Chest CT Features of 182 Patients with Mild Coronavirus Disease 2019 (COVID-19) Pneumonia: A Longitudinal, Retrospective and Descriptive Study

Liu, Huaping; Luo, Shiyong; Zhang, Youming; Jiang, Yuzhu; Jiang, Yuting; Wang, Yayi; Li, Hailan; Huang, Chi-Yao; Zhang, Shunzhen; Li, Xi-Li; Tan, Yiqing; Wang, Wei

doi:10.1007/s40121-020-00352-z

Cited by 7 publications

(10 citation statements)

References 31 publications

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“…In stage 4, the survival group predominantly presented linear opacity patterns whereas the non-survival group showed predominantly the consolidation patterns. These distinct imaging changes over time confirmed our previous hypothesis, 18 that is, an increase in linear opacity indicates a good prognosis, whereas an increase in consolidation is indicative of a poor prognosis. Evidence from the literature also suggests that linear opacity is an organized feature at the end-stage of the infectious lung parenchyma lesions on CT 23 and that consolidation is formed by hyaline membranes in the alveolar cavity.…”

Section: Discussionsupporting

confidence: 89%

“…Two senior radiologists with 15 and 10 years of experience in chest imaging, blinded to clinical data and the patient’s outcome, analysed the CT images using methods reported earlier; 17 , 18 disagreements were resolved by consensus. The image findings included pure ground-glass opacity (GGO), pure consolidation, GGO and consolidation, linear opacity, lung involvement, distribution, predominant location, the extent of lesion involvement, margin definition, interlobular septal thickening, crazy-paving pattern, reversed halo sign, bronchiectasis, air bronchogram sign, bronchial wall thickening, round cystic changes, honeycomb pattern, tree-in-bud, adjacent pleura thickening, pleural effusion, thoracic lymphadenopathy, predominant CT pattern, lung segments of lesion distribution, number of involved lung segments, and the involved lobes.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, a similar scoring system based on quantitative analysis was adopted to evaluate the consolidation lesions, GGO, linear lesions, and total lesions, respectively. 17 , 18 The definitions of the analyzed CT characteristics and the details on the scoring system are provided in a Supplemental Information File . To elucidate the dynamic evolution of CT features during COVID-19, we divided the time axis from illness onset into four stages: stage 1 (1–7 d), stage 2 (8–14 d), stage 3 (15–21 d), and stage 4 (>21 d).…”

Section: Methodsmentioning

confidence: 99%

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Longitudinal Chest CT Features in Severe/Critical COVID-19 Cases and the Predictive Value of the Initial CT for Mortality

Li¹,

Luo²,

Zhang³

et al. 2021

JIR

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Purpose To evaluate longitudinal computed tomography (CT) features and the predictive value of the initial CT and clinical characteristics for mortality in patients with severe/critical coronavirus disease 2019 (COVID-19) pneumonia. Methods A retrospective analysis was performed on patients with COVID-19 pneumonia confirmed by laboratory. By excluding mild and common patients, 155 severe/critical patients with definite outcome were finally enrolled. A total of 516 CTs of 147 patients were divided into four stages according to the time after onset (stage 1, 1–7 days; stage 2, 8–14 days; stage 3, 15–21 days, and stage 4, >21 days). The evolving imaging features between the survival and non-survival groups were compared by using Chi-square, Fisher’s exact test, student’s t -test or Mann–Whitney U -test, as appropriate. The predictive value of clinical and CT features at admission for mortality was analysed through logistic regression analysis. To avoid overfitting caused by CT scores, CT scores were divided into two parts, which were combined with clinical variables, respectively, to construct the models. Results Ground-glass opacities (GGO) patterns were predominant for stages 1 and 2 for both groups (both P >0.05). The numbers of consolidation lesions increased in stage 3 in both groups ( P =0.857), whereas the linear opacity increased in the survival group but decreased in the non-survival group ( P =0.0049). In stage 4, the survival group predominantly presented linear opacity patterns, whereas the non-survival group mainly showed consolidation patterns ( P =0.007). Clinical and imaging characteristics correlated with mortality; multivariate analyses revealed age >71 years, neutrophil count >6.38 × 10 9 /L, aspartate aminotransferase (AST) >58 IU/L, and CT score (total lesions score >17 in model 1, GGO score >14 and consolidation score >2 in model 2) as independent risk factors (all P <0.05). The areas under the curve of the six independent risk factors alone ranged from 0.65 to 0.75 and were 0.87 for model 2, 0.89 for model 1, and 0.92 for the six variables combined. Statistical differences were observed between Kaplan Meier curves of groups separated by cut-off values of these six variables (all P <0.01). Conclusion Longitudinal imaging features demonstrated differences between the two groups, which may help determine the patient’s prognosis. The initial CT score combined with age, AST, and neutrophil count is an excellent predictor for mortality in COVID-19 patients.

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Section: Discussionsupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Longitudinal Chest CT Features in Severe/Critical COVID-19 Cases and the Predictive Value of the Initial CT for Mortality

Li¹,

Luo²,

Zhang³

et al. 2021

JIR

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“…The acute lung injury observed in COVID-19 is characterized by bilateral ground-glass opacities, crazy paving pattern and consolidations in peripheral distribution in computed tomography (CT) scans. Thereby, the extent of CT findings that seem to peak in week 2 to 3 during SARS-CoV2 infection may correlate with disease severity [ 3 , 4 ]. This parenchymal involvement seems to be reflected by the D-Dimer level.…”

Section: Introductionmentioning

confidence: 99%

Impact of persistent D-dimer elevation following recovery from COVID-19

et al. 2021

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Background Elevated D-dimer is known as predictor for severity of SARS-CoV2-infection. Increased D-dimer is associated with thromboembolic complications, but it is also a direct consequence of the acute lung injury seen in COVID-19 pneumonia. Objectives To evaluate the rate of persistent elevated D-dimer and its association with thromboembolic complications and persistent ground glass opacities (GGO) after recovery from COVID-19. Methods In this post hoc analysis of a prospective multicenter trial, patients underwent blood sampling, measurement of diffusion capacity, blood gas analysis, and multidetector computed tomography (MDCT) scan following COVID-19. In case of increased D-dimer (>0,5 μg/ml), an additional contrast medium-enhanced CT was performed in absence of contraindications. Results were compared between patients with persistent D-dimer elevation and patients with normal D-dimer level. Results 129 patients (median age 48.8 years; range 19–91 years) underwent D-Dimer assessment after a median (IQR) of 94 days (64–130) following COVID-19. D-dimer elevation was found in 15% (19/129) and was significantly more common in patients who had experienced a severe SARS-CoV2 infection that had required hospitalisation compared to patients with mild disease (p = 0.049). Contrast-medium CT (n = 15) revealed an acute pulmonary embolism in one patient and CTEPH in another patient. A significant lower mean pO2 (p = 0.015) and AaDO2 (p = 0.043) were observed in patients with persistent D-Dimer elevation, but the rate of GGO were similar in both patient groups (p = 0.33). Conclusion In 15% of the patients recovered from COVID-19, persistent D-dimer elevation was observed after a median of 3 months following COVID-19. These patients had experienced a more severe COVID and still presented more frequently a lower mean pO2 and AaDO2.

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“…Imaging findings significantly support clinical judgement to ensure effective and timely management and prognosis; indeed, the identification of disease severity allows appropriate selection for early involvement of intensive care [ 10 , 11 , 12 ]. Contrary to X-ray, chest computed tomography (CT) plays a pivotal role in the diagnosis and monitoring of interstitial pneumonia [ 13 , 14 ]. Typical CT patterns of COVID-related pneumonia include multifocal bilateral peripheral ground glass opacities associated with subsegmental patchy consolidations, commonly subpleural and predominantly involving lower lung lobes and posterior segments [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

The Role of Lung Ultrasound in SARS-CoV-19 Pneumonia Management

Lugarà¹,

Tamburrini²,

Coppola³

et al. 2022

Diagnostics

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Purpose: We aimed to assess the role of lung ultrasound (LUS) in the diagnosis and prognosis of SARS-CoV-2 pneumonia, by comparing it with High Resolution Computed Tomography (HRCT). Patients and methods: All consecutive patients with laboratory-confirmed SARS-CoV-2 infection and hospitalized in COVID Centers were enrolled. LUS and HRCT were carried out on all patients by expert operators within 48–72 h of admission. A four-level scoring system computed in 12 regions of the chest was used to categorize the ultrasound imaging, from 0 (absence of visible alterations with ultrasound) to 3 (large consolidation and cobbled pleural line). Likewise, a semi-quantitative scoring system was used for HRCT to estimate pulmonary involvement, from 0 (no involvement) to 5 (>75% involvement for each lobe). The total CT score was the sum of the individual lobar scores and ranged from 0 to 25. LUS scans were evaluated according to a dedicated scoring system. CT scans were assessed for typical findings of COVID-19 pneumonia (bilateral, multi-lobar lung infiltration, posterior peripheral ground glass opacities). Oxygen requirement and mortality were also recorded. Results: Ninety-nine patients were included in the study (male 68.7%, median age 71). 40.4% of patients required a Venturi mask and 25.3% required non-invasive ventilation (C-PAP/Bi-level). The overall mortality rate was 21.2% (median hospitalization 30 days). The median ultrasound thoracic score was 28 (IQR 20–36). For the CT evaluation, the mean score was 12.63 (SD 5.72), with most of the patients having LUS scores of 2 (59.6%). The bivariate correlation analysis displayed statistically significant and high positive correlations between both the CT and composite LUS scores and ventilation, lactates, COVID-19 phenotype, tachycardia, dyspnea, and mortality. Moreover, the most relevant and clinically important inverse proportionality in terms of P/F, i.e., a decrease in P/F levels, was indicative of higher LUS/CT scores. Inverse proportionality P/F levels and LUS and TC scores were evaluated by univariate analysis, with a P/F–TC score correlation coefficient of −0.762, p < 0.001, and a P/F–LUS score correlation coefficient of −0.689, p < 0.001. Conclusions: LUS and HRCT show a synergistic role in the diagnosis and disease severity evaluation of COVID-19.

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Chest CT Features of 182 Patients with Mild Coronavirus Disease 2019 (COVID-19) Pneumonia: A Longitudinal, Retrospective and Descriptive Study

Cited by 7 publications

References 31 publications

Longitudinal Chest CT Features in Severe/Critical COVID-19 Cases and the Predictive Value of the Initial CT for Mortality

Longitudinal Chest CT Features in Severe/Critical COVID-19 Cases and the Predictive Value of the Initial CT for Mortality

Impact of persistent D-dimer elevation following recovery from COVID-19

The Role of Lung Ultrasound in SARS-CoV-19 Pneumonia Management

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