Chest computed tomography imaging features in patients with coronavirus disease 2019 (COVID-19)

Objective To analyze computed tomography (CT) features of symptomatic patients with coronavirus disease 2019 (COVID-19). Methods Ninety-five symptomatic patients with COVID-19 confirmed by reverse-transcription polymerase chain reaction from 1 May to 14 July 2020 were retrospectively enrolled. Follow-up CT findings and their distributions were analyzed and compared from symptom onset to late-stage disease. Results Among all patients, 15.8% had unilateral lung disease and 84.2% had bilateral disease with slight right lower lobe predilection (47.4%). Regarding lesion density, 49.4% of patients had pure ground glass opacity (GGO) and 50.5% had GGO with consolidation. Typical early-stage patterns were bilateral lesions in 73.6% of patients, diffuse lesions (41.0%), and GGO (65.2%). Pleural effusion occurred in 13.6% and mediastinal lymphadenopathy in 11.5%. During intermediate-stage disease, 47.4% of patients showed GGO as the disease progressed; however, consolidation was the predominant finding (52.6%). Conclusion COVID-19 pneumonia manifested on lung CT scans with bilateral, peripheral, and right lower lobe predominance and was characterized by diffuse bilateral GGO progressing to or coexisting with consolidation within 1 to 3 weeks. The most frequent CT lesion in the early, intermediate, and late phases was GGO. Consolidation appeared in the intermediate phase and gradually increased, ending with reticular and lung fibrosis-like patterns.

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4DCT radiotherapy for NSCLC: a review of planning methods

Journal of Radiotherapy in Practice ◽

10.1017/s1460396914000041 ◽

2014 ◽

Vol 14 (1) ◽

pp. 70-79 ◽

Cited By ~ 1

Author(s):

A. Hutchinson ◽

P. Bridge

Keyword(s):

Computed Tomography ◽

Radiation Therapy ◽

Early Stage ◽

Organs At Risk ◽

Patient Comfort ◽

Or Education ◽

Optimal Method ◽

Early Stage Disease ◽

Advantages And Disadvantages ◽

Stage Disease

AbstractPurposeTo establish whether the use of a passive or active technique of planning target volume (PTV) definition and treatment methods for non-small cell lung cancer (NSCLC) deliver the most effective results. This literature review assesses the advantages and disadvantages in recent studies of each, while assessing the validity of the two approaches for planning and treatment.MethodsA systematic review of literature focusing on the planning and treatment of radiation therapy to NSCLC tumours. Different approaches which have been published in recent articles are subjected to critical appraisal in order to determine their relative efficacy.ResultsFree-breathing (FB) is the optimal method to perform planning scans for patients and departments, as it involves no significant increase in cost, workload or education. Maximum intensity projection (MIP) is the fastest form of delineation, however it is noted to be less accurate than the ten-phase overlap approach for computed tomography (CT). Although gating has proven to reduce margins and facilitate sparing of organs at risk, treatment times can be longer and planning time can be as much as 15 times higher for intensity modulated radiation therapy (IMRT). This raises issues with patient comfort and stabilisation, impacting on the chance of geometric miss. Stereotactic treatments can take up to 3 hours to treat, along with increases in planning and treatment, as well as the additional hardware, software and training required.ConclusionFour-dimensional computed tomography (4DCT) is superior to 3DCT, with the passive FB approach for PTV delineation and treatment optimal. Departments should use a combination of MIP with visual confirmation ensuring coverage for stage 1 disease. Stages 2–3 should be delineated using ten-phases overlaid. Stereotactic and gated treatments for early stage disease should be used accordingly; FB-IMRT is optimal for latter stage disease.

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Clinicopathological and imaging features of pulmonary alveolar microlithiasis in a dog – a case report

BMC Veterinary Research ◽

10.1186/s12917-020-02593-z ◽

2020 ◽

Vol 16 (1) ◽

Author(s):

Ana Canadas Sousa ◽

Joana C. Santos ◽

Clara Landolt ◽

Catarina Gomes ◽

Patrícia Dias-Pereira ◽

...

Keyword(s):

Computed Tomography ◽

Case Report ◽

Ground Glass Opacity ◽

Imaging Features ◽

Ct Guided ◽

Pulmonary Alveolar Microlithiasis ◽

Reticular Pattern ◽

Pulmonary Parenchyma ◽

Alveolar Microlithiasis ◽

Ct Features

Abstract Background The aetiology of pulmonary alveolar microlithiasis (PAM) in animals is still unknown. In humans, this pulmonary disorder is a rare autosomal recessive disorder triggered by a mutation in the gene SLC34A2, which causes deposition and aggregation of calcium and phosphate in the pulmonary parenchyma with formation of microliths. Although histopathological examination is required for a definite diagnosis, in humans, imaging modalities such as computed tomography can demonstrate typical patterns of the disease. This is the first description of the computed tomographic (CT) features of a histologically confirmed PAM in dogs. Case presentation The following report describes a case of a 7-year-old female Boxer dog evaluated for paroxysmal loss of muscle tone and consciousness with excitement. The main differential diagnoses considered were syncope, seizures, and narcolepsy-cataplexy. The results of the complete blood count, serum biochemistry panel, urinalysis, arterial blood pressure, echocardiography, abdominal ultrasound, Holter monitoring, and ECG were all within normal limits. Additional exams included thoracic radiographs, head and thorax CT, bronchoalveolar lavage (BAL), and CT-guided cytology. Thoracic radiographs revealed micronodular calcifications in the lungs, with sandstorm appearance. Computed tomography of the thorax showed the presence of numerous mineralized high-density agglomerates of multiple sizes throughout the pulmonary parenchyma, a reticular pattern with ground glass opacity and intense mineralized fibrosis of the pleural lining. Head CT was unremarkable. BAL and CT-guided cytology were inconclusive, but imaging features strongly suggest the diagnosis of PAM, which was histologically confirmed after necropsy. Conclusions This case report contributes to the clinicopathological and imaging characterization of pulmonary alveolar microlithiasis in dogs. In this species, the diagnosis of PAM should be considered when CT features evidence a reticular pattern with ground glass opacity and the presence of an elevated number and size of calcifications.

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A Rare Cause of Crazy-Paving and Mediastinal Lymphadenopathy: Congestive Heart Failure

Journal of Clinical Imaging Science ◽

10.4103/2156-7514.115762 ◽

2013 ◽

Vol 3 ◽

pp. 30 ◽

Cited By ~ 1

Author(s):

Aysegul Senturk ◽

Aysegul Karalezli ◽

Ayse Nur Soyturk ◽

H. Canan Hasanoglu

Keyword(s):

Heart Failure ◽

Computed Tomography ◽

Congestive Heart Failure ◽

Lymph Nodes ◽

Inflammatory Diseases ◽

Present Report ◽

Ground Glass Opacity ◽

Mediastinal Lymphadenopathy ◽

Reticular Pattern ◽

Computed Tomography Images

Crazy-paving sign is a pattern seen on multislice computed tomography images of the lungs. It is characterized by a reticular pattern superimposed on ground-glass opacity. It was first described in the late 1980s in patients with pulmonary alveolar proteinosis, but has now been described in some other diseases of the lung. Enlarged mediastinal lymph nodes can be seen in infectious and specific inflammatory diseases and malignancies. The present report describes a case of a 44-year-old man in whom congestive heart failure presented with a crazy-paving appearance and enlarged lymph nodes of the lungs on the chest computed tomography scan.

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New advances in the diagnosis and management of hepatocellular carcinoma

BMJ ◽

10.1136/bmj.m3544 ◽

2020 ◽

pp. m3544 ◽

Cited By ~ 1

Author(s):

Ju Dong Yang ◽

Julie K Heimbach

Keyword(s):

Hepatocellular Carcinoma ◽

Systemic Treatment ◽

Early Stage ◽

Treatment Options ◽

Intermediate Stage ◽

Phase Iii ◽

Advanced Hepatocellular Carcinoma ◽

Long Term Outcomes ◽

Stage Disease

ABSTRACT Hepatocellular carcinoma is one of the leading causes of cancer related death in the world. Biannual surveillance for the disease in patients with cirrhosis and in high risk carriers of hepatitis B virus allows early stage cancer detection and treatment with good long term outcomes. Liver ultrasonography and serum α fetoprotein are the most commonly used surveillance tests. If suspicious results are found on the surveillance test, multiphasic computed tomography or magnetic resonance imaging should be undertaken to confirm the diagnosis of hepatocellular carcinoma. If radiologic tests show inconclusive results, liver biopsy or repeat imaging could be considered for confirmation of hepatocellular carcinoma. Management of the disease is complex. Patients should be evaluated by a multidisciplinary team, and the selection of treatment should consider factors such as tumor burden, severity of liver dysfunction, medical comorbidities, local expertise, and preference of patients. Early stage hepatocellular carcinoma is best managed by curative treatment, which includes resection, ablation, or transplantation. Patients with intermediate stage disease often receive locoregional treatment. Systemic treatment is reserved for patients with advanced disease. Several positive, phase III, randomized controlled trials have expanded the systemic treatment options for advanced hepatocellular carcinoma with promising long term outcomes, especially trials using combination treatments, which could also have eventual implications for the treatment of earlier stage disease.

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CT Imaging Features During Disease Progression of 2019 Novel Coronavirus (COVID-19) Pneumonia

Iranian Journal of Radiology ◽

10.5812/iranjradiol.102925 ◽

2020 ◽

Vol 17 (4) ◽

Author(s):

Nan Yu ◽

Yong Yu ◽

Shubo Cai ◽

Cong Shen ◽

Youmin Guo

Keyword(s):

Disease Progression ◽

Symptom Onset ◽

Early Stage ◽

Ground Glass Opacity ◽

Ct Imaging ◽

Imaging Features ◽

Imaging Characteristics ◽

Novel Coronavirus ◽

Stage 1

Objectives: To describe the characteristics of computed tomography (CT) in patients with 2019 novel coronavirus (COVID-19) pneumonia and their changes during disease progression. Patients and Methods: A total of 96 chest CT scans of 61 pneumonia patients associated with COVID-19 were reviewed to identify CT features associated with the time of symptom onset and the evolution of disease. Results: The initial CTs of 61 patients were obtained during 1 to 11 days after the onset. The main CT pattern of initial CT obtained during 1 - 3 days after the symptom onset was single (7/23, 35%) or multiple ground-glass opacity (GGO, 8/23, 35%). At 4 - 7 days after the symptom onset, the main imaging features were crazy paving GGO mixed with partial consolidation pattern (15/32, 47%). At 8 - 11 days after the symptom onset, the CT images showed consolidation pattern (3/6, 50%). A total of 35 follow up CTs were collected. The mean interval time between each follow up CT was 3 ± 2 days. The CT patterns also changed with the evolution of the disease: the features of GGO manifested at the early stage (1 - 3d). The crazy paving GGO pattern, consolidation pattern and mixed with partial consolidation pattern were found 4 to 14 days after the onset. In the absorption stage (15 - 24d), both density and extent of lesions were reduced. Conclusion: The CT imaging features are associated with the time of symptom onset and evolution of disease. Understanding the imaging characteristics of each stage is very helpful for understanding the development of disease.

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Investigation of HRCT Chest Severity in Patients with COVID-19: A Study of Tertiary Care Hospital in Pakistan

10.53350/pjmhs211551084 ◽

2021 ◽

Vol 15 (5) ◽

pp. 1084-1089

Author(s):

Saulat Sarfraz ◽

Kh. Bilal Waheed ◽

Masood Akhtar ◽

Sarfraz Latif ◽

Muhammad Asif ◽

...

Keyword(s):

Tertiary Care ◽

Lower Lobe ◽

Ground Glass Opacity ◽

Pulmonary Involvement ◽

Clinical Severity ◽

Ground Glass ◽

Care Hospital ◽

Imaging Features ◽

High Resolution Computed Tomography ◽

Cross Sectional

Background: High-resolution computed tomography (HRCT) chest has a key role in diagnosis COVID-19, as it provides specific imaging features, i.e., bilateral, peripheral and sub-pleural, ground-glass opacity (GGO), consolidation and many associated findings. Aim: To provide the detailed chest HRCT findings along with clinical information in patients with COVID-19. Methods: A cross-sectional study was conducted in the Department of Radiology SZPGMI, Lahore. Information on clinical data, chest radiography appearance and comorbidities were recorded ona designed proforma. HRCT chest findings were recorded in terms of pattern, distribution, laterality, and other findings. HRCT chest severity was calculated using a 25 point CT severity score. Kendall’s Tau test applied to investigate the correlation between the severity of HRCT chest with clinical severity levels of COVID-19. Results: Fever (74%) was the most reported presenting symptom, followed by dry cough (70%). The majority of patients had abnormal chest X-ray (57%) as well as abnormal HRCT chest (90%). The majority of patients were in mild clinical scoring levels of disease (61%) and mild category (49%) of HRCT chest severity. In majority of the patients (46%), all five pulmonary lobes were involved, whereas the right lower lobe was most frequently affected. The pattern of ground-glass opacity (GGO) was found in 82% of patients. Most common distribution was ‘peripheral’, reported in 90% patients. Multiple lobe involvement was found in 82% of patients. The unilateral pulmonary involvement was observed in 12% of patients, whereas, bilateral was found in 78% of patients. Reticulations were reported in 22% followed by atelectasis in 18% patients. Conclusion: COVID-19 patients usually present with abnormal HRCT chest, mostly with a benign course. Multiple pulmonary lobes are commonly involved, especially basal lobes with ground glass opacities. Clinical severity of the disease is reflected in HRCT findings. Keywords: COVID-19 Pandemic, HRCT Chest Findings, Ground Glass Opacity (GGO), Consolidation

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Comparison of High Resolution Computed Tomography Features in Covid-19 and Other Viral Pneumonia-

10.53350/pjmhs211561139 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1139-1144

Author(s):

S. Nisar ◽

F. Farooq ◽

Rabia . ◽

M. N. Anjum ◽

M. Fatima ◽

...

Keyword(s):

Computed Tomography ◽

High Resolution ◽

Lower Lobe ◽

Ground Glass Opacity ◽

Viral Disease ◽

Viral Pneumonia ◽

High Resolution Computed Tomography ◽

Keywords Computed Tomography ◽

Comparison Results ◽

High Prevalence

Aim: To compare the high resolution computed tomography features in Covid and other viral pneumonia presented in recent literature. Methodology: For this study, total 25 studies were included which follow the Preferred Reporting Items guideline for conducting this systematic review analysis (PRISMA). Electronic articles of Covid from January 2020 to April 2020 were searched on PUB Med, online Willey library, and Science Direct site by using keywords related to CT imaging and Corona virus. For pneumonia related studies articles from year 2010 to year 2017 were included for better comparison. Results: After pooling data, it was observed that bilateral involvement was found in 76.8% of studies, 68.4% GGO, and 62.2% ratio was occupied by peripheral distribution in different studies. Total 48.7% of studies were concerned about the ground glass opacity (GGO) consolidation, 33.2% observed consolidation, 27.7% look for crazy paving pattern, and 25% of studies observed mixed central and peripheral distribution. Conclusion: Study concludes that the chest CT finding results of selected studies for Covid and pneumonia cases were overlapping. Only high prevalence related to upper and lower lobe involvement and peripheral distribution was relatively high in Covid studies. Keywords: Computed tomography, pneumonia viral disease, Sars Covid-19

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Variety of radiological findings in a family with COVID-19: a case report

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00293-0 ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Farideh Gharekhanloo ◽

Iraj Sedighi ◽

Salman Khazaei

Keyword(s):

Ct Scan ◽

Clinical Symptoms ◽

Close Contact ◽

Pediatric Population ◽

Case Series ◽

Lower Lobe ◽

Ground Glass Opacity ◽

Imaging Features ◽

Standard Regimen ◽

Asymptomatic Children

Abstract Introduction In December 2019, a case series of pneumonia associated with seafood and wet animal market was reported as coronavirus disease 2019 (COVID-19) in Wuhan, Hubei, China. The COVID-19 less frequently affects the pediatric group, and asymptomatic children are commonly reported. This feature is important due to the potential transmissibility of COVID-19 through these cases. There is a variety of atypical clinical symptoms and imaging manifestations among children infected with COVID-19. Case presentation We report two sisters with COVID-19 pneumonia who had close contact with their 77-year-old grandmother. Their grandmother expired with a confirmed diagnosis of COVID-19. The older sister (15 years old) firstly presented with severe cough, fever, dyspnea, diarrhea, and lymphopenia. A chest computed tomography (CT) scan showed atypical lobar pneumonic infiltration only in the left lower lobe. The younger sister (6 years old) was affected the following day with milder symptoms (i.e., fever and cough). Her chest CT scan demonstrated typical mild generalized patchy ground-glass opacity with interlobular septal thickening scattered in both lungs. The CT presentation of their grandmother showed typical bilateral white lungs with crazy paving appearance. The standard regimen for both sisters was administrated, and the patients’ respiratory conditions improved after 5 days of treatment. Both cases were discharged with good general conditions. Conclusion Children are considered potentially important causes of COVID-19 transmission. The symptoms in children are milder, and clinicians should be aware of taking a definite history of infected family members. Atypical clinical symptoms and imaging features are more common in children than adults; therefore, it is necessary to identify the typical and atypical imaging patterns of COVID-19 pneumonia in the pediatric population.

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Early clinical and CT features of COVID-19 and community-acquired pneumonia from a fever observation ward in Ningbo, China

Singapore Medical Journal ◽

10.11622/smedj.2021004 ◽

2021 ◽

Author(s):

G Qian ◽

Y Lin ◽

AHY Ma ◽

X Zhang ◽

G Li ◽

...

Keyword(s):

Early Stage ◽

Laboratory Data ◽

Clinical Manifestations ◽

Lower Lobe ◽

Ground Glass Opacity ◽

Ct Images ◽

Community Acquired Pneumonia ◽

Ground Glass ◽

Significant Difference ◽

Eosinophil Counts

Introduction: We aimed to compare the early clinical manifestations, laboratory results and chest computed tomography (CT) images of coronavirus disease 2019 (COVID-19) patients with those of other community-acquired pneumonia (CAP) patients to differentiate COVID-19 before reverse transcription-polymerase chain reaction results are obtained. Methods: The clinical and laboratory data and chest CT images of 51 patients were assessed in a fever observation ward for evidence of COVID-19 between January and February 2020. Results: 24 patients had laboratory-confirmed COVID-19, whereas 27 individuals had negative results. No statistical difference in clinical features was found between COVID-19 and CAP patients except for diarrhoea. There was a significant difference in lymphocyte and eosinophil counts between COVID-19 and CAP patients. 22 (91.67%) COVID-19 patients had bilateral involvement and multiple lesions according to their lung CT images; the left lower lobe (87.50%) and right lower lobe (95.83%) were most often affected, and all lesions were located in peripheral zones of the lung. The most common CT feature of COVID-19 was ground-glass opacity, found in 95.83% of patients, compared to 66.67% of CAP patients. Conclusion: Diarrhoea, lymphocyte counts, eosinophil counts and CT findings (e.g. ground-glass opacity) could help to distinguish COVID-19 from CAP at an early stage of infection, based on findings from our fever observation ward.

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