Abstract
OBJECTIVE. Available information on CT features of the 2019 novel coronavirus disease (COVID-19) is scattered in different publications, and a cohesive literature review has yet to be compiled. MATERIALS AND METHODS. This article includes a systematic literature search of PubMed, Embase (Elsevier), Google Scholar, and the World Health Organization database. RESULTS. Known features of COVID-19 on initial CT include bilateral multilobar ground-glass opacification (GGO) with a peripheral or posterior distribution, mainly in the lower lobes and less frequently within the right middle lobe. Atypical initial imaging presentation of consolidative opacities superimposed on GGO may be found in a smaller number of cases, mainly in the elderly population. Septal thickening, bronchiectasis, pleural thickening, and subpleural involvement are some of the less common findings, mainly in the later stages of the disease. Pleural effusion, pericardial effusion, lymphadenopathy, cavitation, CT halo sign, and pneumothorax are uncommon but may be seen with disease progression. Follow-up CT in the intermediate stage of disease shows an increase in the number and size of GGOs and progressive transformation of GGO into multifocal consolidative opacities, septal thickening, and development of a crazy paving pattern, with the greatest severity of CT findings visible around day 10 after the symptom onset. Acute respiratory distress syndrome is the most common indication for transferring patients with COVID-19 to the ICU and the major cause of death in this patient population. Imaging patterns corresponding to clinical improvement usually occur after week 2 of the disease and include gradual resolution of consolidative opacities and decrease in the number of lesions and involved lobes. CONCLUSION. This systematic review of current literature on COVID-19 provides insight into the initial and follow-up CT characteristics of the disease.
Highlights
Follow-up CT in the intermediate stage of disease shows an increase in the number and size of ground glass opacification (GGO) and progressive transformation of GGO into multifocal consolidative opacities, septal thickening, and development of a crazy paving pattern, with the greatest severity of CT findings visible around day 10 after the symptom onset
Because of the primary involvement of the respiratory system, chest CT is strongly recommended in suspected COVID-19 cases, for both initial evaluation and follow-up [4]
After combining the available data, we found the characteristic patterns and distribution of CT manifestations: ground glass opacification (GGO) (88.0%), bilateral involvement (87.5%), peripheral distribution (76.0%), and multilobar involvement (78.8%) (Table 2)
Summary
This article includes a systematic literature search of PubMed, Embase (Elsevier), Google Scholar, and the World Health Organization database. A systematic literature search of PubMed and Embase (Elsevier) databases was performed on February 12, 2020, and updated on February 19, 2020, using the keywords “coronavirus,” “nCoV,” “2019-nCoV,” and “COVID-19.”. Considering the urgency of the topic and to increase the sensitivity of the search, a gray literature search was performed using the same keywords on Google Scholar to capture the most recently published articles. The following data categories were collected when available: study design, country, patient demographics, and chest CT findings. A metaanalysis was planned to assess the association of various imaging findings with demographic data, outcomes, and disease characteristics; this analysis was omitted because of the lack of sufficient data
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