The role of imaging in 2019 novel coronavirus pneumonia (COVID-19)

Abstract

Almost the entire world, not only China, is currently experiencing the outbreak of a novel coronavirus that causes respiratory disease, severe pneumonia, and even death. The outbreak began in Wuhan, China, in December of 2019 and is currently still ongoing. This novel coronavirus is highly contagious and has resulted in a continuously increasing number of infections and deaths that have already surpassed the SARS-CoVoutbreak that occurred in China between 2002 and 2003. It is now officially a pandemic, announced by WHO on the 11th of March. Currently, the 2019 novel coronavirus (SARS-CoV-2) can be identified by virus isolation or viral nucleic acid detection; however, false negatives associated with the nucleic acid detection provide a clinical challenge and thus make the imaging examination crucial. Imaging exams have been a main clinical diagnostic criteria for the 2019 novel coronavirus disease in China. Imaging features of multiple patchy areas of ground glass opacity and consolidation predominately in the periphery of the lungs are characteristic manifestations on chest CT and extremely helpful in the early detection and diagnosis of this disease, which aids prompt diagnosis and the eventual control of this emerging global health emergency. Key Points• In December 2019, China, an outbreak of pneumonia caused by a novel, highly contagious coronavirus raised grave concerns and posed a huge threat to global public health.• Among the infected patients, characteristic findings on CT imaging include multiple, patchy, ground-glass opacity, crazypaving pattern, and consolidation shadows, mainly distributed in the peripheral and subpleural areas of both lungs, which are very helpful for the frontline clinicians.• Imaging examination has become the indispensable means not only in the early detection and diagnosis but also in monitoring the clinical course, evaluating the disease severity, and may be presented as an important warning signal preceding the negative RT-PCR test results.

Analysis of the role of Chest X-Ray in a large cohort of 1117 patients with SARS-CoV-2 infection: an Italian multicenter study

“…The most frequent lung abnormality detected on CXR was the GGO, present in 66.1% of our positive baseline CXR, confirming the data of the recent literature on both CXR and CT findings. [6,[9][10][11][12] Moreover, in line with the common CT findings of recent studies, the most frequent locations of lung abnormalities were the peripheral and middle-lower zone distribution, indicating that the disease, may initially involve the parenchyma distal to the secondary lobule. [13] The bilateral involvement was also prevalent both in the baseline CXR (73.9%) and in the follow-up CXR (85.9%), consistent with other studies.…”

Possible silent hypoxemia in a COVID-19 patient: a case report

“…Risk factors for silent hypoxemia are old age and having diabetes [9]. Therefore, early detection of silent hypoxemia such as using prehospital pulse oximetry [5], or radiology imaging [16,17] might be used as a red ag sign of impending danger of eminent cardiac arrest or sudden respiratory failure.…”

Chest CT features of the novel coronavirus disease (COVID-19)

“…Pulmonary consolidation is defined as an increase in lung density with obscuring vascular margins in the lung parenchyma due to the complete replacement of air spaces (alveolus and alveolar sacs) by fluid, pus, blood, or cells [17]. Peripheral, segmental, or sub-segmental consolidation areas with the multi-lobar distribution are usually seen in cases with COVID-19 pneumonia, especially in older patients and patients with severe or critical disease ( Figure 2) [11,[14][15][16]31,39]. Consolidation areas are usually seen in mixed patterns with GGO, and the new emergence of consolidation areas in the followup imaging of COVID-19 patients was considered as an indicator of progressive disease [11].…”

“…Moreover, chest radiography can be used in COVID-19 patients, but its diagnostic value is very limited. Therefore, it is recommended to use chest radiography in the assessment of lung involvement in paediatric and pregnant patients or in the follow-up of hospitalized patients, especially in case of severe or critical illness [16].…”