Initial Chest Chest Computed Tomography Research Articles

A Cross-Sectional Study Conducted in Tehran, Iran, Analyzed the Typical Patterns of Primary Lung CT Scans in Critically Ill COVID-19 Patients Using a Semi-Quantitative Scoring System

Background: Given the ongoing COVID-19 global pandemic and the potential for respiratory failure in several COVID-19 patients, early diagnosis and timely treatment are of paramount importance. Objectives: In this context, we aimed to investigate the role of initial chest computed tomography (CT) in predicting the severity of COVID-19. Methods: The study, conducted at Imam Hossein Hospital between March 6, 2020, and May 6, 2020, was cross-sectional in nature. All patients diagnosed with severe to critical COVID-19 underwent high-resolution chest CT (HRCT), and the findings of the chest CT were meticulously analyzed using a semi-quantitative scoring system. Results: Out of 47 patients with severe to critical COVID-19, 72.4% were male, with a mean age of 62 ± 14 years. The most common chest CT findings were ground-glass opacity (55%) and consolidation (30%). Bilateral involvement was observed in all patients, with the most frequently affected areas being the peribronchovascular distribution (76%) and peripheral distribution (74%). Most patients had pulmonary involvement across all five lobes, with scores ranging from a minimum of 3.25 to a maximum of 21.25 (CI: 12 - 15; mean: 13.25). Conclusions: This study suggests a relationship between the initial chest CT scan findings and the severity of respiratory disease in COVID-19 patients. However, further studies are needed to confirm these findings.

Prognostic value of chest computed tomography in adult inpatients with coronavirus disease 2019 pneumonia in Goma, in the Democratic Republic of the Congo

Objectives: Chest computed tomography (CT) plays a crucial role in evaluating patients with coronavirus disease 2019 (COVID-19) pneumonia. This study aimed to assess the association between initial chest CT findings and mortality in adult inpatients with COVID-19 in the city of Goma, North Kivu province, the Democratic Republic of the Congo. Materials and Methods: This was a multicenter retrospective study of patients hospitalized in Goma with COVID-19 pneumonia who underwent chest CT from January 1, 2021, to December 31, 2022. For each patient included, two experienced radiologists independently reviewed the initial chest CT. A multivariate logistic regression was performed to identify chest CT findings associated with mortality at the 5% significance level. Results: Of 76 patients included in the study, 26 (34.2%) died. The degree of lung parenchymal involvement >25% (adjusted odds ratio [aOR] = 16.27 [3.30–80.16]) and the presence of consolidations (aOR = 3.33 [1.00–11.47]) were predictive of mortality with an area under the receiver operating characteristic curve of 0.8392. Sensitivity was 73.08%, specificity was 82%, positive predictive value was 67.86%, and negative predictive value was 85.42%. Conclusion: Lung involvement >25% and consolidations on chest CT appear to predict death in adult inpatients with COVID-19 pneumonia.

A chest CT-based nomogram for predicting survival in acute myeloid leukemia

BackgroundThe identification of survival predictors is crucial for early intervention to improve outcome in acute myeloid leukemia (AML). This study aim to identify chest computed tomography (CT)-derived features to predict prognosis for acute myeloid leukemia (AML).Methods952 patients with pathologically-confirmed AML were retrospectively enrolled between 2010 and 2020. CT-derived features (including body composition and subcutaneous fat features), were obtained from the initial chest CT images and were used to build models to predict the prognosis. A CT-derived MSF nomogram was constructed using multivariate Cox regression incorporating CT-based features. The performance of the prediction models was assessed with discrimination, calibration, decision curves and improvements.ResultsThree CT-derived features, including myosarcopenia, spleen_CTV, and SF_CTV (MSF) were identified as the independent predictors for prognosis in AML (P < 0.01). A CT-MSF nomogram showed a performance with AUCs of 0.717, 0.794, 0.796 and 0.792 for predicting the 1-, 2-, 3-, and 5-year overall survival (OS) probabilities in the validation cohort, which were significantly higher than the ELN risk model. Moreover, a new MSN stratification system (MSF nomogram plus ELN risk model) could stratify patients into new high, intermediate and low risk group. Patients with high MSN risk may benefit from intensive treatment (P = 0.0011).ConclusionsIn summary, the chest CT-MSF nomogram, integrating myosarcopenia, spleen_CTV, and SF_CTV features, could be used to predict prognosis of AML.

Survey on chest CT findings in COVID-19 patients in Okinawa, Japan: differences between the delta and omicron variants

To investigate the frequency of pneumonia and chest computed tomography (CT) findings in patients with coronavirus disease 2019 (COVID-19) during the fifth Delta variant-predominant and sixth Omicron variant-predominant waves of the COVID-19 pandemic in Okinawa, Japan. A survey on chest CT examinations for patients with COVID-19 was conducted byhospitals with board-certified radiologists who provided treatment for COVID-19 pneumonia in Okinawa Prefecture. Data from 11 facilities were investigated. Indications for chest CT; number of COVID-19 patients undergoing chest CT; number of patients with late-onset pneumonia, tracheal intubation, and number of deaths; and COVID-19 Reporting and Data System classifications of initial chest CT scans were compared by the chi-squared test between the two pandemic waves (Delta vs. Omicron variants). A total of 1944 CT scans were performed during the fifth wave, and 1178 were performed during the sixth wave. CT implementation rates, which were the number of patients with COVID-19 undergoing CT examinations divided by the total number of COVID-19 cases in Okinawa Prefecture during the waves, were 7.1% for the fifth wave and 2.1% for the sixth wave. The rates of tracheal intubation and mortality were higher in the fifth wave. Differences between the distributions of the CO-RADS classifications were statistically significant for the fifth and sixth waves (p < 0.0001). In the fifth wave, CO-RADS 5 (typical of COVID-19) was most common (65%); in the sixth wave, CO-RADS 1 (no findings of pneumonia) was most common (50%). The finding of “typical for other infection but not COVID-19” was more frequent in the sixth than in the fifth wave (13.6% vs. 1.9%, respectively). The frequencies of pneumonia and typical CT findings were higher in the fifth Delta variant-predominant wave, and nontypical CT findings were more frequent in the sixth Omicron variant-predominant wave of the COVID-19 pandemic in Okinawa, Japan.

Type A Aortic Dissection and Non-Contrast Computed Tomography.

Non-contrast enhanced chest computed tomography (CT) carries a low sensitivity for acute aortic dissection; CT Angiography remains the gold standard. We highlight the potential utility of non-contrast CT for detection of aortic dissection in a case of a young, immunocompromised man presenting with acute abdominal pain and renal injury. Given elevated creatinine, an initial non-contrast chest CT demonstrated subtle findings suggestive of aortic dissection (aneurysmal dilation of the proximal ascending aorta as well as displaced calcified intimal flap/intraluminal high linear density in the thoracic descending and distal abdominal aorta). Subsequent CT angiography confirmed the presence of an extensive type A aortic dissection. He underwent emergent exploratory laparotomy and hemiarch repair. Displaced calcified intimal flaps, intraluminal high-densities, intramural hematoma, and aneurysmal aortic dilation are common non-contrast computed tomography imaging findings that suggest aortic dissection.

Follow-up the severity of abnormalities diagnosed in chest CT imaging of COVID-19 patients: A cross-sectional study.

Background and AimsThis study aimed to evaluate the severity of diagnosed lung abnormalities of coronavirus disease 2019 (COVID‐19) patients based on the pre‐and postrecovery follow‐up chest computed tomography (CT) scan findings done at regular intervals.MethodsThis cross‐sectional study was performed in three phases. The severity of lung abnormalities was recorded and compared based on the initial and follow‐up chest CT findings carried out pre‐and at regular intervals (3 and 6 months) of postrecovery of COVID‐19 patients. Statistical data analysis was conducted using SPSS‐Version 26. Pearson Chi‐square test was used to analyze the results. p‐value < 0.05 was considered statistically significant.ResultsRegarding the initial chest CT findings, although ground‐glass opacity (GGO) was observed as the most common lung lesion, almost all the evaluated COVID‐19 patients had multiple lung lesions and involvements, especially with more involvement of the lower lobes. concerning the frequency of lung lesions and involvements in all phases of the study, almost no statistically significant differences were observed between male and female COVID‐19 patients and different age groups. However, older age groups had relatively more lung abnormalities due to Covid‐19 based on initial CT images which take more time to be eliminated. Lung abnormalities of Covid‐19 patients decreased significantly during the follow ups based on chest CT findings at different study phases.ConclusionAccording to evaluated pre‐ and post‐recovery chest CT scans, the frequency of lung lesions and lung involvement distribution decreased significantly in COVID‐19 patients, 3 and 6 months after recovery, and most of the recovered patients had no lung lesions or involvement anymore.

Residual Lung Parenchymal CT Changes in COVID-19 Patients and its Association with Common Predictors

Introduction: Chest computed tomography (CT) is used for the screening and diagnosis of COVID-19 pneumonia. The aim of the study is to study the prevalence of residual lung parenchymal CT changes in COVID-19 patients and its association with common predictors. Methods: Longitudinal study conducted at Shree Birendra Hospital in which diagnosed COVID-19 patients with initial CT scan showing COVID-19 related changes were retrospectively enrolled after ethics approval. The study period was from 15 February 2020 to 15 November 2021. Chest CT changes were evaluated and CT scan severity score (CT SS) assigned. Data was entered in Microsoft Excel and analysed in SPSS (Statistical Package for Social Sciences) version 16. Results: Males were more common (72.6%) among the 62 enrolled participants with the mean age 53.63 ± 15.05 years. Median interval between two scans was 137 days. Residual lung parenchymal CT changes were seen in 43 (69.4%) participants. Hypertension (25, 40.3%) and GGO (55, 88.7%) were the most common comorbidity and CT features respectively. The mean initial and final CT SS was 10.84 ± 5.87 and 3.55 ± 4.58 respectively (Total score 25, p = 0.001). Age was significantly associated with severity of CT score (p = 0.04). Conclusions: A large percentage of COVID-19 patients have chest CT changes after three months of initial chest CT scan. CT SS reduced significantly in the second scan. Similar studies with long term serial CT follow up of patients is recommended to be carried out in future.

Can Chest Computed Tomography Findings of Symptomatic COVID-19 Patients Upon Admission Indicate Disease Prognosis and Clinical Outcome?

This study aimed to investigate whether initial chest Computed Tomography (CT) findings of COVID-19 patients could predict clinical outcomes, prognoses, and mortality rates associated with the infection. Published studies on chest CT in COVID-19 infection do not go beyond describing the characteristics of the current period. Comparative analysis of chest CT findings upon hospital admission among patients with different clinical outcomes is scarce. We sought to retrospectively evaluate and compare clinical outcomes, prognoses, and mortality rates based upon the initial chest CT findings of 198 consecutive symptomatic patients with COVID-19 confirmed by Polymerase Chain Reaction (PCR). Patients (N = 198) were divided into three groups according to their clinical outcomes as follows: group 1 (n = 62) included patients discharged from the service, group 2 (n= 60) included patients hospitalized in the intensive care unit, and group 3 (n = 76) included patients who died despite treatment. Predictors of poor prognosis and mortality with regard to chest CT findings included mediastinal lymphadenopathy, pleural effusion, and pericardial effusion, and clinical characteristics of age, dyspnea, and hypertension. The halo sign on chest CT was a good prognosis predictor in multivariate analysis. Some CT findings, such as discharge, intensive care unit hospitalization, and death as the worst consequence, significantly correlated with endpoints. These findings support the role of CT imaging for potentially predicting clinical outcomes of patients with COVID-19.

COVID-19 illness and treatment decrease bone mineral density of surviving hospitalized patients.

The number patients surviving COVID-19 hospitalization is steadily increasing. Follow-up management for these patients relies on an understanding of the long-term effects of COVID-19. Specifically, there are insufficient data about the lasting effects of COVID-19 on bone health. We aim in this study to evaluate whether COVID-19 illness and treatment adversely affect the bone health of surviving patients. We assessed the bone mineral density (BMD) of hospitalized COVID-19 patients at diagnosis and at follow-up visits. Using the chest computed tomography (CT) scans of patients that were obtained for clinical management at diagnosis and follow-up visits, BMD was retrospectively measured by quantitative CT. The effect of COVID-19 severity markers and treatment-related factors on BMD were also assessed. BMD decreased by a mean of 8.6% (± 10.5%) from diagnosis to follow-up. The follow-up visits occurred at a mean of 81 (± 48) days after hospital discharge. The BMD decrease was significantly greater than expected for age-related annual BMD loss. The osteoporosis ratio increased two-fold after hospitalization for COVID-19 because of this substantial bone loss. On multivariable linear regression, only severity of COVID-19 pneumonia on initial chest CT and total steroid dose were predictive of change in BMD after COVID-19 hospitalization. Secondary osteoporosis may occur as a post-acute sequela of COVID-19. Therefore, the bone health status of patients surviving COVID-19 hospitalization should be monitored closely at follow-up visits, to facilitate the prevention and early treatment of osteoporosis complications.

Radiological Findings on Chest Computed Tomography in Patients With the Primary Diagnosed Chronic Lymphoproliferative Diseases.

IntroductionThe presence of concomitant respiratory pathology complicates the process of treatment and recovery of patients with chronic lymphoproliferative diseases (CLDs). Therefore, the diagnosis of lung injury is an important step in the management of such patients.ObjectivesThe aim of this study was to determine the prevalence, nature, extent, and location of changes diagnosed by high-resolution chest computed tomography (CT) in patients with CLDs at the initial examination.MethodsMedical records of inpatients who were hospitalized in 2018-2019 to the City Hematology Center of the Public Non-Profit Enterprise “City Clinical Hospital #4” of Dnipro City Council with a confirmed clinical diagnosis of CLDs were included in the retrospective study. The results of initial high-resolution chest CT were studied and analyzed.ResultsOut of 1,004 hospitalized patients with confirmed CLDs, 119 patients were primarily diagnosed. Among them, 81 patients underwent chest CT examination (68.1%) before the beginning of specific therapy. The average age was 65 (56;68) years, 46 (56.8%) were men. 23 (28.4%) patients were diagnosed with chronic lymphocytic leukemia, 28 (34.6%) patients with multiple myeloma, 24 (29.6%) patients with lymphoma, and six patients (7.4%) had other CLDs. It was found that both central and peripheral lymphadenopathy had about a third of the studied cohort of patients (33.3 and 29.6%, respectively), and these symptoms dominated in patients with chronic lymphocytic leukemia (43.5 and 50%, respectively), lymphoma (50 and 52.2%, respectively), and other CLDs (45.8 and 16.7%, respectively), in contrast to patients with multiple myeloma (7.1 and 0%, respectively). Lesions of the lung parenchyma were found in 45.7% of the studied cohort and were met more often in patients with multiple myeloma (67.9%). However, when comparing the prevalence of their categories, no statistically significant differences were found. Predictable bone-destructive changes were statistically significantly more common in patients with multiple myeloma than in other groups of patients with CLDs (P=0.0003).ConclusionsSigns of pulmonary diseases during initial chest CT were found almost in half of the patients with CLDs. It potentially may affect the frequency of treatment complications in such patients. Lymphadenopathy was the most common finding on chest CT, especially in patients with chronic lymphocytic leukemia and lymphoma. And enlarged intrathoracic lymph nodes possibly could lead to pulmonary functions disorders. Among the types of lung parenchyma lesions, pneumofibrosis and foci of consolidation in the lower lung lobes were the most often diagnosed. Chest CT is informative at the stage of the initial examination of patients with CLDs not only for clinical diagnosis but also for the diagnosis of respiratory comorbidities and prediction of the disease outcome and treatment complications.

Organizing pneumonia-like pattern in COVID-19.

Organizing pneumonia (OP) is a radio-histologic pattern that forms in response to lung damage in patients with focal or diffuse lung injury. OP is frequently observed subsequent to viral-induced lung damage and is associated with a diverse range of clinical outcomes. We included 210 patients (mean age: 55.8 ± 16.5 years old; 61% male) with mild Coronavirus disease 2019 (COVID-19) who underwent chest computed tomography (CT) from 25 February to 22 April, 2020. The patients were divided into two groups based on the presence (n = 103) or absence of typical OP-like pattern (n =107) on initial chest CT. The extent of lung involvement and final outcome was compared across the two groups. Serial changes in imaging were also evaluated in 36 patients in the OP-group with a second CT scan. Duration from symptom onset to presentation was significantly higher in the OP group (7.07 ± 3.71 versus 6.13 ± 4.96 days, p = 0.008). A higher COVID-19-related mortality rate was observed among patients with OP-like pattern (17.5% vs 3.7%, p = 0.001).There was no significant difference in the overall involvement of the lungs (p = 0.358), but lower lobes were significantly more affected in the OP group (p < 0.001). Of the 36 patients with follow-up imaging (mean duration of follow-up = 8.3 ± 2.1 days), progression of infiltration was seen in more than 61% of patients while lesions had resolved in only 22.2% of cases. Our observation indicates that physicians should carefully monitor for the presence of OP-like pattern on initial CT as it is associated with a poor outcome. Furthermore, we recommend interval CT to evaluate the progression of infiltrations in these patients.

Predictors of residual pulmonary vascular obstruction after anticoagulation monotherapy in patients with intermediate-risk pulmonary embolism.

BackgroundPatients with intermediate-risk pulmonary embolism (PE) can be treated with anticoagulation monotherapy. However, clinicians are concerned as to whether anticoagulation monotherapy is sufficient to reduce mortality in patients with a large embolic burden, and to resolve vascular obstruction. We investigated whether anticoagulation monotherapy was appropriate in patients with intermediate risk PE in terms of the occurrence of residual pulmonary vascular obstruction (RPVO), and the factors that independently predict the occurrence of RPVO.MethodsThis was a multicenter retrospective observational study of patients at intermediate risk of PE who were admitted to three hospitals between January 2012 and December 2017.ResultsOf total 91 patients, the median age was 72 years and 37 (40.7%) were male. Twenty-five patients (27.5%) were diagnosed with RPVO during follow-up. Multivariate logistic regression revealed chronic lung disease [odds ratio (OR), 4.14; 95% confidence interval (CI), 1.243–13.797; P=0.021] and the ratio of the diameters of the main pulmonary artery and ascending aorta ratio (P/A ratio) >1.0 documented on a chest computed tomography (CT) at presentation (OR, 3.46; 95% CI, 1.113–10.770; P=0.032) were significant independent predictors of RPVO occurrence. The incidence of RPVO in patients without these two factors was only 9.7%, but in those with the two factors it was 60% (P=0.004).ConclusionsAnticoagulation monotherapy did not seem to be a sufficient treatment to reduce RPVO, but the outcome was similar to that of patients treated with other therapies. Therefore, considering the risk-benefit ratio, we do not need to change the initial treatment as systemic thrombolytic therapy or catheter-based therapy in patient with intermediate risk PE. Underlying chronic lung disease and a P/A ratio >1 on the initial chest CT predicted the occurrence of RPVO. Therefore, we should carefully assess persistent of dyspnea and exercise limitations using various methods in patients with these risk factors, to detect the occurrence of chronic thromboembolic pulmonary disease (CTEPD) earlier.

Chest CT Imaging Characteristics of COVID-19 Pneumonia in Surviving and Non-surviving Hospitalized Patients: A Retrospective Study in a Referral Center in Tehran, Iran

Background: Coronavirus disease 2019 (COVID-19) has several chest computed tomography (CT) characteristics, which are important for the early management of this disease, because viral detection via RT-PCR can be time-consuming, resulting in a delayed pneumonia diagnosis. The Radiological Society of North America (RSNA) proposed a reporting language for CT findings related to COVID-19 and defined four CT categories: typical, indeterminate, atypical, and negative. Objectives: To retrospectively evaluate the chest CT characteristics of patients with COVID-19 pneumonia. Patients and Methods: A total of 115 hospitalized laboratory-verified COVID-19 cases, underdoing chest CT scan, were included in this study from April 30 to May 15, 2020. Of 115 cases, 53 were discharged from the hospital, and 62 expired. The initial clinical features and chest CT scans were assessed for the type, pattern, distribution, and frequency of lesions. Moreover, the findings were compared between ward-hospitalized, intensive care unit (ICU)-admitted, and non-surviving (expired) patients. Results: Of four CT categories, typical CT findings for COVID-19 were more frequent in the expired group (77.4%), compared to the ward-admitted (44.8%) and ICU-admitted (70.8%) groups (P = 0.017). However, no significant difference was observed in the prevalence of intermediate or atypical CT findings between the groups. Negative CT scans for the diagnosis of COVID-19 were significantly fewer in the expired group (0%) as compared to the ward-admitted (10.3%) and ICU-admitted (8.3%) groups (P = 0.0180). Also, the mean number of involved lung lobes and segments was significantly higher in the expired group compared to the other two groups (P = 0.032 and 0.010, respectively). The right upper lobe involvement, right middle lobe involvement, bilateral involvement, central lesion, air bronchogram, and pleural effusion were among CT scan findings with a significantly higher prevalence in non-surviving cases (P &lt; 0.0001, 0.047, 0.01, 0.036, 0.038, and 0.047, respectively). Conclusion: The increased number of involved lung lobes and segments, bilateral and central distribution patterns, air bronchogram, and severe pleural effusion in the initial chest CT scan can be related to the increased severity and poor prognosis of COVID-19.

Chest CT Images for COVID-19: Radiologists and Computer-Based Detection.

BackgroundCharacteristic chest computed tomography (CT) manifestation of 2019 novel coronavirus (COVID-19) was added as a diagnostic criterion in the Chinese National COVID-19 management guideline. Whether the characteristic findings of Chest CT could differentiate confirmed COVID-19 cases from other positive nucleic acid test (NAT)-negative patients has not been rigorously evaluated.PurposeWe aim to test whether chest CT manifestation of 2019 novel coronavirus (COVID-19) can be differentiated by a radiologist or a computer-based CT image analysis system.MethodsWe conducted a retrospective case-control study that included 52 laboratory-confirmed COVID-19 patients and 80 non-COVID-19 viral pneumonia patients between 20 December, 2019 and 10 February, 2020. The chest CT images were evaluated by radiologists in a double blind fashion. A computer-based image analysis system (uAI System, Lianying Inc., Shanghai, China) detected the lesions in 18 lung segments defined by Boyden classification system and calculated the infected volume in each segment. The number and volume of lesions detected by radiologist and computer system was compared with Chi-square test or Mann-Whitney U test as appropriate.ResultsThe main CT manifestations of COVID-19 were multi-lobar/segmental peripheral ground-glass opacities and patchy air space infiltrates. The case and control groups were similar in demographics, comorbidity, and clinical manifestations. There was no significant difference in eight radiologist identified CT image features between the two groups of patients. There was also no difference in the absolute and relative volume of infected regions in each lung segment.ConclusionWe documented the non-differentiating nature of initial chest CT image between COVID-19 and other viral pneumonia with suspected symptoms. Our results do not support CT findings replacing microbiological diagnosis as a critical criterion for COVID-19 diagnosis. Our findings may prompt re-evaluation of isolated patients without laboratory confirmation.

Application of Mobile Helical Computed Tomography in Combatting COVID-19

Background: Chest computed tomography (CT) is a recommended screening and assessment tool for patients with suspected coronavirus disease (COVID-19). However, CT units are currently not available in many temporary hospitals and centralized isolation places. Objectives: To delineate the workflow of mobile CT unit and evaluate its role in screening for COVID-19 infection in temporary hospitals and centralized isolation locations. Patients and Methods: Two hundred and twenty-three patients under medical observation in temporary centralized isolation were enrolled in this study. All patients underwent reverse-transcription polymerase chain reaction (RT-PCR) testing and mobile CT chest examinations. Communication, storage, and browsing of CT data were performed with 4G and cloud technology. Image quality and radiation dose were evaluated and compared with a commercial conventional 64-row CT scanner. Additionally, the sensitivity of initial chest CT and the initial RT-PCR for COVID-19 were compared. Results: CT examination of 223 patients was completed within 19 work hours. Communication, storage, and browsing of CT data via 4G and cloud technology were seamless. There were no significant differences in subjective image quality scores between groups (P &gt; 0.05). COVID-19 pneumonia was eventually confirmed in 49 patients (21.97%). The sensitivity of initial chest CT was greater than that of the initial RT-PCR (85.71% and 67.35%, respectively) (P &lt; 0.05). Conclusion: Screening suspected patients for COVID-19 by mobile CT in temporary hospitals and isolation points is a simple, efficient, and highly sensitive technique for early diagnosis and control of COVID-19.

Comparison of Clinical and Chest CT Characteristics of Adult Patients with COVID-19 and Mycoplasma Pneumonia

Background: Early differential diagnosis of coronavirus disease 2019 (COVID-19) and Mycoplasma Pneumonia (MP) are hampered by non-specific symptoms, the lack of rapid responding laboratory measures and the presence of family aggregation. Chest computed tomography (CT) plays a significant role to detect the distribution, density and morphology of lesions caused by either COVID-19 or MP. Objectives: To compare the symptoms, laboratory parameters, and chest CT results of adults with COVID-19 and MP and to assess the use of these findings in the differential diagnosis of these diseases. Patients and Methods: The initial clinical manifestations, laboratory results, and chest CT findings of 45 adult patients with COVID-19 (COVID-19 group) and 55 adult patients with MP (MP group) were reviewed retrospectively. All of the patients were diagnosed in the public hospitals in the epidemic area from 20 January to 28 February 2020. Results: Muscle ache and fatigue were more frequently present in the COVID-19 group (P = 0.009 and 0.029, respectively). Increased procalcitonin levels were more common in the MP group (P = 0.001). The chest CT results indicated that bilateral lung involvement, ground glass opacities, “crazy-paving” patterns, and air bronchogram signs were more common in the COVID-19 group (P &lt; 0.001 for all), respectively. However, single lobe involvement, pulmonary consolidations, lobular central nodules, generalized bronchial wall thickening with luminal stenosis, and bronchial mucus impaction were more common in the MP group (P &lt; 0.001 for all). Receiver operating characteristic analysis of a model established using CT parameters indicated a good or excellent performance in distinguishing COVID-19 from MP. Conclusion: COVID-19 and MP have similar clinical manifestations and laboratory results in early stage. However, the chest CT findings are valuable in the differential diagnosis of these two diseases, particularly in patients from COVID-19 epidemic areas.

Correlation between CT findings and outcomes in 46 patients with coronavirus disease 2019

The aim of this study was to analyze initial chest computed tomography (CT) findings in COVID-19 pneumonia and identify features associated with poor prognosis. Patients with RT-PCR-confirmed COVID-19 infection were assigned to recovery group if they made a full recovery and to death group if they died within 2 months of hospitalization. Chest CT examinations for ground-glass opacity, crazy-paving pattern, consolidation, and fibrosis were scored by two reviewers. The total CT score comprised the sum of lung involvement (5 lobes, scores 1–5 for each lobe, range; 0, none; 25, maximum). 40 patients who recovered from COVID-19 and six patients who died were enrolled. The initial chest CTs showed 27 (58.7%) patients had ground-glass opacity, 19 (41.3%) had ground glass and consolidation, and 35 (76.1%) patients had crazy-paving pattern. None of the patients who died had fibrosis in contrast to six (15%) patients who recovered from COVID-19. Most patients had subpleural lesions (89.0%) as well as bilateral (87.0%) and lower (93.0%) lung lobe involvement. Diffuse lesions were present in four (67%) patients who succumbed to coronavirus but only one (2.5%) patient who recovered (p < 0.001). In the death group of patients, the total CT score was higher than that of the recovery group (p = 0.005). Patients in the death group had lower lymphocyte count and higher C-reactive protein than those in the recovery group (p = 0.011 and p = 0.041, respectively). A high CT score and diffuse distribution of lung lesions in COVID-19 are indicative of disease severity and short-term mortality.

Prognostic value of initial chest CT findings for clinical outcomes in patients with COVID-19

Rationale: To identify whether the initial chest computed tomography (CT) findings of patients with coronavirus disease 2019 (COVID-19) are helpful for predicting the clinical outcome.Methods: A total of 224 patients with laboratory-confirmed COVID-19 who underwent chest CT examination within the first day of admission were enrolled. CT findings, including the pattern and distribution of opacities, the number of lung lobes involved and the chest CT scores of lung involvement, were assessed. Independent predictors of adverse clinical outcomes were determined by multivariate regression analysis. Adverse outcome were defined as the need for mechanical ventilation or death.Results: Of 224 patients, 74 (33%) had adverse outcomes and 150 (67%) had good outcomes. There were higher frequencies of more than four lung zones involved (73% vs 32%), both central and peripheral distribution (57% vs 42%), consolidation (27% vs 17%), and air bronchogram (24% vs 13%) and higher initial chest CT scores (8.6±3.4 vs 5.4±2.1) (P < 0.05 for all) in the patients with poor outcomes. Multivariate analysis demonstrated that more than four lung zones (odds ratio [OR] 3.93; 95% confidence interval [CI]: 1.44 to 12.89), age above 65 (OR 3.65; 95% CI: 1.11 to 10.59), the presence of comorbidity (OR 5.21; 95% CI: 1.64 to 19.22) and dyspnea on admission (OR 3.19; 95% CI: 1.35 to 8.46) were independent predictors of poor outcome.Conclusions: Involvement of more than four lung zones and a higher CT score on the initial chest CT were significantly associated with adverse clinical outcome. Initial chest CT findings may be helpful for predicting clinical outcome in patients with COVID-19.

The effect of hepatic steatosis on COVID-19 severity: Chest computed tomography findings

Background:The objective of our study was to investigate the location, extension and type of novel coronavirus-induced disease 2019 (COVID-19) infection involvement and hepatic steatosis on initial chest computed tomography (CT). The relationship between fatty liver and severity of the disease was also investigated by measuring the liver attenuation index (LAI).Methods:This study evaluated the chest CT images of 343 patients (201 male, mean age 48.43 years) who were confirmed to have COVID-19, using nasopharyngeal swab. The chest CTs were analyzed for laterality, number of involved lobes, diffuseness, number of lesions, and lesion types. The CT attenuation values of liver and spleen were measured, and LAI was calculated for the detection of hepatic steatosis. Univariate and multivariate logistic regression analysis were used to identify the independent early predictors for severe COVID-19.Results:There was no significant difference between genders in terms of clinical course. Liver density and LAI were significantly lower in the intensive care unit (ICU) patients. The prevalence of severe disease was higher in the patients with hepatic steatosis than in the non-steatotic group (odds ratio [OR] 3.815, 95% confidence interval [CI] 1.97–7.37, P < 0.001). After adjusting for age and comorbidities including hypertension, diabetes mellitus, coronary artery disease, chronic obstructive pulmonary disease, and chronic kidney disease, multivariate logistic regression analysis showed that non-alcoholic fatty liver disease (NAFLD) was an independent risk factor for COVID-19 severity (OR 3.935, 95% CI 1.77-8.70, P = 0.001). The optimal cut-off value for LAI was calculated as 0.5 for predicting patients who required ICU treatment.Conclusions:On the initial chest CT images of COVID-19 patients, presence of fatty liver is a strong predictor for severe disease.

Chest CT Findings of COVID-19 Patients with Mild Clinical Symptoms at a Single Hospital in Korea.

PurposeTo retrospectively evaluate the chest computed tomography (CT) findings of coronavirus disease 2019 (COVID-19) in patients with mild clinical symptoms at a single hospital in South Korea.Materials and MethodsCT scans of 87 COVID-19 patients [43 men and 44 women; median age: 41 years (interquartile range: 26.1–51.0 years)] with mild clinical symptoms (fever < 38℃ and no dyspnea) were evaluated.ResultsCT findings were normal in 39 (44.8%) and abnormal in 48 (55.2%) patients. Among the 48 patients with lung opacities, 17 (35.4%) had unilateral disease and 31 (64.6%) had bilateral disease. One (2.1%) patient showed subpleural distribution, 9 (18.8%) showed peribronchovascular distribution, and 38 (79.2%) showed subpleural and peribronchovascular distributions. Twenty-two (45.8%) patients had pure ground-glass opacities (GGOs) with no consolidation, 17 (35.4%) had mixed opacities dominated by GGOs, and 9 (18.8%) had mixed opacities dominated by consolidation. No patients demonstrated consolidation without GGOs.ConclusionThe most common CT finding of COVID-19 in patients with mild clinical symptoms was bilateral multiple GGO-dominant lesions with subpleural and peribronchovascular distribution and lower lung predilection. The initial chest CT of almost half of COVID-19 patients with mild clinical symptoms showed no lung parenchymal lesions. Compared to relatively severe cases, mild cases were more likely to manifest as unilateral disease with pure GGOs or GGO-dominant mixed opacities and less likely to show air bronchogram.