Chest Computed Tomography Abnormalities Research Articles

Utility of Computed Tomography for the Diagnosis of Invasive Aspergillosis in Hematological Malignancy

Background: Pulmonary computed tomography (CT) scans are commonly used as part of the clinical criteria in diagnostic workup of invasive aspergillosis (IA). Other criteria for diagnosing IA include a combination of host, clinical and mycological factors, such as those recommended in the 2008 European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria. Chest CT criteria include dense, well-circumscribed lesions(s) with or without a halo sign, air-crescent sign, or cavity. We assessed the diagnostic utility of these findings at baseline in a cohort of patients with hematological malignancy and suspected IA who received antifungal treatment.Material/methods: This post hoc analysis assessed data from a prospective, multicenter international trial of voriconazole (with and without anidulafungin) in patients with suspected (possible, probable, or proven using 2008 EORTC/MSG criteria) IA (NCT00531479). Patients who had received at least one dose of study drug and who had at least one CT scan with a description of ‘lung’ at baseline were included in this analysis. Patient records as provided by the investigators were retrospectively reviewed in a blinded manner to identify physician notes describing the presence of observable lesions or abnormalities on CT scan at baseline. The presence of IA was subsequently evaluated to confirm the infection. Patients with proven or probable IA were termed ‘confirmed’ (cIA) and all others as ‘non-confirmed’ (nIA). This assessment was in accordance with 2008 EORTC/MSG criteria, and conducted by an independent review committee.Results: Of 395 patients included, 240 patients (60.8%) were classified as cIA and 155 patients (39.2%) as nIA. Baseline characteristics were comparable between cIA and nIA groups: the mean age was 52.3 years vs 50.5 years, 56.3% vs 60.0% were male, and 71.7% vs 71.0% were white, respectively. The most commonly reported CT scan abnormalities at baseline were pulmonary nodules (46.8% of all patients; Table 1), bilateral lung lesions (37.5%), unilateral lung lesions (28.4%), and consolidation (24.8%). Abnormalities associated with subsequent confirmation of IA were ground-glass attenuation (cIA: 24.2%; nIA: 11.6%; p <0.05) and pulmonary nodules (cIA: 52.5%; nIA: 38.1%; p <0.05). Bilateral lung lesions were more common in cIA (41.3%) than in nIA (31.6%) patients, but this did not reach statistical significance (p=0.0561). No other CT scan abnormality appeared to be associated with confirmation of IA.Conclusions: Generally, chest CT scan abnormalities (including halo signs and air crescent signs) at baseline in patients with hematological malignancy and suspected IA based on the EORTC/MSG criteria were not associated with subsequent confirmation of IA. However, ground-glass attenuation, nodules and, to a lesser degree, bilateral lung lesions were associated with subsequent confirmation of IA. It should be considered that patients with possible IA and abnormal chest CT findings may have had the infection, even if further investigation failed to upgrade the diagnosis to proven/probable; this could result in an underestimation of the discriminative value of chest CT. These findings suggest that chest CT should be interpreted in conjunction with other available clinical data to guide management decisions on individual patients, including whether treatment is reasonable, pending full evaluation. Caution must be taken given this is a post-hoc analysis of a randomized, controlled, prospective trial; further confirmative studies are warranted. [Display omitted] DisclosuresLiu:Pfizer Inc, Beijing: Employment. Pan:Pfizer Inc, Beijing: Employment. Yan:Pfizer Inc, New York: Employment. Aram:Pfizer Inc, New York: Employment. Zhang:Pfizer Inc, Beijing: Employment.

Comparison of Residual Pulmonary Abnormalities 3 Months After Discharge in Patients Who Recovered From COVID-19 of Different Severity.

Background and Objectives: To investigate whether coronavirus disease 2019 (COVID-19) survivors who had different disease severities have different levels of pulmonary sequelae at 3 months post-discharge.Methods: COVID-19 patients discharged from four hospitals 3 months previously, recovered asymptomatic patients from an isolation hotel, and uninfected healthy controls (HCs) from the community were prospectively recruited. Participants were recruited at Wuhan Union Hospital and underwent examinations, including quality-of-life evaluation (St. George Respiratory Questionnaire [SGRQ]), laboratory examination, chest computed tomography (CT) imaging, and pulmonary function tests.Results: A total of 216 participants were recruited, including 95 patients who had recovered from severe/critical COVID-19 (SPs), 51 who had recovered from mild/moderate disease (MPs), 28 who had recovered from asymptomatic disease (APs), and 42 HCs. In total, 154 out of 174 (88.5%) recovered COVID-19 patients tested positive for serum SARS-COV-2 IgG, but only 19 (10.9%) were still positive for IgM. The SGRQ scores were highest in the SPs, while APs had slightly higher SGRQ scores than those of HCs; 85.1% of SPs and 68.0% of MPs still had residual CT abnormalities, mainly ground-glass opacity (GGO) followed by strip-like fibrosis at 3 months after discharge, but the pneumonic lesions were largely absorbed in the recovered SPs or MPs relative to findings in the acute phase. Pulmonary function showed that the frequency of lung diffusion capacity for carbon monoxide abnormalities were comparable in SPs and MPs (47.1 vs. 41.7%), while abnormal total lung capacity (TLC) and residual volume (RV) were more frequent in SPs than in MPs (TLC, 18.8 vs. 8.3%; RV, 11.8 vs. 0%).Conclusions: Pulmonary abnormalities remained after recovery from COVID-19 and were more frequent and conspicuous in SPs at 3 months after discharge.

Clinical, laboratory, and chest CT features of severe versus non-severe pediatric patients with COVID-19 infection among different age groups

BackgroundThis study was performed with the intention of comparing the clinical, laboratory, and chest computed tomography (CT) findings between severe and non-severe patients as well as between different age groups composed of pediatric patients with confirmed COVID-19.MethodThis study was carried out on a total of 53 confirmed COVID-19 pediatric patients who were hospitalized in Namazi and Ali Asghar Hospitals, Shiraz, Iran. The patients were divided into two severe (n = 27) and non-severe (n = 28) groups as well as into other three groups in terms of their age: aged less than two years, aged 3–12 years and 13–17 years. It should be noted that CT scans, laboratory, and clinical features were taken from all patients at the admission time. Abnormal chest CT in COVID-19 pneumonia was found to show one of the following findings: ground-glass opacities (GGO), bilateral involvement, peripheral and diffuse distribution.ResultFever (79.2%) and dry cough (75.5%) were the most common clinical symptoms. Severe COVID-19 patients showed lymphocytosis, while the non-severe ones did not (P = 0.03). C-reactive protein (CRP) was shown to be significantly lower in patients aged less than two years than those aged 3–12 and 13–17 years (P = 0.01). It was shown also that O2 saturation experienced a significant increase as did patients’ age (P = 0.01). Severe patients had significantly higher CT abnormalities than non-severe patients (48.0% compared to 17.9%, respectively) (P = 0.02).ConclusionLymphocytosis and abnormal CT findings are among the factors most associated with COVID-19 severity. It was, moreover, showed that the severity of COVID-19, O2 saturation, and respiratory distress were improved as the age of confirmed COVID-19 pediatric patients increased.

Can laboratory findings predict pulmonary involvement in children with COVID-19 infection?

BackgroundStudies investigating clinical and imaging findings of coronavirus disease 2019 (COVID‐19) pneumonia and predictors for lung injury mostly focus on adults. In this study, we aimed to evaluate the role of laboratory findings in predicting lung involvement in children with COVID‐19.MethodsChildren with COVID‐19 confirmed by reverse‐transcription polymerase chain reaction or COVID‐19 IgM and who underwent chest computed tomography (CT) scans were reviewed retrospectively. Admission absolute neutrophil count (ANC), absolute lymphocyte count (ALC), ANC/ALC ratio, platelet count, d‐dimer, fibrinogen, ferritin, procalcitonin, C‐reactive protein (CRP), and lactate dehydrogenase levels were compared in patients with normal and abnormal CT scans.ResultsA total of 101 children were included. Among the patients, 68 (67.3%) had normal CT scans, and 33 (32.7%) had pulmonary involvement. The median CRP, ferritin, and fibrinogen levels were significantly higher in children with abnormal CT findings. The model of binary logistic regression based on the presence of cough, shortness of breath, fibrinogen, ferritin, and CRP levels showed that the possibility of having abnormal CT was 1.021 times more likely for every one unit increase in fibrinogen levels.ConclusionFibrinogen might be useful to predict pulmonary involvement of COVID‐19 in children. Restricting radiological imaging to patients with significant symptoms and high fibrinogen levels might be helpful in children with COVID‐19 infections.

Outcome of asymptomatic patients with positive SARS-CoV-2 viral RNA reverse transcriptase-PCR undergoing surgery: A matched cohort study.

Outcome of asymptomatic patients with positive SARS-CoV-2 viral RNA reverse transcriptase-PCR undergoing surgery: A matched cohort study.

Pulmonary abnormalities on high-resolution computed tomography in patients with long standing rheumatoid arthritis

Background. Rheumatoid arthritis (RA) is a systemic inflammatory disease, associated with a number of extra-articular organ manifestations. Pulmonary involvement is a frequent and severe extraarticular manifestations of rheumatoid arthritis. RA can affect lung parenchyma, airways and pleura. Objectives. To identify RA-related lung disease on chest computed tomography (CT). Material and methods. We performed high-resolution computed tomography (HRCT) on a total of 92 patients with longstanding RA. Results. The subjects were predominantely female (79.3%), the age at entry was 63.77 ±11.56 years, and 42.9% had a history of smoking. Disease duration was 15.00±11.55 years. Pulmonary CT abnormalities were found in 71 of the 92 patients (77.2%). The most common HRCT anomalies were: linear attenuation (reticulation) (52.11%), bronchiectasis andbronchial wall thickening (45%), nodular attenuation (39.43%) and pleural involvement (pleural effusion or thickening) (39.43%). Conclusions. We conclude that RA-related lung disease was commonly detected on chest CT imaging in longstanding RA patients.

Radiological and functional lung sequelae of COVID-19: a systematic review and meta-analysis

BackgroundThe coronavirus disease 2019 (COVID-19) causes a wide spectrum of lung manifestations ranging from mild asymptomatic disease to severe respiratory failure. We aimed to clarify the characteristics of radiological and functional lung sequelae of COVID-19 patients described in follow-up period.MethodPubMed and EMBASE were searched on January 20th, 2021 to investigate characteristics of lung sequelae in COVID-19 patients. Chest computed tomography (CT) and pulmonary function test (PFT) data were collected and analyzed using one-group meta-analysis.ResultsOur search identified 15 eligible studies with follow-up period in a range of 1–6 months. A total of 3066 discharged patients were included in these studies. Among them, 1232 and 1359 patients were evaluated by chest CT and PFT, respectively. The approximate follow-up timing on average was 90 days after either symptom onset or hospital discharge. The frequency of residual CT abnormalities after hospital discharge was 55.7% (95% confidential interval (CI) 41.2–70.1, I2 = 96.2%). The most frequent chest CT abnormality was ground glass opacity in 44.1% (95% CI 30.5–57.8, I2 = 96.2%), followed by parenchymal band or fibrous stripe in 33.9% (95% CI 18.4–49.4, I2 = 95.0%). The frequency of abnormal pulmonary function test was 44.3% (95% CI 32.2–56.4, I2 = 82.1%), and impaired diffusion capacity was the most frequently observed finding in 34.8% (95% CI 25.8–43.8, I2 = 91.5%). Restrictive and obstructive patterns were observed in 16.4% (95% CI 8.9–23.9, I2 = 89.8%) and 7.7% (95% CI 4.2–11.2, I2 = 62.0%), respectively.ConclusionsThis systematic review suggested that about half of the patients with COVID-19 still had residual abnormalities on chest CT and PFT at about 3 months. Further studies with longer follow-up term are warranted.

Post-discharge chest CT findings and pulmonary function tests in severe COVID-19 patients

PurposeTo evaluate chest computed tomography (CT) and pulmonary function test (PFT) findings in severe COVID-19 patients after discharge and correlate CT pulmonary involvement with PFT results. MethodsCOVID-19 patients admitted to our hospital between February 25 and May 2, 2020, were retrospectively included according to the following criteria: (a) COVID-19 defined as severe based on the WHO interim guidance (i.e., clinical signs of pneumonia plus respiratory rate > 30 breaths/min, severe respiratory distress, and/or SpO2 < 90 % on room air); (b) chest radiograph in the acute setting; (c) post-discharge unenhanced chest CT; and (d) post-discharge comprehensive PFT. Imaging findings were retrospectively evaluated in consensus by two readers, and volume of abnormal lung was measured on CT using 3D Slicer software. Differences between demographics, comorbidities, acute radiographic findings, PFT, and post-discharge clinical and laboratory data of patients with normal and abnormal CT findings were assessed by Mann-Whitney or Fisher tests, and the compromised lung volume-PFT association by Pearson correlation after removing possible outliers. ResultsAt a median of 105 days from symptom onset, 74/91 (81 %) patients had CT abnormalities. The most common CT pattern was combined ground-glass opacity and reticular pattern (46/74, 62 %) along with architectural distortion (68/74, 92 %) and bronchial dilatation (66/74, 89 %). Compromised lung volume had a median value of 15 % [11–23], was higher in dyspneic patients, and negatively correlated with the percentage of predicted DLCO, VA, and FVC values (r = -0.39, -0.5, and -0.42, respectively). These PFT parameters were significantly lower in patients with CT abnormalities. Impairment of DLCO and KCO was found in 12 (13 %) cases, possibly implying an underlying pulmonary vasculopathy in this subgroup of patients. ConclusionsMost severe COVID-19 survivors still had physiologically relevant CT abnormalities about three months after the disease onset, with an impairment of diffusion capacity on PFT. A pulmonary vasculopathy was suggested in a minor proportion of patients.

Clinical Characteristics and CT Findings in 148 Non-COVID-19 Influenza-Like Illness Cases: A Retrospective Control Study.

Background: This study was to collect clinical features and computed tomography (CT) findings of Influenza-Like Illness (ILI) cases, and to evaluate the correlation between clinical data and the abnormal chest CT in patients with the Influenza-Like Illness symptoms.Methods: Patients with the Influenza-Like Illness symptoms who attended the emergency department of The Six Medical Center of The PLA General Hospital from February 10 to April 1, 2020 were enrolled. Clinical and imaging data of the enrolled patients were collected and analyzed. The association between clinical characteristics and abnormal chest CT was also analyzed.Results: A total of 148 cases were enrolled in this study. Abnormalities on chest CT were detected in 61/148 (41.2%) patients. The most common abnormal CT features were as follows: patchy consolidation 22/61(36.1%), ground-glass opacities 21/61(34.4%), multifocal consolidations 17/61(27.9%). The advanced age and underlying diseases were significantly associated with abnormal chest CT.Conclusions: Abnormal chest CT is a common condition in Influenza-Like Illness cases. The presence of advanced age and concurrent underlying diseases is significantly associated with abnormal chest CT findings in patients with ILI symptoms. The chest CT characteristic of ILI is different from the manifestation of COVID-19 infection, which is helpful for differential diagnosis.

Lung diffusing capacity for nitric oxide and carbon monoxide following mild-to-severe COVID-19.

A decreased lung diffusing capacity for carbon monoxide (DLCO) has been reported in a variable proportion of subjects over the first 3 months of recovery from severe coronavirus disease 2019 (COVID‐19). In this study, we investigated whether measurement of lung diffusing capacity for nitric oxide (DLNO) offers additional insights on the presence and mechanisms of gas transport abnormalities. In 94 subjects, recovering from mild‐to‐severe COVID‐19 pneumonia, we measured DLNO and DLCO between 10 and 266 days after each patient was tested negative for severe acute respiratory syndrome coronavirus 2. In 38 subjects, a chest computed tomography (CT) was available for semiquantitative analysis at six axial levels and automatic quantitative analysis of entire lungs. DLNO was abnormal in 57% of subjects, independent of time of lung function testing and severity of COVID‐19, whereas standard DLCO was reduced in only 20% and mostly within the first 3 months. These differences were not associated with changes of simultaneous DLNO/DLCO ratio, while DLCO/VA and DLNO/VA were within normal range or slightly decreased. DLCO but not DLNO positively correlated with recovery time and DLCO was within the normal range in about 90% of cases after 3 months, while DLNO was reduced in more than half of subjects. Both DLNO and DLCO inversely correlated with persisting CT ground glass opacities and mean lung attenuation, but these were more frequently associated with DLNO than DLCO decrease. These data show that an impairment of DLNO exceeding standard DLCO may be present during the recovery from COVID‐19, possibly due to loss of alveolar units with alveolar membrane damage, but relatively preserved capillary volume. Alterations of gas transport may be present even in subjects who had mild COVID‐19 pneumonia and no or minimal persisting CT abnormalities.Trial registryClinicalTrials.gov PRS: No.: NCT04610554 Unique Protocol ID: SARS‐CoV‐2_DLNO 2020.

Clinical characteristics of 1327 patients with coronavirus disease 2019 (COVID-19) in the largest Fangcang shelter hospital in Wuhan.

Clinical characteristics of 1327 patients with coronavirus disease 2019 (COVID-19) in the largest Fangcang shelter hospital in Wuhan.

Chest CT abnormalities in COVID-19: a systematic review.

Computed tomography (CT) of the chest is one of the main diagnositic tools for coronavirus disease 2019 (COVID-19) infection. To document the chest CT findings in patients with confirmed COVID-19 and their association with the clinical severity, we searched related literatures through PubMed, MEDLINE, Embase, Web of Science (inception to May 4, 2020) and reviewed reference lists of previous systematic reviews. A total of 31 case reports (3768 patients) on CT findings of COVID-19 were included. The most common comorbid conditions were hypertension (18.4%) and diabetes mellitus (8.3%). The most common symptom was fever (78.7%), followed by cough (60.2%). It took an average of 5.6 days from symptom onset to admission. The most common chest CT finding was vascular enlargement (84.8%), followed by ground-glass opacity (GGO) (60.1%), air-bronchogram (47.8%), and consolidation (41.4%). Most lung lesions were located in the lung periphery (72.2%) and involved bilateral lung (76%). Most patients showed normal range of laboratory findings such as white blood cell count (96.4%) and lymphocyte (87.2%). Compared to previous published meta-analyses, our study is the first to summarize the different radiologic characteristics of chest CT in a total of 3768 COVID-19 patients by compiling case series studies. A comprehensive diagnostic approach should be adopted for patients with known COVID-19, suspected cases, and for exposed individuals.

Sensitivity and specificity of chest computed tomography scan based on RT-PCR in COVID-19 diagnosis.

PurposeCOVID-19 is a novel, severely contagious and progressive infection occurring worldwide. The diagnosis of the disease is based on real-time polymerase chain reaction (RT-PCR) and computed tomography (CT) scan, even though they are still controversial methods.Material and methodsWe studied 54 patients with suspected COVID-19 and the two mentioned methods were compared with each other.ResultsSensitivity and specificity of the abnormal chest CT scan, ground-glass opacity (GGO), consolidation opacity, and both of GGO and consolidation were also surveyed based on RT-PCR. The results showed that RT-PCR assay was negative in 23 (42.6%) patients and positive in 31 (57.4%) cases. Also, the patients with an abnormal chest CT scan comprised 37 (68.5%). The sensitivity and specificity of abnormal CT scan were 78.6% and 42.3%, respectively, based on the RT-PCR method.ConclusionsOther techniques alongside CT scan and RT-PCR are advocated for accuracy of the COVID-19 diagnosis.

Assessment of COVID-19 severity using computed tomography imaging: A systematic review and meta-analysis

Computed tomography (CT) imaging has been reported to be a reliable tool for the evaluation of suspected cases and follow-up of confirmed cases of coronavirus disease 2019 (COVID-19). Despite the generation of a considerable amount of imaging data related to COVID-19, there is a need for an updated systematic review and meta-analysis pertaining to the questions of clinical significance. We aimed to analyze the correlation between abnormal chest CT findings and disease severity in patients with COVID-19. We searched for case series/studies published in the English language until March 24, 2020 that reported the clinical and chest CT imaging features of confirmed cases of COVID-19 in the PubMed database. A total of 208 studies were screened, and 71 were finally included in the meta-analysis. Study characteristics and relative risk (RR) estimates were extracted from each article and pooled using the random-effects meta-analysis model. There were a total of 6406 patients studied in a total of 71 studies; the male to female ratio was 1.08:1, and the mean age was 45.76 years; of these, 2057 patients from 14 studies were categorized into severe (24.3%) and mild (75.7%) disease groups. Imaging features that were more frequently noted in patients with severe disease than in those with mild disease included bilateral lung involvement (88.7% vs. 49.8%), scattered distribution (80.4% vs. 46.5%), multiple lobe involvement (95.7% vs. 59.6%), consolidation (88.3% vs. 60.3%), crazy-paving pattern (45.4% vs. 27.6%), air-bronchogram sign (29.7% vs. 15.1%), interlobular septal thickening (84.2% vs. 55.8%), and subpleural line (36.8% vs. 26.4%) differences between the two disease groups were statistically significant (P < 0.001). For 3778 patients in 29 studies, a significant pooled RR estimate was associated with abnormal chest CT findings in patients with COVID-19 (RR, 5.46%; 95% confidence interval [CI], 3.72%–8.04%; I2 = 86%). Individual assessment of the CT features revealed that a significant pooled RR estimate was associated with pure ground-glass opacity (GGO) (RR, 1.63%; 95% CI, 1.12%–2.38%; I2 = 79%), while lower pooled RR estimates were associated with CT features like crazy-paving pattern (RR, 1.37%; 95% CI, 1.10%–1.71%; I2 = 60%), consolidation (RR, 0.47%; 95% CI, 0.32%–0.7%; I2 = 83.5%), GGO with consolidation (RR, 0.73%; 95% CI, 0.52%–1.02%; I2 = 75%), and air-bronchogram sign (RR, 0.58%; 95% CI, 0.36%–0.96%; I2 = 94%). In conclusion, the number, location, extent, and type of radiological lesions are associated with COVID-19 progression and severity, suggesting the feasibility of using CT imaging in the assessment of disease severity in all age groups and efficient allocation of resources for patient management at the institutional level.

Imaging characteristics of coronavirus disease 2019 (COVID-19) in pediatric cases: a systematic review and meta-analysis.

BackgroundThe confirmed coronavirus disease 2019 (COVID-19) cases, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have exceeded 21 million (with more than 775,000 fatalities), and the number of children with COVID-19 is also increasing. This study aimed to summarize the chest imaging characteristics of pediatric COVID-19 cases and provide a reference for the diagnosis and control of pediatric COVID-19.MethodsThe study protocol was registered in PROSPERO, number CRD42020177391. Studies related to pediatric COVID-19 imaging manifestations were accessed from PubMed, Web of Science, and the Cochrane library databases, without language limitations. The publication date was limited to April 1, 2020, and it was updated on May 1 and May 27, 2020. Data normalization was determined with the Freeman-Tukey double arcsine transformation. Summarized incidences with 95% confidence intervals of various imaging manifestations were assessed by random-effects models. Heterogeneity was assessed with meta-regression and subgroup analyses, robustness with sensitivity analyses; and publication biases with Egger’s test.ResultsTwenty-three with 517 cases were included in this study. The summarized incidence of chest computed tomography abnormalities in pediatric COVID-19 cases was 70%, which was lower than what has been seen in adults. The incidence of halo signs in pediatric COVID-19 cases was 26%, which is rarely seen in adult COVID-19 cases. The incidences of ground-glass opacities (GGOs), GGOs and consolidations, consolidations, reverse halo signs, crazy paving signs, pleural effusion, bronchopneumonia-like signs, air bronchograms, and increased lung markings were 40%, 25%, 10%, 2%, 4%, 1%, 15%, 12%, and 31%, respectively. Pericardial effusions were found in the computed tomography images of adult COVID-19 cases but were scarcely seen in the computed tomography images of pediatric COVID-19 cases. The incidences of bilateral lesions, unilateral lesions, and peripheral lesions were 35%, 22%, and 26%, respectively.ConclusionsChest computed tomography imaging of pediatric COVID-19 cases resulted in various abnormalities that were milder than those of adults. This study will hopefully provide a reference to help identify pediatric COVID-19 cases.

Chest CT features in COVID-19 patients: A systematic review and meta-analysis

Objective: To derive the pooled estimate of chest computed tomography (CT) findings in coronavirus disease 2019 (COVID-19) patients. Methods: A comprehensive systematic search was conducted according to the PRISMA checklist from January 2020 to September 2020 in electronic databases including PubMed, Google Scholar, and Scopus based on search terms in title and texts. Original descriptive studies with epidemiological parameters of interest were included into the systematic review and meta-analysis. Results: Totally 54 articles comprised of 4 879 patients with a mean age of 49.05 years were eligible for this study. The pooled prevalence for abnormal CT images was 86.0%. Pooled prevalence for ground-glass opacity was 68.0%, 71.0% for bilateral abnormalities, 47.0% for mixed ground-glass opacity and consolidation and 29.0% for consolidation. In addition, 64.0% of lesions were peripheral, and 12.0% were central while 28.0% were both central and peripheral. Furthermore, 61.0% of lower lungs were involved, and 7.0% and 5.0% of the cases presented with pleural effusion and pericardial effusion, respectively. Besides, 11% of the cases showed lymphadenopathy, and 37% had air broncho gram sign. The pooled prevalence of other chest CT findings ranged from 8.0% to 65.0%. Conclusions: Chest CT can be used as predictive tools for the detection of COVID-19 disease along with clinical manifestations and the RT-PCR method.

Three-month outcomes of recovered COVID-19 patients: prospective observational study.

Aims:A novel coronavirus SARS-CoV-2 has resulted in an ongoing global pandemic of Coronavirus disease 2019 (COVID-19). However, the outcomes of recovered patients have not been well defined.Methods:This is a prospective observational follow-up study of survivors with COVID-19 from a designated tertiary center in Hefei, China. We examined chest computed tomography (CT) scanning, pulmonary function, 6-min walk distance (6MWD), and 36 item Short Form General Health Survey (SF-36).Results:Among 81 enrolled patients, 62 (77%) patients and 61 (75%) patients, respectively, completed 1-month and 3-month follow-ups. Abnormal CT findings were still present in 73% of patients at 1 month and 54% at 3 months, whereas chest CT scan scores improved progressively at 1-month (5.0 ± 5.1) and 3-month follow up (3.0 ± 4.5) compared with that during hospitalization (11 ± 6.8). Mild restrictive pulmonary impairment was detected in 11% and 10% of patients at 1-month and 3-month follow up, respectively. The 6MWD was 523 ± 77 m in male patients and 484 ± 58 m in female patients, which was significantly lower than in healthy controls (606 ± 68 m, 568 ± 78 m, p < 0.001). SF-36 scores were significantly impaired in the domains of role physical (RP), role emotional (RE), and social functioning (SF) compared with the normal age-matched population. RP was improved at 3-month compared with 1-month follow up in the 41–64 years group (p < 0.01). Multivariable analysis showed that older age (over 40 years) and steroid administration during hospitalization were independently associated with worse chest CT scores at 3-month follow up.Conclusions:At 3 months, chest CT abnormalities were present in one half of COVID-19 survivors and worse chest CT scores were independently associated with older age and steroid administration during hospitalization. Residual pulmonary function impairments were modest, whereas exercise capacity and SF-36 scores were significantly lower than the general population. Support program and further follow-up evaluations may be needed. The reviews of this paper are available via the supplemental material section.

The Spectrum of Chest CT-Scans in the Hospitalized Patients with the Coronavirus Disease

Background: Coronaviruses are a large family of RNA viruses, which range from the common cold virus to the causative agent of more severe diseases. Coronavirus was declared a pandemic in December 2019 in Wuhan, China. Iran has been an endemic zone for the spread of the coronavirus since the outset of this global epidemic and has remained among the countries largely affected by high rates of the disease. Objectives: The present study aimed to investigate the range of the chest computed tomography (CT) scan findings among the hospitalized patients with COVID-19 in Kermanshah, Iran during March-April 2020 to contribute to the accurate diagnosis of the infected patients. Methods: The sample population consisted of 286 hospitalized patients diagnosed with or suspected of the coronavirus disease. Chest CT-scan images and clinical data were reviewed, and their correlation was analyzed. Results: In total, 176 patients (61.53%) were male, and 110 (38.47%) were female. The mean age of the patients was 56 years. Polymerase chain reaction (PCR) results showed that 35.31% of the cases had coronavirus, while the results were negative in 64.69% of the cases. In addition, the CT-scan findings indicated 77.27% abnormal and 22.73% normal chest CT-scans. Among the patients, 75.87% recovered completely, and 18.53% died. The major CT abnormalities were diffuse ground-glass opacification (35.66%), peripheral ground-glass opacification (bilateral; 21.33%), and a combination of diffuse and peripheral ground-glass lesions (18.88%). The consolidation lesion of one lobe was detected in 16 patients, and the consolidation lesion of more than one lobe was observed in 40 patients. Conclusions: According to the results, the most common chest CT-scan findings in COVID-19 include diffuse ground-glass opacification, peripheral ground-glass opacification (bilateral), central ground-glass opacification (bilateral), a combination of diffuse and peripheral ground-glass opacification, a combination of central and peripheral ground-glass opacification, the consolidation lesion of one lobe, and the consolidation lesion of more than one lobe. Furthermore, significant correlations were observed between the CT-scans and the main clinical symptoms, while no significant correlations were denoted between the chest CT-scan and PCR results.

The role of a chest computed tomography severity score in coronavirus disease 2019 pneumonia.

The chest computed tomography (CT) characteristics of coronavirus disease 2019 (COVID-19) are important for diagnostic and prognostic purposes. The aim of this study was to investigate chest CT findings in COVID-19 patients in order to determine the optimal cut-off value of a CT severity score that can be considered a potential prognostic indicator of a severe/critical outcome.The CT findings were evaluated by means of a severity score that included the extent (0–4 grading scale) and nature (0–4 grading scale) of CT abnormalities. The images were evaluated at 3 levels bilaterally. A receiver operating characteristics (ROC) curve was used to identify the optimal score (Youden's index) predicting severe/critical COVID-19.The study involved 165 COVID-19 patients (131 men [79.4%] and 34 women [20.6%] with a mean age of 61.5 ± 12.5 years), of whom 30 (18.2%) had severe/critical disease and 135 (81.8%) mild/typical disease. The most frequent CT finding was bilateral predominantly subpleural and basilar airspace changes, with more extensive ground-glass opacities than consolidation. CT findings of consolidation, a crazy-paving pattern, linear opacities, air bronchogram, and extrapulmonary lesions correlated with severe/critical COVID-19. The mean CT severity score was 63.95 in the severe/critical group, and 35.62 in the mild/typical group (P < .001). ROC curve analysis showed that a CT severity score of 38 predicted the development of severe/critical symptoms.A CT severity score can help the risk stratification of COVID-19 patients.

Impact of the COVID-19 epidemic at a high-volume facility in gynecological oncology in Tokyo, Japan: a single-center experience

BackgroundThe number of cases of novel coronavirus disease 2019 (COVID-19) in Japan have risen since the first case was reported on January 24, 2020, and 6225 infections have been reported as of June 30, 2020. On April 8, 2020, our hospital began screening patients via pre-admission reverse transcriptase-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and chest computed tomography (CT). Although no patients exhibited apparent pneumonia, treatment delay or changes in treatment plans were required for a few patients based on the results of screening tests. During an emerging infectious disease pandemic, the likelihood of being infected, as well as the disease itself, affects clinical decision making in several ways. We summarized and presented our experience.Case presentationAfter the introduction of pre-admission screening, RT-PCR and CT were performed in 200 and 76 patients, respectively, as of June 30, 2020. The treatment of five patients, including two patients with cervical cancer, two patients with ovarian tumors, and one patient with ovarian cancer, was affected by the results. Two asymptomatic RT-PCR-positive patients did not develop COVID-19, but their treatment was delayed until the confirmation of negative results. The other three patients were RT-PCR-negative, but abnormal CT findings suggested the possibility of COVID-19, which delayed treatment. The patients receiving first-line preoperative chemotherapy for ovarian cancer had clinically evident exacerbations because of the treatment delay.ConclusionDuring the epidemic phase of an emerging infectious disease, we found that COVID-19 has several other effects besides its incidence. The postponing treatment was the most common, therefore, treatment of ovarian tumors and ovarian cancer was considered to be the most likely to be affected among gynecological diseases. Protocols that allow for easy over-diagnosis can be disadvantageous, mainly because of treatment delays, and therefore, the protocols must be developed in light of the local infection situation.