Background Chest computed tomography (CT) has proven its critical importance in detection, grading, and follow-up of lung affection in COVID-19 pneumonia. There is a close relationship between clinical severity and the extent of lung CT findings in this potentially fatal disease. The extent of lung lesions in CT is an important indicator of risk stratification in COVID-19 pneumonia patients. This study aims to explore automated histogram-based quantification of lung affection in COVID-19 pneumonia in volumetric computed tomography (CT) images in comparison to conventional semi-quantitative severity scoring. This retrospective study enrolled 153 patients with proven COVID-19 pneumonia. Based on the severity of clinical presentation, the patients were divided into three groups: mild, moderate and severe. Based upon the need for oxygenation support, two groups were identified as follows: common group that incorporated mild and moderate severity patients who did not need intubation, and severe illness group that included patients who were intubated. An automated multi-level thresholding histogram-based quantitative analysis technique was used for evaluation of lung affection in CT scans together with the conventional semi-quantitative severity scoring performed by two expert radiologists. The quantitative assessment included volumes, percentages and densities of ground-glass opacities (GGOs) and consolidation in both lungs. The results of the two evaluation methods were compared, and the quantification metrics were correlated. Results The Spearman’s correlation coefficient between the semi-quantitative severity scoring and automated quantification methods was 0.934 (p < 0.0001). Conclusions The automated histogram-based quantification of COVID-19 pneumonia shows good correlation with conventional severity scoring. The quantitative imaging metrics show high correlation with the clinical severity of the disease.

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