Chest CT Features of COVID-19 in Rome, Italy

Abstract

glass opacities, associated with multilobe and posterior involvement, bilateral distribution, and subsegmental vessel enlargement.Keys Results:1. In this prospective study of patients in Rome, Italy, the sensitivity, specificity, and accuracy of CT for COVID-19 were 97%, 56%, and 72%, respectively, using RT-PCR as standard of reference. 2.On chest CT, ground-glass opacities (GGO) were present in 100% of patients with RT-PCR confirmed COVID-19. 93% of patients had multilobe and posterior lung involvement; 91% of patients had bilateral pneumonia. 3.On CT, subsegmental vascular enlargement (more than 3 mm diameter) in areas of lung opacity was observed in 89% of patients with confirmed COVID-19 pneumonia, with unclear etiology. Abbreviations:SARS-CoV-2: Severe Acute Respiratory Syndrome Coronavirus 2 Abstract BackgroundThe 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. 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. ResultsOur 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. ConclusionThe 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%).

Facing COVID-19 in the ICU: vascular dysfunction, thrombosis, and dysregulated inflammation

“…Pulmonary shunting is consistent with intense vasodilation and endothelial dysfunction. The observation that 89% of hospitalized patients in Rome showed subsegmental vascular enlargement on their admission computed tomography scan supports this view [6]. Reports of increased respiratory dead space suggest lung-vascular thrombosis from thrombotic microangiopathy or pulmonary embolism.…”

Radiological approaches to COVID-19 pneumonia

“…multilobe and posterior involvement, bilateral distribution, and subsegmental vessel enlargement (>3 mm). Chest CT sensitivity was high (97%) but with lower specificity (56%) [18].…”

Hospital preparedness for COVID-19 pandemic: experience from department of medicine at Veterans Affairs Connecticut Healthcare System

“…We developed a clinical algorithm to help direct providers toward testing for COVID-19 (Table 1). This algorithm is based on review of clinical data from China, Italy, and within the U.S.A. [7][8][9][10][11][12][13][14]. It can be used by providers to help determine whether COVID-19 is a likely diagnosis for patients in outpatient setting, those being seen in ER, and those hospitalized for another reason and later developing suggestive symptoms.…”