Well-aerated Lung on Admitting Chest CT to Predict Adverse Outcome in COVID-19 Pneumonia

Abstract

This copy is for personal use only. To order printed copies, contact reprints@rsna.org I n P r e s s Summary StatementVisual and software-based quantification of well aerated lung parenchyma on admission chest CT were predictors of intensive care unit (ICU) admission or death in patients with pneumonia. Key Results� Patients with COVID-19 pneumonia at baseline chest CT who had ICU admission or who died had 4 or more lobes of the lung affected compared to patients without ICU admission or death (16% versus 6% of patients, p<.04).� After adjustment for patient demographics and clinical parameters, visually assessed well aerated lung parenchyma on admission on chest CT less than 73% was associated with ICU admission or death (OR 5.4, p<.001); software methods for lung quantification showed similar results. List of abbreviations SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2; COVID-19 = coronavirus disease 19; RT-PCR = reverse-transcription polymerase chain reaction; WOG = worse outcome group; N-WOG = not-worse outcome group; %V-WAL = visual assessment of well aerated lung percentage; %S-WAL = software-based assessment of well aerated lung percentage; VOL-WAL = open-source software assessment of well aerated lung absolute volume; AT = adipose tissue. I n P r e s sAbstract Background: Computed tomography (CT) of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease depicts the extent of lung involvement in COVID-19 pneumonia.Purpose: The aim of the study was to determine the value of quantification of the well-aerated lung obtained at baseline chest CT for determining prognosis in patients with COVID-19 pneumonia. Materials and Methods: Patients who underwent chest CT suspected for COVID-19 pneumonia at the emergency department admission between February 17 to March 10, 2020 were retrospectively analyzed. Patients with negative reverse-transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 in nasalpharyngeal swabs, negative chest CT, and incomplete clinical data were excluded. CT was analyzed for quantification of well aerated lung visually (%V-WAL) and by open-source software (%S-WAL and absolute volume, VOL-WAL). Clinical parameters included demographics, comorbidities, symptoms and symptom duration, oxygen saturation and laboratory values. Logistic regression was used to evaluate relationship between clinical parameters and CT metrics versus patient outcome (ICU admission/death vs. no ICU admission/ death). The area under the receiver operating characteristic curve (AUC) was calculated to determine model performance.Results: The study included 236 patients (females 59/123, 25%; median age, 68 years). A %V-WAL<73% (OR, 5.4; 95% CI, 2.7-10.8; P<0.001), %S-WAL<71% (OR, 3.8; 95% CI, 1.9-7.5; P<0.001), and VOL-WAL<2.9 L (OR, 2.6; 95% CI, 1.2-5.8; P<0.01) were predictors of ICU admission/death. In comparison with clinical model containing only clinical parameters (AUC, 0.83), all three quantitative models showed higher diagnostic performance (AUC 0.86 for all models). ...

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

“…Moreover, chest CT is not just a diagnostic or screening method in cases with suspected COVID-19. In patients with COVID-19, chest CT is especially crucial in determining the severity of pneumonia, which has a prognostic impact [11,37,41].…”

“…The reticular pattern is usually seen in COVID-19 patients with pneumonia and reticulation may increase in patients with longer disease course [8,19,31]. The reported prevalence of reticular pattern and linear opacification is very variable in the literature and has been reported between 1% and 81% [13,14,18,19,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]. Moreover, subpleural curvilinear lines and fibrous stripes have been reported in COVID-19 patients (Figures 5a and 5b) [14,, and both may represent the replacement of cellular components by fibrosis [14,19].…”

“…Mediastinal lymphadenopathy has been infrequently reported in COVID-19 patients, and lymphadenopathy has been shown as a risk factor for severe and progressive COVID-19 pneumonia [14,31,37]. In the literature, the frequency of mediastinal lymphadenopathy has been reported between 0% and 29% in patients with COVID-19 [11,13,14,.…”

“…An overall lung involvement score was reached by summing the 5 lobe scores (0-20). Besides, quantitative CT assessment methods and artificial intelligence applications can be successfully applied in the diagnosis of COVID-19 and in the evaluation of disease severity [37,52,53].…”

Serial measurements in COVID-19-induced acute respiratory disease to unravel heterogeneity of the disease course: design of the Maastricht Intensive Care COVID cohort;MaastrICCht

“…We intend to collect data from echocardiography, chest X-rays and chest CT-scans performed in daily care. [32] The latter will be performed for primary pulmonary assessment (acquired as non-contrast triage scans) [33], or for dedicated cardiovascular assessment (based on contrast-enhanced CT scans).…”