Pure Ground-glass Opacity Research Articles

Predicting occult lymph node metastasis bynomogram in patients with lung adenocarcinoma ≤2cm.

Background: Previous researches had not proposed any prediction models for occult lymph node metastasis (OLNM). Considering the occurrence of OLNM and the importance of OLNM management, we aimed to develop a nomogram to predict OLNM of patients with lung adenocarcinoma ≤2cm. Methods: Characteristics of patients with lung adenocarcinoma of≤2cm diameter at the Peking Union Medical College Hospital were retrospectively reviewed. Univariate and multivariate logistic regressions were performed. A nomogram model was developed. The concordance index (C-index) and calibration and decision curves were used to evaluate the predictive ability. Results: A total of 473 patients were enrolled, with an OLNM incidence of 7.4%. Four factors were selected as risk factors. The model had a C-index of 0.932. Calibration and decision curves were determined. Conclusion: Patients with pure ground-glass opacity (pGGO) or noninvasive adenocarcinoma have significantly lower risk of OLNM. SUVmax, CEA, micropapillary and solid component were identified as independent risk factors. The nomogram model was effective in predicting OLNM preoperatively.

High-Resolution CT Chest Findings in Suspected COVID-19 Pneumonia Patients With Negative Real-Time Polymerase Chain Reaction Assay.

ObjectiveThe study was conducted with the objective of describing High-resolution computed tomography (HRCT) chest findings of clinically suspected COVID-19 patients having a negative real-time polymerase chain reaction (RT-PCR) assay as well as prevalence and distribution of the HRCT chest manifestations consistent with the diagnosis of COVID-19 pneumonia.MethodsThis descriptive cross-sectional study was conducted prospectively on a total of 48 patients with high clinical suspicion for COVID-19 and a negative RT-PCR assay that was presented to the Diagnostic Radiology Department of Capital Hospital, Islamabad from July 2020 to December 2020. These patients were included via non-probability consecutive sampling, had a positive history of contact with a known COVID-19 patient and/or any two of the following signs and symptoms; fever, cough, malaise, body aches, arthralgia, new-onset loss of taste and smell, and dyspnea or oxygen saturation less than 85%. A detailed history was sought after informed consent and all these patients underwent non-contrast HRCT chest scans that were reported by an experienced consultant radiologist. The scans showing positive features for COVID-19 pneumonia were assessed for the nature and distribution of the disease.ResultsAmongst 48 suspects with negative RT-PCR assay, 38 (79.2%) showed ground-glass opacities, a hallmark feature of COVID-19 pneumonia. A total of 22 (57.89%) of these 38 patients had ground-glass opacities with a crazy-paving pattern, nine (23.68%) mixed ground-glass opacities with consolidation, and seven (18.42%) had pure ground-glass opacities. Among these 79.2% suspects, ground-glass opacities were multifocal in 37 (97.37%), bilateral in 35 (92.10%), peripheral in 36 (94.74%), and dorsally located in 32 (81.6%) cases. Subpleural atelectatic bands were seen in 18 (47.36%) of these, bronchovascular markings were prominent in 15 (39.47%), and reverse halo sign was positive in nine (23.68%) cases. Out of the rest of the cases, three were diagnosed as interstitial lung disease, two as chronic lung disease, and one as active pulmonary tuberculosis.ConclusionThe majority of clinically suspected cases for COVID-19 showed hallmark findings on non-contrast HRCT chest scans in keeping with coronavirus disease regardless of a negative RT-PCR assay.

Asymptomatic SARS-CoV-2 infection: Incidental findings on FDG PET/CT

Rationale and ObjectivesIdentify the incidental findings of Covid-19 pneumonitis on 18F-FDG PET/CT scan in asymptomatic oncologic patients. The goal was to detect clinically unsuspected Covid-19 infections to prevent community spread. Materials and MethodsRetrospective analysis was conducted to recognize the pattern of metabolic and radiographic alterations on 18F-FDG PET/CT scans in Covid-19 patients. 492 18F-FDG PET/CT scans were reviewed for pulmonary and systemic abnormalities. Results18F-FDG PET/CT demonstrated new lung infiltrates in 29 asymptomatic patients. 13/29 patients had Covid-19 infection confirmed by nasopharyngeal nucleic acid PCR test. The most common lung abnormality was pure ground-glass opacity (GGO) (90%) in peripheral distribution (100%), involving 1 lobe in four patients (30.8%), 2–3 lobes in four patients, and 4-5 lobes in five patients (38.4%). Mean SUVmax was 4.7 (range 1.3–13.1). Ten patients developed symptoms, mainly fever, fatigue, and dry cough, within 6.4 ± 7.8 days (range 1–24). Of the available laboratory data of 12 patients, eight developed lymphopenia, and five patients had neutrophilia. Five patients required hospitalization, and two died of complications. ConclusionFor a given geographic region in the later stage of a pandemic, such as Covid-19, community spread of the disease is common. Therefore, it is not surprising to find it in asymptomatic being imaged for other indications. Recognition of its manifestation and effectively mounting mitigation protocols is essential to further reduce SARS-CoV-2 spread, especially to susceptible groups, predominantly the elderly and people with comorbidities.

Características en tomografía computarizada de la neumonía por coronavirus-2019 (COVID-19) en tres grupos de pacientes iraníes: estudio de un solo centro

Introduction and ObjectivesThe pivotal role of chest computed tomographic (CT) to diagnosis and prognosis coronavirus disease-2019 (COVID-19) is still an open field to be explored. This study was conducted to assess the CT features in confirmed cases with COVID-19. Materials and MethodsRetrospectively, initial chest CT data of 363 confirmed cases with COVID-19 were reviewed. All subjects were stratified into three groups based on patients’ clinical outcomes; non-critical group (n=194), critical group (n=65), and death group (n=104). The detailed of CT findings were collected from patients’ medical records and then evaluated for each group. In addition, multinomial logistic regression was used to analyze risk factors according to CT findings in three groups of patients with COVID-19. ResultsCompared with the non-critical group, mixed ground-glass opacities (GGO) and consolidation lesion, pleural effusion lesion, presence of diffuse opacity in cases, more than 2 lobes involved and opacity scores were significantly higher in the critical and death groups (P<0.05). Having more mixed GGO with consolidation, pleural effusion, lack of pure GGO, more diffuse opacity, involvement of more than 2 lobes and high opacity score identified as independent risk factors of critical and death groups. ConclusionCT images of non-critical, critical and death groups with COVID-19 had definite characteristics. CT examination plays a vital role in managing the current COVID-19 outbreak, for early detection of COVID-19 pneumonia. In addition, initial CT findings may be useful to stratify patients, which have a potentially important utility in the current global medical situation.

Chest CT findings in RT-PCR positive asymptomatic COVID-19 patients

PurposeTo investigate chest computed tomography (CT) findings in asymptomatic patients tested positive for coronavirus disease (COVID-19) by reverse transcription-polymerase chain reaction (RT-PCR). Material and methodsThe chest CT images of 64 patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who were RT-PCR test–positive but asymptomatic were retrospectively evaluated for the appearance and distribution of abnormal parenchymal findings. ResultsOf the 64 patients (mean age 59.4 ± 12; range 23–85), 42 (65%) were female, and 22 (35%) were male, and 16 (25%) of the patients had no abnormal findings on chest CT. Of the remaining 48 patients, lung involvement was bilateral in 32 (67%). Right upper lobe in 26 (54%), right middle lobe in 20 (42%), right lower lobe in 38 (79%), left upper lobe in 27 (56%), and left lower lobe were affected in 34 (71%) patients. The mean number of opacities detected in patients was 7.5 ± 5.7. The opacities were located only peripherally/subpleural in 22 (46%), only centrally/peribronchovascular in 5 (10%), and mixed in 21 (44%) patients. The frequency of pure ground glass opacities (GGO) was 63% GGO with a crazy-paving pattern or consolidation was 33%. Pure consolidation was detected in only two (4%) patients. Parenchymal opacities were only round in 27 (56%), only geographic demarcated in 3 (6%), only patchy in 2 (4%), and mixed in 16 (33%) patients. ConclusionChest CT was normal in only one-quarter of the asymptomatic patients. CT findings in asymptomatic COVID-19 patients were often peripherally located, mostly round-shaped GGO.

Automated approach for segmenting gross tumor volumes for lung cancer stereotactic body radiation therapy using CT-based dense V-networks.

The aim of this study was to develop an automated segmentation approach for small gross tumor volumes (GTVs) in 3D planning computed tomography (CT) images using dense V-networks (DVNs) that offer more advantages in segmenting smaller structures than conventional V-networks. Regions of interest (ROI) with dimensions of 50 × 50 × 6–72 pixels in the planning CT images were cropped based on the GTV centroids when applying stereotactic body radiotherapy (SBRT) to patients. Segmentation accuracy of GTV contours for 192 lung cancer patients [with the following tumor types: 118 solid, 53 part-solid types and 21 pure ground-glass opacity (pure GGO)], who underwent SBRT, were evaluated based on a 10-fold cross-validation test using Dice’s similarity coefficient (DSC) and Hausdorff distance (HD). For each case, 11 segmented GTVs consisting of three single outputs, four logical AND outputs, and four logical OR outputs from combinations of two or three outputs from DVNs were obtained by three runs with different initial weights. The AND output (combination of three outputs) achieved the highest values of average 3D-DSC (0.832 ± 0.074) and HD (4.57 ± 2.44 mm). The average 3D DSCs from the AND output for solid, part-solid and pure GGO types were 0.838 ± 0.074, 0.822 ± 0.078 and 0.819 ± 0.059, respectively. This study suggests that the proposed approach could be useful in segmenting GTVs for planning lung cancer SBRT.

COVID-19 Viral Pneumonia Complicated with Acute Pulmonary Embolism: A Descriptive Study.

Objective To evaluate acute pulmonary embolism in patients with 2019 novel coronavirus (COVID-19) pneumonia using pulmonary CT angiography. Subjects and Methods. From 95 symptomatic patients confirmed with COVID-19 by RT-PCR from 1 May to 14 July 2020 in Dallah Hospital, Riyadh, Saudi Arabia, CT angiography was done for 25 patients suspected to have pulmonary embolism and have no contraindication for contrast study. 11 cases of them showed CT evidence of acute pulmonary embolism (PE). Retrospectively, CT angiography was analyzed and detailed findings were recorded. This study was approved by the Institutional Review Board of our hospital, and the patient consent was waived. Results The mean age of the included patients was 49 ± 11 years; the youngest was 22 years, and the oldest was 64 years. Common symptoms in the 25 cases that underwent CT angiography were fever that was noted in 21/25 cases (84%), shortness of breath in 18/25 cases (72%), cough in 16/25 cases (64%), and severe myalgia/body fatigue in 13/25 cases (52%). The less common symptoms were sore throat in 11/25 cases (44%) and headache in 10/25 cases (40%). Regarding CT findings, 4/25 cases (16%) had unilateral lung disease and 21/25 cases (84%) had bilateral disease, with slight predilection for the right lower lobe (10/25 cases, 40%). Pure ground-glass opacity (GGO) was seen in 13/25 cases (52%), and GGO with consolidation was seen in 12/25 cases (48%). Common accompanying CT signs included crazy paving stone sign in 15/25 cases (60%) and air bronchogram in 12/25 cases (48%). From the 25 patients that showed respiratory deterioration and elevated serum D-dimer level, 11 cases confirmed to have acute pulmonary embolism, while 14 cases showed negative result for pulmonary embolism. 6/11 were male and 5/11 were female. Pulmonary embolism was diagnosed at a mean of 21 days from symptom onset. Unilateral acute pulmonary embolism was seen in 3/11 cases, while 8/11 cases showed bilateral distribution. Among 11 cases with acute pulmonary embolism, no emboli at the central level could be seen, but 3 cases showed pulmonary embolism at the lobar level, 3 cases at the segmental level, and 5 cases at lobar, segmental, and subsegmental levels. Conclusion In patients with confirmed COVID-19, we should maintain a high suspicion for its thromboembolic complications such as acute pulmonary embolism that was mainly diagnosed at the end of 3rd week from symptom onset. We suggest that whenever a CT evaluation of the parenchymal involvement of COVID-19 pneumonia is performed, a simultaneous evaluation of the pulmonary arteries is also essential in order to identify early signs of associated pulmonary embolism.

Spectrum of Chest Dual-Energy Computed Tomography Findings in COVID Patients in North India.

PurposeTo study the spectrum of chest dual-energy computed tomography (DECT) imaging findings in severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) or COVID-19 infected Indian patients and classify them on the basis of the Radiological Society of North America CT classification.MethodA total of 110 reverse transcription-polymerase chain reaction (RT-PCR)-positive patients (subjects) in which noncontrast chest DECT was done in our COVID-19 care center (CCC) were enrolled in this study. The prevalence of various abnormalities of lung parenchyma due to SARS-COV-2 and their distribution with extent was recorded. Various types of lung parenchyma abnormalities due to COVID-19 were evaluated in all patients. Data were analyzed and various prevalent abnormalities were calculated as a percentage for each type. All the cases were also sorted into four major groups on the basis of the Radiological Society of North America CT classification of COVID patients.ResultAmong the total 110 patients that were enrolled in this study, 80 (72.7%) were males and 30 (27.3%) were females with a mean age of 40.5 ± 7 years (range 24-84). Out of this, we observed that 59 (53.6%) cases had abnormalities of lung parenchyma and were designated as DECT positive, whereas 51 (46.3%) cases had completely normal DECT. Only 14 (12.7%) of the patients (cases) presented with dyspnoea, 10 (9%) had hyperpnoea, whereas 12 (10.8%) had other associated comorbidities. Among the patients having abnormal DECT findings, multilobar (86%), bilateral lung field involvement (72.8%) with the ascendancy of peripheral and posterior distribution was most commonly noted. With respect to the different types of opacities noted in various patients, we found that ground-glass opacity (GGO) was the common abnormality found in almost all cases for the greatest part. Pure GGO was reported in 16 (28%), GGO admixed with a crazy-paving pattern were elicited in 17 (28.8%) and GGO mixed with consolidation was noted in 25 (42.3%) cases. Thirty-eight (64.4%) cases were having peri-lesional or intra-lesional segments or involving a small segment enlargement of the pulmonary vessel. Among the cases showing DECT positivity, the typical pattern on the basis of the Radiological Society of North America (RSNA) classification was noted in 71.2% of cases, whereas the atypical pattern was found in 1.2% percent of cases and the intermediate type was depicted in 25.4% percent of cases. Forty-six point three percent (46.3%) of the total cases that were enrolled in the study were grouped as the no pneumonia category.ConclusionThe result of this study proved that the maximum number of RT-PCR-positive COVID-19 patients had mild symptoms and few comorbidities with normal chest DECT and fell under the no pneumonia category of the RSNA CT classification of COVID patients. However, out of the remaining patients, the majority of patients had GGO on DECT as a typical finding mixed with other patterns in a bilateral distribution and peripheral predominance. A preponderance of patients presented with the typical appearance of pneumonia followed by an intermediate type.

CT chest analysis of 2019 novel coronavirus pneumonia: An Indian perspective.

Context:Since its outbreak, the COVID-19 pneumonia pandemic is rapidly spreading across India; although computed tomography of chest (CT chest) is not recommended as a screening tool, there is a rapid surge in the CT chest performed in suspected cases. We should be aware of the imaging features among the Indian population.Aim:To analyze the CT chest features in Indian COVID-19 patients.Settings and Design:Retrospective study.Subjects and Methods:CT chest of 31 polymerase chain reaction (PCR) verified patients of COVID-19 was assessed for ground-glass opacities (GGO), consolidations, bronchiectasis, pleural effusions, vascular enlargement, crazy paving, and reverse halo sign.Statistical Analysis Used:The data was analyzed in Microsoft Excel 2019.Results:Only one patient showed a normal scan. Multilobar involvements with parenchymal abnormalities were seen in all the patients with bilateral involvement in 74.1%. 42.5% of the lung parenchymal abnormalities were pure GGOs, while 41.6% had GGOs mixed with consolidation. Peripheral and posterior lung field involvement was seen in 70.5% and 65.5%, respectively; 56.8% had well-defined margins. Pure GGOs were seen in all six patients, who underwent CT in the first 2 days of onset of symptoms. Seventeen patients scanned between 3 and 6 days of the illness showed GGOs mixed with consolidation and pure consolidations 76%. Vascular enlargement, crazy paving, and reverse halo sign were seen in 70%, 53%, and 35% of the patients, respectively. Patients scanned after 1 week of symptoms showed traction bronchiectasis along with GGOs and or consolidations.Conclusions:COVID-19 pneumonia showed multifocal predominantly subpleural basal posteriorly located GGOs and/or consolidations which were predominantly well defined. “Crazy paving” was prevailing in the intermediate stage while early traction bronchiectasis among the patients presented later in the course of illness.

The value of HRCT chest in diagnosis of COVID 19 and its correlation with RT-PCR

Objective: Aim of the study is to correlate CT findings of pulmonary involvement in COVID-19 positive patients with clinical findings and to investigate the role of CT Score in predicting result of patients. Study Design: Single-centered retrospective analysis Place and Duration of Study: The study has been conducted from June to November, 2020. Research has been carried out in District Headquarter Teaching Hospital, Sargodha. Methodology: From June to November 2020, 138 COVID-19 patients who appeared positive for reverse transcriptase polymerase chain reaction were registered for chest CT analysis and clinical examination. Based on the range of lobular involvement quantitative CT scores were considered. Data was correlated with clinical findings. Results: Among the patients 106(76.8%) were males and 32(23.18%) were females. Among 138 positive patients, 51(36.9%) cases were categorized as severe while 87(63.04%) were placed in mild group. Normal chest CT is shown by 89 (64.4%) patients while 49 (35.5%) patients show parenchymal abnormalities. Among the patients with abnormal CT findings bilateral 39/51 (76.5 %), multilobar (88.2 %) lung involvement with a predominant peripheral and posterior distribution is commonly observed. Ground glass opacity is the dominant abnormality which we observe in all 48 (97.9 %) cases. Pure Ground glass opacity is detected in 13 (27.08 %) and Ground glass opacity with mixed consolidation is noted in 17(35.4 %). Conclusion: Chest CT findings have potential role in predicting consequence of COVID-19 positive patients. It can be beneficial for speeding up diagnostic workflow as CT findings are correlated with disease severity and clinical findings.

The Spectrum of CT Findings of COVID-19 Pneumonia: Acute Alveolar Insult and Organizing Pneumonia as Different Phases of Lung Injury and Repair.

PurposeTo analyze the findings and serial changes in chest CT lesions in 123 symptomatic patients with coronavirus disease 2019 (COVID-19).Materials and MethodsFrom February 19 to April 7, 2020, a total of 123 confirmed COVID-19 patients (male, 44; female, 79; mean age, 59.2 ± 18.6) were enrolled in this retrospective study. A total of 234 CT scans were reviewed for the following patterns: acute alveolar insult (AAI) patterns: ground-glass opacity (GGO), crazy-paving appearance, mixed pattern, and consolidation; organizing pneumonia (OP) patterns: perilobular patterns, band opacity, curvilinear opacity, reversed halo opacity, and small nodular consolidation; resolving patterns: pure GGO, remnant curvilinear, small nodular consolidation, and serial changes of lung abnormalities. We compared the proportions of AAI pattern, OP pattern, or resolving pattern with time progression and analyzed the association between the patterns and disease severity using Pearson chi-square and Fisher's exact test.ResultsPredominant CT patterns were AAI pattern (87%) in the early hospital period group (0–10 days, after the onset of symptoms), OP pattern (45.7%) in the later hospital period group (after 10 days), and resolving pattern in discharge and follow-up group (47.2% and 84.8%, respectively). The difference in the proportions of predominant CT patterns with time progression was statistically significant (p < 0.001, Pearson's chi-square test). No statistically significant association was observed between the patterns and disease severity (p = 0.055, Fisher's exact test). No fibrous changes in the lesions were observed on follow-up CT scans.ConclusionThe serial CT scans of COVID-19 patients showed the spectrum of COVID pneumonia CT manifestations as different phases of lung injury and repair.

Chest computed tomography scan findings of coronavirus disease 2019 (COVID-19) patients: a comprehensive systematic review and meta-analysis.

IntroductionNumerous cases of pneumonia caused by coronavirus disease 2019 (COVID-19) were reported in Wuhan, China. Chest computed tomography (CT) scan is highly important in the diagnosis and follow-up of lung disease treatment. The present meta-analysis was performed to evaluate chest CT scan findings in COVID-19 patients.Material and methodsAll research steps were taken according to the Meta-Analysis of Observational Studies In Epidemiology (MOOSE) protocol and the final report was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We registered this review at the International Prospective Register of Systematic Reviews (PROSPERO, CRD42019127858).ResultsForty eligible studies including 4598 patients with COVID-19 were used for meta-analysis. The rate of positive chest CT scan in patients with COVID-19 was 94.5% (95% CI: 91.7-96.3). Bilateral lung involvement, pure ground-glass opacity (GGO), mixed (GGO pulse consolidation or reticular), consolidation, reticular, and presence of nodule findings in chest CT scan of COVID-19 pneumonia patients were respectively estimated to be 79.1% (95% CI: 70.8-85.5), 64.9% (95% CI: 54.1-74.4), 49.2% (95% CI: 35.7-62.8), 30.3% (95% CI: 19.6-43.6), 17.0% (95% CI: 3.9-50.9) and 16.6% (95% CI: 13.6-20.2). The distribution of lung lesions in patients with COVID-19 pneumonia was peripheral (70.0% [95% CI: 57.8-79.9]), central (3.9% [95% CI: 1.4-10.6]), and peripheral and central (31.1% [95% CI: 19.5-45.8]). The pulmonary lobes most commonly involved were the right lower lobe (86.5% [95% CI:57.7-96.8]) and left lower lobe (81.0% [95% CI: 50.5-94.7]).ConclusionsThe most important outcomes in chest CT scan of patients with COVID-19 pneumonia were bilateral lung involvement, GGO or mixed (GGO pulse consolidation or reticular) patterns, thickened interlobular septa, vascular enlargement, air bronchogram sign, peripheral distribution, and left and right lower lobes involvement. Our study showed that chest CT scan has high sensitivity in the diagnosis of COVID-19, and may therefore serve as a standard method for diagnosis of COVID-19.

Identification, Monitoring, and Prediction of Disease Severity in Patients with COVID-19 Pneumonia Based on Chest Computed Tomography Scans: A Retrospective Study.

Background and Aims Non-contrast chest computed tomography (CT) scans can accurately evaluate the type and extent of lung lesions. The aim of this study was to investigate the chest CT features associated with critical and non-critical patients with coronavirus disease 2019 (COVID-19). Methods A total of 1078 patients with COVID-19 pneumonia who underwent chest CT scans, including 169 critical cases and 909 non-critical cases, were enrolled in this retrospective study. The scans of all participants were reviewed and compared in two groups of study. In addition, the risk factors associated with disease in critical and non-critical patients were analyzed. Results Chest CT scans showed bilateral and multifocal involvement in most (86.4%) of the participants, with 97.6 and 84.3% reported in critical and non-critical patients, respectively. The incidences of pure consolidation (p=0.019), mixed ground-glass opacities (GGOs) and consolidation (p<0.001), pleural effusion (p<0.001), and intralesional traction bronchiectasis (p=0.007) were significantly higher in critical compared to non-critical patients. However, non-critical patients showed higher incidence of pure GGOs than the critical patients (p<0.001). Finally, the total opacity scores of the critical patients were significantly higher than those of non-critical patients (13.71±6.26 versus 4.86±3.52, p<0.001), with an area under the curve of 0.91 (0.88-0.94) for COVID-19 detection. Conclusions Our results revealed that the chest CT examination was an effective means of detecting pulmonary parenchymal abnormalities in the natural course of COVID-19. It can distinguish the critical patients from the non-critical patients (AUC=0.91), which is helpful for the judgment of clinical condition and has important clinical value for the diagnosis and follow-up of COVID-19 pneumonia.

COVID-19 or non-COVID viral pneumonia: How to differentiate based on the radiologic findings?

Influenza viruses were responsible for most adult viral pneumonia. Presently, coronavirus disease 2019 (COVID-19) has evolved into serious global pandemic. COVID-19 outbreak is expected to persist in months to come that will be synchronous with the influenza season. The management, prognosis, and protection for these two viral pneumonias differ considerably and differentiating between them has a high impact on the patient outcome. Reverse transcriptase polymerase chain reaction is highly specific but has suboptimal sensitivity. Chest computed tomography (CT) has a high sensitivity for detection of pulmonary disease manifestations and can play a key-role in diagnosing COVID-19. We reviewed 47 studies and delineated CT findings of COVID-19 and influenza pneumonia. The differences observed in the chest CT scan can be helpful in differentiation. For instance, ground glass opacities (GGOs), as the most frequent imaging finding in both diseases, can differ in the pattern of distribution. Peripheral and posterior distribution, multilobular distribution, pure or clear margin GGOs were more commonly reported in COVID-19, whereas central or peri-bronchovascular GGOs and pure consolidations were more seen in influenza A (H1N1). In review of other imaging findings, further differences were noticed. Subpleural curvilinear lines, sugar melted sign, intra-lesional vascular enlargement, reverse halo sign, and fibrotic bands were more reported in COVID-19 than H1N1, while air space nodule, tree-in-bud, bronchiectasia, pleural effusion, and cavitation were more seen in H1N1. This delineation, when combined with clinical manifestations and laboratory results may help to differentiate these two viral infections.

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.

Prediction of disease progression in patients with COVID-19 by artificial intelligence assisted lesion quantification

To investigate the value of artificial intelligence (AI) assisted quantification on initial chest CT for prediction of disease progression and clinical outcome in patients with coronavirus disease 2019 (COVID-19). Patients with confirmed COVID-19 infection and initially of non-severe type were retrospectively included. The initial CT scan on admission was used for imaging analysis. The presence of ground glass opacity (GGO), consolidation and other findings were visually evaluated. CT severity score was calculated according to the extent of lesion involvement. In addition, AI based quantification of GGO and consolidation volume were also performed. 123 patients (mean age: 64.43 ± 14.02; 62 males) were included. GGO + consolidation was more frequently revealed in progress-to-severe group whereas pure GGO was more likely to be found in non-severe group. Compared to non-severe group, patients in progress-to-severe group had larger GGO volume (167.33 ± 167.88 cm3 versus 101.12 ± 127 cm3, p = 0.013) as well as consolidation volume (40.85 ± 60.4 cm3 versus 6.63 ± 14.91 cm3, p < 0.001). Among imaging parameters, consolidation volume had the largest area under curve (AUC) in discriminating non-severe from progress-to-severe group (AUC = 0.796, p < 0.001) and patients with or without critical events (AUC = 0.754, p < 0.001). According to multivariate regression, consolidation volume and age were two strongest predictors for disease progression (hazard ratio: 1.053 and 1.071, p: 0.006 and 0.008) whereas age and diabetes were predictors for unfavorable outcome. Consolidation volume quantified on initial chest CT was the strongest predictor for disease severity progression and larger consolidation volume was associated with unfavorable clinical outcome.

HIGH-RESOLUTION CT FEATURES OF THE COVID-19 INFECTION, INITIALAND FOLLOW-UP CHANGES AMONG DIFFERENT CLINICAL TYPES

Background: To discuss the high resolution computed tomography (HRCT) manifestations of corona virus disease 2019 (COVID-19) patients among different clinical types on initial and follow-up CT. Methods: Seventy COVID-19 patients admitted to the Affiliated Hospital of SP Medical Collage Bikaner were enrolled. All patients underwent initial and follow-up chest HRCT. The main CT features and semi-quantitative score which represent disease severity among different clinical types were evaluated. Result: On initial CT, the main abnormalities observed in common and severe cases respectively were pure ground glass opacities (GGOs) and patchy consolidation surrounded by GGOs. Critical cases had multiple consolidation surrounded by wide range of GGOs distributed in the whole lung fields. The CT severity score and density score in mild (up to 8 and 5), moderate (&gt;8 to 15 and 9) and severe (&gt;15 and 12) cases were increased by gradient. On follow-up CT, mild and moderate types manifested as decreasing density of lesion, absorbed consolidation and GGOs. Severe cases showed progression of the disease. The extent and progression scores in mild and moderate patients were significantly decreased, while the range score of patients with severe disease reached the highest points, accompanied with an increase in the density score. Conclusion: CT scanning can accurately assess the severity of COVID-19, and help to monitor disease transformation during follow-up among different clinical conditions.

Dandelion and focal crazy paving signs: the lung CT based predictors for evaluation of the severity of coronavirus disease

Purpose To describe the radiological features of coronavirus disease 19 (COVID-19) and to explore the significant signs that indicate severity of disease. Materials and methods We collected data retrospectively of 180 cases of COVID-19, from 15 January 2020 to 31 March 2020, from both the Wuhan Zhongnan and Beijing Ditan Hospitals, including 103 cases of mild and 77 cases of severe pneumonia. All patients had their first chest computed tomography scan within five days of symptom onset. The dandelion sign was defined by a focal ground glass opacity (GGO) with a central thickening of the airway wall, and the focal crazy paving sign was defined by a focal GGO with thickening of the interlobular septa. Results Consolidation presented in only 4.9% (5/103) of the mild pneumonia cases, which was significantly lower than that in severe pneumonia cases (70.1% 54/77), p < .001). Multifocal distribution and pure GGOs were observed more frequently in severe cases of pneumonia (p < .05). The dandelion sign was present in 86.4% (89/103) of the mild pneumonia cases, significantly more frequent than those with severe pneumonia (13.0% [10/77], p < .001). The focal crazy paving sign presented in 65.0% (67/103) of the mild pneumonia cases and was significantly more frequent than in severe cases (23.4% [18/77], p < .001). The hospital stay duration of the mild pneumonia group (13.6 ± 7.2 days) was significantly shorter than the severe pneumonia group (26.6 ± 11.7 days, p < .001) Conclusions Consolidation, pure GGO and multifocal distribution on a CT scan were associated with severe COVID-19. The dandelion and focal crazy paving signs indicate mild COVID-19.

Chest CT features and progression of patients with coronavirus disease 2019.

Objectives:Coronavirus disease 2019 (COVID-19) is a major public health emergency. It poses a grave threat to human life and health. The purpose of the study is to investigate the chest CT findings and progression of the disease observed in COVID-19 patients.Methods:Forty-nine confirmed cases of adult COVID-19 patients with common type, severe and critically severe type were included in this retrospective single-center study. The thin-section chest CT features and progress of the disease were evaluated. The clinical and chest imaging findings of COVID-19 patients with different severity types were compared. The CT severity score and MuLBSTA score (a prediction of mortality risk) were calculated in those patients.Results:Among the 49 patients, 35 patients (71%) were common type and 14 patients (28%) were severe and critically severe type. Nearly all patients (98%) had pure ground-glass opacities (GGO) in CT imaging. Of the severe and critically severe type patients, 86% exhibited GGO with consolidation, in comparison with 54% of the patients with common type. Fibrosis presented in 79% of the severe and critically severe type patients and 43% of the common type patients. The severe and critically severe type patients were significantly more prone to experience five-lobe involvement compared to the common type patients (p = 0.002). The severe and critically severe type patients also had higher CT severity and MuLBSTA scores than the common type patients (5.43 ± 2.38 vs 3.37 ± 2.40, p < 0.001;and 10.21 ± 3.83 vs 4.63 ± 3.43, p < 0.001, respectively). MuLBSTA score was positively correlated with admittance to the intensive care unit (p = 0.005, r = 0.351). Nineteen patients underwent three times CT scan. The interval between first and second CT scan was 4[4,8] days, second and third was 3[2,4] days. There were greater improvements in the third CT follow-up findings compared to the second (p = 0.002).Conclusions:The severe and critically severe type patients often experienced more severe lung lesions, including GGO with consolidation. The CT severity score and MuLBSTA score may be helpful for the assessment of COVID-19 severity and progression.Advances in knowledge:Chest CT has the value of evaluated radiographical features of COVID-19 and allow for dynamic observation of the disease progression. Considering coagulation disorder of COVID-19, MuLBSTA score may need to be updated to increase new understanding of COVID-19.

Evaluation of solid portions in non-small cell lung cancer-the solid part is not always measurable for clinical T factor.

Solid component size on thin-section computed tomography is used for T-staging according to the eighth edition of the Tumor Node Metastasis classification of lung cancer. However, the feasibility of using the solid component to measure clinical T-factor remains controversial. We evaluated the feasibility of measuring the solid component in 859 tumours, which were suspected cases of primary lung cancers, requiring surgical resection regardless of the procedure or clinical stage. After excluding 126 pure ground-glass opacity tumours and 450 solid tumours, 283 part-solid tumours were analysed to determine the frequency of cases where the measurement of the solid portion was difficult along with the associated cause. Pathological invasiveness was also evaluated. The solid portion of 10 lesions in 283 part-solid nodules was difficult to measure due to an underlying lung disease (emphysema and pneumonitis). The solid portion of 62 lesions (21.9%) without emphysema and pneumonitis was difficult to measure due to imaging features of the tumours. Among the 62 patients, five had no malignancy and one with a tumour size of 33mm had nodal metastasis. There were 56 lesions with a tumour size of ≤30mm, wherein nodal metastases, vascular and/or lymphatic invasions were not observed. For one-fifth of the part-solid tumours, measurement of the solid component was difficult. Moreover, these lesions had low invasiveness, especially in T1. The measurement of the solid portion and the classification of T1 in 1-cm increments may be complex.