COVID-19 Imaging: What We Know Now and What Remains Unknown

Abstract

Essentials • The chest CT and CXR findings of COVID-19 pneumonia and the evolution of findings over time are well described. An organizing pneumonia pattern of lung injury is most common with some patients developing a pattern of diffuse alveolar damage. Patients with few or no symptoms may have normal imaging. • Extent of CXR and CT findings correlates with a variety of clinical indicators and severity of clinical course. However, imaging alone is insufficient to determine outcome. • Classification systems of CT findings related to COVID-19 have high interobserver agreement across levels of experience. Performance will depend on the local prevalence of COVID-19, and their role greatly depends on availability of RT-PCR testing. • AI has shown promise in both diagnosis and prognosis of COVID-19. Larger datasets and prospective studies are needed to assess performance and generalizability. • Cardiovascular complications of COVID-19 include thromboembolic disease, myocarditis, and MIS-C with coronary artery aneurysms. • Abdominal complications of COVID-19 may be the consequence of cardiovascular effects or critical illness rather than direct abdominal organ infection. • Neurologic complications of COVID-19 are not well defined and likely are the result of the cardiovascular effects and not direct CNS infection.

COVID-19 pneumonia: current evidence of chest imaging features, evolution and prognosis

“…Nonetheless, considering the multi-organ involvement of COVID-19 and due to the unknown possible evolution and sequelae even in patients fully recovered [60], a multidisciplinary post-acute and late approach becomes mandatory to define clinical needs and ensure a global evaluation [53].…”

Detecting COVID-19–related Chronic Pulmonary Injury with 129Xe MRI

“…The demand for radiological diagnosis of associated pulmonary injury is of particular interest (1). First-line imaging modalities in COVID-19 pneumonia are chest x-ray and CT (2). But there is growing interest in MRI for the assessment of post-COVID-19 symptoms (Long COVID) of the lungs (3).…”

Impact of the COVID-19 pandemic on the selection of chest imaging modalities and reporting systems: a survey of Italian radiologists

“…However, along with the issue related to radiation exposure, one of the main drawbacks of CT in COVID-19 diagnosis is its moderate to low specificity [ 13 , 16 ]. Therefore, using CT as a first-line diagnostic tool to confirm or exclude the possibility of COVID-19 infection is not recommended by several scientific societies [ 15 ], including the Italian Society of Medical and Interventional Radiology (SIRM) [ 25 ].…”

“…Although the sensitivity of CXR for the detection of lung abnormalities is relatively low, especially in the early stages of COVID-19 pneumonia [ 4 , 8 , 13 ], there is ample evidence in the literature that the use of CXR can be advantageous in the management of patients with COVID-19 [ 6 – 13 ]. Therefore, CXR is generally used as the first-line imaging modality for evaluating and monitoring COVID-19 pneumonia, particularly in areas with a high number of infected individuals [ 6 – 13 , 15 , 25 ].…”

“…Unfortunately, there is currently no consensus on the optimal chest imaging approach in the evaluation of patients with clinically suspected COVID-19 pneumonia, and even though recommendations do exist [ 4 , 5 , 15 , 25 , 26 ], radiology departments in Italy tend to use different approaches in the evaluation of such cases. Thus, we decided to conduct a survey among the Italian radiologists, members of the SIRM, to assess how chest imaging modalities have been used during the different phases of the first wave of COVID-19 and which diagnostic technique would have been preferred based on the experience gained during the pandemic.…”