CT Scans of Patients with 2019 Novel Coronavirus (COVID-19) Pneumonia

Abstract

Rationale:The increasing speed of confirmed 2019 novel coronavirus (COVID-19) cases is striking in China. The purpose of this study is to summarize the outcomes of patients with novel COVID-19 pneumonia (NCP) at our institution. Methods: In this single-center study, we retrospectively included 118 cases of NCP, from January 16, 2020 to February 4, 2020. The clinical outcomes were monitored up to February 11, 2020. The outcomes of NCP patients were phase summarized at our institution. Three kinds of responses to clinical treatment were defined and evaluated: 1) good, symptoms continually improved; 2) fair, symptoms not improved or relapsed; 3) poor, symptoms aggravated. The risk factors, including basal clinical characteristics, CT imaging features, and follow-up CT changes (no change, progress, and improvement) related to poor/fair outcomes, were also investigated. Results: Six patients were improved to no-emergency type, 2 remained the same, and 2 progressed to fatal type. Besides, 13 patients progressed from the common type group to the emergency group (3 in fatal type and 10 in severe type). Forty-two (35.6%) patients were discharged with a median hospital stay of 9.5 days (range, 4.0-15.0 days). Thus, the numbers in different responses were, 73 patients in good response group (4 emergency cases, 69 no-emergency cases), 28 in fair response group (3 emergency cases, 25 no-emergency cases), and 17 in poor response group (3 emergency cases, 14 no-emergency cases). No patient has died in our hospital to date. The median duration of progress observed from CT scans was 6 days (range, 2-14 days). The progression in abnormal imaging findings indicate a poor/fair response, whereas the alleviated symptoms seen from CT suggest a good response. Conclusion: Most cases are no-emergency type and have a favorable response to clinical treatment. Follow-up CT changes during the treatment can help evaluate the treatment response of patients with NCP.

Chest CT Imaging Signature of Coronavirus Disease 2019 Infection

“…Fourth, temporal changes on chest CT imaging during the course of disease could not be assessed. Although several of the studies that were included also reported some information on temporal changes on chest CT images during the course of disease, 15,22,27,28,32,[34][35][36][37][38]40 they had from a considerable amount of flaws and limitations in the analysis of temporal changes on chest CT images. None of these studies described sufficient details of the patients who underwent chest CT imaging at different time points to understand potentially confounding factors on the temporal course of chest CT imaging findings (such as pulmonary comorbidities and therapies that were administered).…”

“…Time points of chest CT imaging during the course of disease were dissimilar among all studies, and all studies provided mere descriptive data without performing comprehensive statistical analyses to assess for differences in chest CT imaging findings between different time points. 15,22,27,28,32,[34][35][36][37][38]40 Furthermore, one study compared different patients who underwent chest CT imaging at different time points rather than evaluating the time course of chest CT imaging findings in the same patients. 15 In the other studies that did perform an intrapatient evaluation during the course of disease, either only a subset of patients underwent followup chest CT imaging, which caused selection bias, 22,27,28,32,[34][35][36][37][38] or chest CT imaging findings were insufficiently reported.…”

“…15 In the other studies that did perform an intrapatient evaluation during the course of disease, either only a subset of patients underwent followup chest CT imaging, which caused selection bias, 22,27,28,32,[34][35][36][37][38] or chest CT imaging findings were insufficiently reported. 40 Consequently, the available data on temporal changes on chest CT images are unreliable, lack clinical applicability, and cannot be summarized systematically. The same concerns apply to the studies that were excluded from this systematic review and metaanalysis.…”

“…Risk of bias with respect to patient spectrum was rated "unclear" in two studies, 34,39 because the number of patients with normal chest CT imaging findings was not reported. Risk of bias with respect to flow and timing was rated "unclear" in 24 studies, 15,16,[18][19][20][21][22][23][24][26][27][28][29][30][31][32][34][35][36][37][38][39][40][41] because these studies did not report the time interval between CT scanning and RT-PCR/gene sequencing. Risk of bias with respect to flow and timing was rated "high" in two studies, 14,25 because the time interval between CT and RT-PCR procedures exceeded 72 hours (maximum of 7 and 14 days, respectively).…”

“…Risk of bias with respect to flow and timing was rated "high" in two studies, 14,25 because the time interval between CT and RT-PCR procedures exceeded 72 hours (maximum of 7 and 14 days, respectively). Risk of bias with respect to observer variation was rated "high" in 27 studies, 40,41 because these studies did not report data on observer agreement. Finally, risk of bias in the domain blinding to the reference standard was rated "unclear" in 14 studies, 15,16,20,22,23,27,[30][31][32][34][35][36][37]41 because these studies did not report whether the interpreters of chest CT scans were blinded to the RT-PCR results.…”