CT appearance in the 330 patients with coronavirus disease 2019 (COVID-19) in Serbia
CT appearance of COVID- 19
Abstract
Background/Aim. The corona virus disease 2019 (COVID-19) primarily affects the respiratory system, so radiological diagnosis has been shown to be necessary. Chest computed tomography (CT) is to be shown the best modality in suspected COVID-19 cases for initial evaluation because CT findings may be present before the onset of symptoms. The aim of this study was to show different CT imaging features or patterns in COVID-19 patients with a different time course and disease severity. Methods. This prospective cohort study analysed 330 patients (the average age was 52.37 ± 15.36) with confirmed COVID-19 via laboratory testing. During hospitalization, all patients included in the study underwent chest CT in order to assess the extent of changes in their lungs. COVID-19 patients, with a different time course and disease severity, were classified into four categories: lung, bronchial, pleural and mediastinal changes. Based on the time interval between the onset of symptoms and performed CT scan, all patients were divided into three groups: group 1 (CT scans done ≤ 1 week after symptom onset); group 2 (from > 1 to 2 weeks after symptom onset); group 3 (from > 2 weeks after symptom onset). In order to monitor the distribution of changes in the lungs more accurately, bilateral lungs were divided into 12 ‘lung’ zones. Each zone was assigned a CT score. Total severity score was calculated by summing the scores for each zone. Results. In 93.6% patients with COVID-19, the CT findings were positive. About 92.1% patients had multiple lesions. The lesions were bilateral in 87.6% of patients, localized both peripheral and centrally in 63.3% of patients, and occurred more frequently in posterior areas (93%), as well as in lower lung zones (91.2%). The average total severity score was 11.00 (7.00–16.00). The most common CT findings in all patients were the ground-glass opacities (97.7%), reticular pattern (91.3%), consolidation (71.5%) and fibrotic streaks (63.8%). In the group 1, changes on CT were found in 80.0%, in the group 2 in 95.0%, and in the group 3 in 99.4% of the patients. Conclusion. CT is proven to be a very important diagnostic method in COVID-19 patients, and together with clinical and laboratory findings, gives a complete picture of the patient's condition and contributes significantly to decision-making for further treatment.
References
Li B, Li X, Wang Y, Han Y, Wang Y, Wang C, et al. Diagnos-tic value and key features of computed tomography in Coro-navirus Disease 2019. Emerg Microbes Infect 2020; 9(1): 787‒93
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. China Novel Coronavirus Investigating and Research Team. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med 2020; 382(8): 727‒33.
Eurosurveillance Editorial Team. Note from the editors: World Health Organization declares novel coronavirus (2019-nCoV) sixth public health emergency of international concern. Euro Surveill 2020; 25(5): 200131e.
Mahase E. Covid-19: WHO declares pandemic because of "alarming levels" of spread, severity, and inaction. BMJ 2020;368: m1036.
Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radi-ology 2020; 296(2): E115‒7.
Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radi-ology 2020; 296(2): E32‒E40.
Kim JY, Choe PG, Oh Y, Oh KJ, Kim J, Park SJ, et al. The First Case of 2019 Novel Coronavirus Pneumonia Imported into Korea from Wuhan, China: Implication for Infection Preven-tion and Control Measures. J Korean Med Sci 2020; 35(5): e61
Pan Y, Guan H, Zhou S, Wang Y, Li Q, Zhu T, et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol 2020; 30(6): 3306‒9.
Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Radiology 2020; 295(3): 200463
An P, Song P, Lian K, Wang Y. CT Manifestations of Novel Coronavirus Pneumonia: A Case Report. Balkan Med J 2020; 37(3): 163‒5.
Feng Z, Yu Q, Yao S, Luo L, Zhou W, Mao X, et al. Early pre-diction of disease progression in COVID-19 pneumonia pa-tients with chest CT and clinical characteristics. Nat Commun 2020; 11(1): 4968.
Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, et al. Radiolog-ical findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis 2020; 20(4): 425‒34.
Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time Course of Lung Changes at Chest CT during Recovery from Coronavirus Disease 2019 (COVID-19). Radiology 2020; 295(3): 715‒21
Ye Z, Zhang Y, Wang Y, Huang Z, Song B. Chest CT manifesta-tions of new coronavirus disease 2019 (COVID-19): a pictori-al review. Eur Radiol 2020; 30(8): 4381‒9.
Zhou S, Wang Y, Zhu T, Xia L. CT Features of Coronavirus Disease 2019 (COVID-19) Pneumonia in 62 Patients in Wu-han, China. AJR Am J Roentgenol 2020; 214(6): 1287‒94.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395(10223): 497‒506.
Zhang R, Ouyang H, Fu L, Wang S, Han J, Huang K, et al. CT features of SARS-CoV-2 pneumonia according to clinical presentation: a retrospective analysis of 120 consecutive pa-tients from Wuhan city. Eur Radiol 2020; 30(8): 4417‒26.
Poon LC, Yang H, Dumont S, Lee JCS, Copel JA, Danneels L, et al. ISUOG Interim Guidance on coronavirus disease 2019 (COVID-19) during pregnancy and puerperium: information for healthcare professionals - an update. Ultrasound Obstet Gynecol 2020; 55(6): 848‒62.
Committee on Obstetric Practice. Committee Opinion No. 723: Guidelines for Diagnostic Imaging During Pregnancy and Lactation. Obstet Gynecol 2017; 130(4): e210‒6.
Terpos E, Ntanasis-Stathopoulos I, Elalamy I, Kastritis E, Ser-gentanis TN, Politou M, et al. Hematological findings and com-plications of COVID-19. Am J Hematol 2020; 95(7): 834‒47.
Frater JL, Zini G, d'Onofrio G, Rogers HJ. COVID-19 and the clinical hematology laboratory. Int J Lab Hematol 2020; 42 Suppl 1: 11‒8.
Lu G, Wang J. Dynamic changes in routine blood parameters of a severe COVID-19 case. Clin Chim Acta 2020; 508: 98‒102.
Merad M, Martin JC. Pathological inflammation in patients with COVID-19: a key role for monocytes and macrophages. Nat Rev Immunol 2020; 20: 355‒62.
Vargas-Vargas M, Cortés-Rojo C. Ferritin levels and COVID-19. Rev Panam Salud Publica 2020; 44: e72
Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coro-navirus Disease 2019 (COVID-19): A Systematic Review of Imaging Findings in 919 Patients. AJR Am J Roentgenol 2020; 215(1): 87‒93.
Li K, Wu J, Wu F, Guo D, Chen L, Fang Z, et al. The Clinical and Chest CT Features Associated With Severe and Critical COVID-19 Pneumonia. Invest Radiol 2020; 55(6): 327‒31.
Wu J, Wu X, Zeng W, Guo D, Fang Z, Chen L, et al. Chest CT Findings in Patients With Coronavirus Disease 2019 and Its Relationship With Clinical Features. Invest Radiol 2020; 55(5): 257‒61.
Song F, Shi N, Shan F, Zhang Z, Shen J, Lu H, et al. Emerging 2019 Novel Coronavirus (2019-nCoV) Pneumonia. Radiology 2020; 295(1): 210‒7.
Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Patho-logical findings of COVID-19 associated with acute respirato-ry distress syndrome. Lancet Respir Med 2020; 8(4): 420‒2.