Role of CT in the Management of COVID-19 Patients

32 views 0 04/20/2020

 

1) Main radiologic findings

  1. Bilateral multilobar ground-glass opacification with a peripheral or posterior distribution is found in COVID-19. 
  2. Generally in lower lobes and less frequently the right middle lobe. 
  3. Greatest severity of CT scan found around day 10 of symptom onset. 

 

This data was provided by a systematic review of the literature conducted on February 12th 2020 and published in the AJR.

Source:

Salehi, Abedi et al. (February 2020). Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging Findings in 919 Patients. American Journal of Roentgenology. 10.2214/AJR.20.23034. Retrieved from : https://www.ajronline.org/doi/full/10.2214/AJR.20.23034

 

2) Sensitivity and specificity of CT 

  1. In a retrospective study, chest CT for patients with COVID-19 pneumonia had a sensitivity of 98% and a specificity of 25%
  2. PPV and NPV were 65% and 83%, respectively

 

This data was provided by: 

  • A retrospective study of 51 patients in Shanghai, China published in the Radiology journal on February 19 2020.
  • A retrospective study of 1014 patients in Wuhan, China published in the Radiology journal on February 26 2020.

Sources:

  1. Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P et al. (February 19, 2020). Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radiology. https://doi.org/10.1148/radiol.2020200432. Retrieved from : https://pubs.rsna.org/doi/10.1148/radiol.2020200432: : 
  2. Ai, Tao, et al. « Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. » Radiology (2020): 200642. Retreived from : https://pubs.rsna.org/doi/full/10.1148/radiol.2020200642

 

3) CT Features in Young and Older Adults

  1. Patients aged 45-59 years and aged ≥60 years had more bilateral lung, lung lobe, and lung field involvement, and greater lesion numbers than patients <18 years. 
  2. GGO accompanied with the interlobular septa thickening or a crazy-paving pattern, consolidation, and air bronchogram sign were more common in patients aged 45-59 years, and ≥60 years, than in those aged <18 years, and aged 18-44 years.
  3. Compared with the younger group, the proportion of extensive involvement of lung lobes was higher in the elderly group (71.4% vs. 36.4%), and subpleural line and pleural thickening were more likely to occur (50.0% vs. 25.0%, and 71.4% vs. 40.9%.

 

This data was provided by:

  1. A case study data of 98 patients diagnosed with COVID-19 infection in Hangzhou City, China were collected, and chest HRCT signs of infected patients in different age groups  were compared. Published in the European Journal of Radiology on March 24.
  2. A retrospective study published on March 31 in the Journal of Thoracic Imaging, analysing the most common CT findings of 72 patients with COVID-19 infection.

Sources:

  1. Chen Z, Fan H, Cai J, Li Y, Wu B, Hou Y, Xu S, Zhou F, Liu Y, Xuan W, Hu H, Sun J. High-resolution computed tomography manifestations of COVID-19 infections in patients of different ages. Eur J Radiol. 2020 Mar 24. doi: 10.1016/j.ejrad.2020.108972. Retrieved from : https://www.ejradiology.com/article/S0720-048X(20)30161-3/pdf
  2. Zhu T, Wang Y, Zhou S, Zhang N, Xia L. A Comparative Study of Chest Computed Tomography Features in Young and Older Adults With Corona Virus Disease (COVID-19). J Thorac Imaging. 2020 Mar 31 doi: 10.1097/RTI.0000000000000513. Retrieved from : https://journals.lww.com/thoracicimaging/Abstract/publishahead/A_Comparative_Study_of_Chest_Computed_Tomography.99433.aspx

 

4) Differential diagnosis of COVID19 on CT

  1. The most discriminating features for COVID-19 pneumonia from viral pneumonia on chest CT included a peripheral distribution (80% vs. 57%), ground-glass opacity (91% vs. 68%) and vascular thickening (58% vs. 22%).
  2. Three Chinese radiologists had an average sensitivity of 79% and specificity of 69% in differentiating 219 COVID-19 from 205 non-COVID-19 pneumonia
  3. For the same patients, four United States radiologists had average sensitivities of  81% and specificities of 96%.

 

This data was provided by:

  1. A retrospective study published in Radiology identified CT scans of patients positive for COVID-19 as well as patients with viral pneumonia from 7 Chinese hospitals in Hunan Providence, China. Three Chinese and four U.S radiologists blindly reviewed all chest CTs to differentiate COVID-19 from viral pneumonia.

Source:

  1. Bai HX, Hsieh B, Xiong Z, Halsey K, Choi JW, Tran TML, Pan I, Shi LB, Wang DC, Mei J, Jiang XL, Zeng QH, Egglin TK, Hu PF, Agarwal S, Xie F, Li S, Healey T, Atalay MK, Liao WH. Performance of radiologists in differentiating COVID-19 from viral pneumonia on chest CT. Radiology. 2020 Mar 10.doi: 10.1148/radiol.2020200823. Retrieved from https://pubs.rsna.org/doi/10.1148/radiol.2020200823?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

 

5) Definition of Chest CT Severity Score

  1. The CT-SS  uses lung opacification as a surrogate for extension of the disease in the lungs.
  2. This score was defined by summing up individual scores from 20 lung regions; scores of 0, 1, and 2 are respectively assigned for each region if parenchymal opacification involved 0%, less than 50%, or equal or more than 50% of each region.
  3. The CT-SS was defined as the sum of the individual scored in the 20 lung segment regions, which may range from 0 to 40 points.

 

6) Prognosis value of CT- SS

  • The proposed pulmonary inflammation load score was higher in patients with severe COVID-19 in comparison with patients with mild disease.
  • The optimal inflammation load score threshold for identifying severe patients was 19.5, with 83.3% sensitivity and 94% specificity, resulting in an NPV of 96.3%

 

This data was provided by:

  1. A retrospective study published in the Radiology Journal on March 30 included 102 patients with COVID-19 to evaluate the value of chest computed tomography severity score (CT-SS) in differentiating clinical forms of COVID-19.

Source:

  1. Yang R, Li X, Liu H, Zhen Y, Zhang X, Xiong Q, et al. Chest CT Severity Score: An Imaging Tool for Assessing Severe COVID-19. Radiol Cardiothorac Imaging. 2020;2(2):e200047. Retrieved from: https://pubs.rsna.org/doi/pdf/10.1148/ryct.2020200047
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