaluation was based on summing up the acute lung inflammatory lesions involving each lobe, which was scored as 0 (0%), 1 (1-25%), 2 (26-50%), 3 (51-75%), or 4 (76-100%), respectively. The total severity score (TSS) was reached by summing the five lobe scores. The consistency of two observers was evaluated. The TSS was compared with the clinical classification. ROC was used to test the diagnosis ability of TSS for severe-critical type.
RESULTS: This study included 78 patients, 38 males and 40 females. There were 24 mild (30.8%), 46 common (59.0%), and 8 severe-critical (10.2%) cases, respectively. The median TSS of severe-critical-type group was significantly higher than common type (p < 0.001). The ICC value of the two observers was 0.976 (95% CI 0.962-0.985). ROC analysis showed the area under the curve (AUC) of TSS for diagnosing severe-critical type was 0.918. The TSS cutoff of 7.5 had 82.6% sensitivity and 100% specificity.
CONCLUSIONS: The proportion of clinical mild-type patients with COVID-19 was relatively high; CT was not suitable for independent screening tool. The CT visual quantitative analysis has high consistency and can reflect the clinical classification of COVID-19.
KEY POINTS: • CT visual quantitative evaluation has high consistency (ICC value of 0.976) among the observers. The median TSS of severe-critical type group was significantly higher than common type (p < 0.001). • ROC analysis showed the area under the curve (AUC) of TSS for diagnosing severe-critical type was 0.918 (95% CI 0.843-0.994). The TSS cutoff of 7.5 had 82.6% sensitivity and 100% specificity. • The proportion of confirmed COVID-19 patients with normal chest CT was relatively high (30.8%); CT was not a suitable screening modality.
OBJECTIVE: The study was aimed to describe the clinical characteristics and evaluate the dynamic changes of chest CT features in the first three weeks in the common type fo COVID-19 pneumonia patients in Jiangsu Province.
METHODS: 307 patients infected SARS-CoV-2 classified as common type were enrolled in the study. 628 chest CT scans were divided into three groups based on the time interval between symptoms and chest CT scan. The clinical characteristics were descriptively analyzed.The chest CT features were quantitatively evaluated. Mann-Whitney U test was used to test the differences in three groups and between men and women. Spearman rank correlation was used to test the association between the arterial blood gas(ABG) analysis results and chest CT scores.
RESULTS: Fever (69.1%) and cough (62.8%) were common symptoms. 111(36.2%) patients were anorexia. GGO was the most common manifestation of COVID-19 pneumonia, which could be followed by consolidation and fibrosis. Lower lobe or subpleural region was the most common distribution form of lesion. More lung lobes were involved in the third week. Total chest CT scores in the second week were higher than the first week. Fibrosis Scores increased in the second and third week. Total CT score, GGO score and fibrosis score of male patients were significantly higher than female in the second week. Male patients had higher consolidation score and fibrosis score than female in the third week. Total CT score and GGO score had weak to moderate correlation with arterial blood gas indices.
CONCLUSION: Changes in chest CT were difficult to assess quantitatively in the first third weeks. Male patients recovered slower than female in the second week. Although CT score had correlations with arterial blood gas indices, long-term follow-up of pulmonary function test is needed to determine the recovery of lung.
OBJECTIVES: The purpose of this study was to observe the imaging characteristics of the novel coronavirus pneumonia.
METHODS: Sixty-three confirmed patients were enrolled from December 30, 2019 to January 31, 2020. High-resolution CT (HRCT) of the chest was performed. The number of affected lobes, ground glass nodules (GGO), patchy/punctate ground glass opacities, patchy consolidation, fibrous stripes and irregular solid nodules in each patient's chest CT image were recorded. Additionally, we performed imaging follow-up of these patients.
RESULTS: CT images of 63 confirmed patients were collected. M/F ratio: 33/30. The mean age was 44.9 ± 15.2 years. The mean number of affected lobes was 3.3 ± 1.8. Nineteen (30.2%) patients had one affected lobe, five (7.9%) patients had two affected lobes, four (6.3%) patients had three affected lobes, seven (11.1%) patients had four affected lobes while 28 (44.4%) patients had 5 affected lobes. Fifty-four (85.7%) patients had patchy/punctate ground glass opacities, 14 (22.2%) patients had GGO, 12 (19.0%) patients had patchy consolidation, 11 (17.5%) patients had fibrous stripes and 8 (12.7%) patients had irregular solid nodules. Fifty-four (85.7%) patients progressed, including single GGO increased, enlarged and consolidated; fibrous stripe enlarged, while solid nodules increased and enlarged.
CONCLUSIONS: Imaging changes in novel viral pneumonia are rapid. The manifestations of the novel coronavirus pneumonia are diverse. Imaging changes of typical viral pneumonia and some specific imaging features were observed. Therefore, we need to strengthen the recognition of image changes to help clinicians to diagnose quickly and accurately.
KEY POINTS: • High-resolution CT (HRCT) of the chest is critical for early detection, evaluation of disease severity and follow-up of patients with the novel coronavirus pneumonia. • The manifestations of the novel coronavirus pneumonia are diverse and change rapidly. • Radiologists should be aware of the various features of the disease and temporal changes.
Objective To investigate the CT and clinical features of 2019 novel coronavirus (NCP) pneumonia. Methods Chest CT and clinical data of confirmed 103 patients with 2019 novel coronavirus pneumonia in January 2020, retrospectively. According to diagnosis and treatment of NCP infected pneumonia (trial version 5), all the patients were classified into mild( n =58), severe ( n =36) and very severe ( n =9) type, and their clinical findings, laboratory examination and CT finding were analyzed. CT features included lesions’ distribution, location, size, shape, edge, number, density, percentage of pneumonia lesions of the whole lung and extra-pulmonary manifestations. The CT features of different clinical subtypes were compared using χ 2 test or Fisher's exact probability. Comparisons between the percentage of pneumonic lesions to total lung volume were computed by using analysis of variance (normal distribution) or Kruskal-Wallis rank sum test (non-normal distribution). Results In terms of clinical manifestations, the patients with severe NCP were more common in elderly men, with a median age of 65 years. Fever was the first symptom in 49 (84%) of 58 patients with NCP, and fever was the first symptom in both severe and critical NCP patients. The incidence of cough in severe (25 / 36, 69%) and critical (6 /9, 67%) NCP patients was higher than that in general (20 /58, 34%). All critical patients have dyspnea. In terms of CT findings, common NCP showed double lung (40/58,71%) multiple (40 / 58,69%) ground glass (31/58,52%) or mixed (25 / 58,43%) lesions (56 / 58,97%); severe and critical NCP showed double lung lesions, heavy NCP mainly showed multiple (34 / 36,96%) patches (33 / 36,92%) mixed density lesions (26 / 36,72%); 9 severe NCP lesions were more than 3 cm Mixed density lesions. The percentage of pneumonia focus in the whole lung volume: the common type (12.5% ± 6.1%) was significantly lower than the severe type (25.9% ± 10.7%) and the critical type (47.2% ± 19.2%) NCP, the difference was statistically significant ( P values were < 0.001 and 0.002 respectively), and the severe type NCP was also significantly lower than the critical type ( P = 0.032). Conclusions CT and clinical features of different clinical types of NCP pneumonia are different. Chest CT findings have unique characteristic, which can not only make early diagnosis, but also evaluate its clinical course and severity.
Rationale: The increasing speed of confirmed 2019 novel coronavirus (COVID-19) cases is striking in China. The purpose of this study is to summarize the outcomes of patients with novel COVID-19 pneumonia (NCP) at our institution. Methods: In this single-center study, we retrospectively included 118 cases of NCP, from January 16, 2020 to February 4, 2020. The clinical outcomes were monitored up to February 11, 2020. The outcomes of NCP patients were phase summarized at our institution. Three kinds of responses to clinical treatment were defined and evaluated: 1) good, symptoms continually improved; 2) fair, symptoms not improved or relapsed; 3) poor, symptoms aggravated. The risk factors, including basal clinical characteristics, CT imaging features, and follow-up CT changes (no change, progress, and improvement) related to poor/fair outcomes, were also investigated. Results: Six patients were improved to no-emergency type, 2 remained the same, and 2 progressed to fatal type. Besides, 13 patients progressed from the common type group to the emergency group (3 in fatal type and 10 in severe type). Forty-two (35.6%) patients were discharged with a median hospital stay of 9.5 days (range, 4.0-15.0 days). Thus, the numbers in different responses were, 73 patients in good response group (4 emergency cases, 69 no-emergency cases), 28 in fair response group (3 emergency cases, 25 no-emergency cases), and 17 in poor response group (3 emergency cases, 14 no-emergency cases). No patient has died in our hospital to date. The median duration of progress observed from CT scans was 6 days (range, 2-14 days). The progression in abnormal imaging findings indicate a poor/fair response, whereas the alleviated symptoms seen from CT suggest a good response. Conclusion: Most cases are no-emergency type and have a favorable response to clinical treatment. Follow-up CT changes during the treatment can help evaluate the treatment response of patients with NCP.
The recent outbreak of pneumonia cases in Wuhan, PR China, was caused by a novel beta coronavirus, the 2019 novel coronavirus (COVID-19).
PURPOSE:
To summarize chest computed tomography (CT) manifestations of the early stage of COVID-19 infection and provide a piece of reliable imaging evidence for initial screening and diagnosis.
MATERIAL AND METHODS:
From 10 January 2020 to 10 February 2020, we continuously observed chest CT imaging of 14 patients with clinically suspected new coronavirus infection in the two weeks after onset of symptoms. Ground-glass opacity (GGO), consolidation, reticular pattern, and ground-glass mimic nodules in each patient's chest CT image were recorded.
RESULTS:
We enrolled 14 patients, of which nine patients had the infection confirmed by reverse transcription polymerase chain reaction (RT-PCR). Five patients were highly suspected of infection. All cases had epidemiological evidence. GGO was a dominant imaging manifestation in the initial days of infection. GGO performance accounts for 40% in 1- 2 days, 90% in 3- 6 days, and 85% in 7- 10 days. With disease progression, consolidation appeared on follow-up CT. Consolidation performance accounts for 0% in 1- 2 days, 40% in 3- 6 days, and 71% in 7- 10 days. The lesions are mostly near the pleura. The number of lesions and the extent of the lesions increased as the disease progressed.
CONCLUSION:
Patients with novel coronavirus pneumonia have characteristic CT features in the initial stage of infection, which can be used as an essential supplement for nucleic acid examination.