Longitudinal Radiological Findings in Patients With COVID-19 With Different Severities: From Onset to Long-Term Follow-Up After Discharge

Objective: This study aimed to investigate the evolution of radiological findings in the patients with coronavirus disease 2019 (COVID-19) pneumonia with different severities from onset to 1-year follow-up and identify the predictive factors for different pulmonary lesion absorption status in the patients infected with COVID-19.Methods: A retrospective study was performed on the clinical and radiological features of 175 patients with COVID-19 pneumonia hospitalized at three institutions from January 21 to March 20, 2020. All the chest CT scans during hospitalization and follow-ups after discharge were collected. The clinical and radiological features from the chest CT scans both at the peak stage and before discharge from the hospital were used to predict whether the pulmonary lesions would be fully absorbed after discharge by Cox regression. Then, these patients were stratified into two groups with different risks of pulmonary lesion absorption, and an optimal timepoint for the first CT follow-up was selected accordingly.Results: A total of 132 (75.4%) patients were classified into the non-severe group, and 43 (24.6%) patients were classified into the severe group, according to the WHO guidelines. The opacification in both the groups changed from ground-glass opacity (GGO) to consolidation and then from consolidation to GGO. Among the 175 participants, 135 (112 non-severe and 23 severe patients with COVID-19) underwent follow-up CT scans after discharge. Pulmonary residuals could be observed in nearly half of the patients (67/135) with the presentation of opacities and parenchymal bands. The parenchymal bands in nine discharged patients got fully absorbed during the follow-up periods. The age of patient [hazard ratio (HR) = 0.95, 95% CI, 0.95–0.99], level of lactate dehydrogenase (LDH) (HR = 0.99; 95% CI, 0.99–1.00), level of procalcitonin (HR = 8.72; 95% CI, 1.04–73.03), existence of diffuse lesions (HR = 0.28; 95% CI, 0.09–0.92), subpleural distribution of lesions (HR = 2.15; 95% CI, 1.17–3.92), morphology of residuals (linear lesion: HR = 4.58, 95% CI, 1.22–17.11; nodular lesion: HR = 33.07, 95% CI, 3.58–305.74), and pleural traction (HR = 0.41; 95% CI, 0.22–0.78) from the last scan before discharge were independent factors to predict the absorption status of COVID-19-related pulmonary abnormalities after discharge. According to a Kaplan–Meier analysis, the probability of patients of the low-risk group to have pulmonary lesions fully absorbed within 90 days reached 91.7%.Conclusion: The development of COVID-19 lesions followed the trend from GGO to consolidation and then from consolidation to GGO. The CT manifestations and clinical and laboratory variables before discharge could help predict the absorption status of pulmonary lesions after discharge. The parenchymal bands could be fully absorbed in some COVID-19 cases. In this study, a Cox regression analysis indicated that a timepoint of 3 months since onset was optimal for the radiological follow-up of discharged patients.

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Clinical and radiological features of patients with 2019 novel coronavirus (SARS-CoV-2) in Haikou, China

10.21203/rs.3.rs-19849/v1 ◽

2020 ◽

Author(s):

Hui Juan Chen ◽

Jie Qiu ◽

Biao Wu ◽

Zhen Ping Wang ◽

Yang Chen ◽

...

Keyword(s):

Clinical Outcomes ◽

Chest Ct ◽

Ground Glass ◽

Radiological Findings ◽

Lung Lesions ◽

Radiological Features ◽

Ct Findings ◽

Imported Cases ◽

Novel Coronavirus

Abstract To describe the clinical and radiological findings of patients confirmed with 2019 novel coronavirus disease (COVID-19) infection in Haikou, China. A total of 67 patients confirmed with COVID-19 infection were included in this study. 50 were imported cases. Most infected patients presented with fever and cough. The typical CT findings of lung lesions were bilateral, multifocal lung lesions (52[78%]), with subpleural distribution, and more than two lobes involved (51[78%]). 54 (81%) patients of COVID-19 pneumonia had ground glass opacities. Consolidation was in 30 (45%) patients, crazy paving pattern or interlobular thickening in 17 (25%), adjacent pleura thickening in 23 (34%) patients. Additionally, baseline chest CT did not reveal positive CT findings in 7 patients (23%), but 3 patients presented unilateral ground glass opacities at follow-up. Importantly, the follow-up CT findings were fitted well with the clinical outcomes.

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Solitary round pulmonary lesions in the pediatric population: a pictorial review

Acta Radiologica Open ◽

10.1177/2058460119851998 ◽

2019 ◽

Vol 8 (5) ◽

pp. 205846011985199

Author(s):

Nikolaos-Achilleas Arkoudis ◽

Angeliki Pastroma ◽

Georgios Velonakis ◽

Athanasios Tsochatzis ◽

Argyro Mazioti ◽

...

Keyword(s):

Differential Diagnosis ◽

Pediatric Population ◽

Clinical Information ◽

Pulmonary Lesion ◽

Radiological Findings ◽

Pulmonary Lesions ◽

Pictorial Review ◽

Work Up

The purpose of this current pictorial review is to define the solitary round pulmonary lesion (SRPL), to familiarize with its prevalence in the pediatric population, and, moreover, to educate radiologists on its vast differential diagnosis and imaging manifestations. Furthermore, by highlighting valuable clues, it intends to assist radiologists efficiently partake in its diagnosis, work-up, and follow-up in order to narrow down the differential diagnosis by working alongside the clinician and combining clinical information, lab results, and radiological findings.

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Follow-up Chest CT findings from discharged patients with severe COVID-19: an 83-day observational study

10.21203/rs.3.rs-27359/v1 ◽

2020 ◽

Author(s):

Tianhe Ye ◽

Yanqing Fan ◽

Jiacheng Liu ◽

Chongtu Yang ◽

Songjiang Huang ◽

...

Keyword(s):

Symptom Onset ◽

Virus Disease ◽

Ground Glass Opacity ◽

Chest Ct ◽

Ct Scans ◽

Ground Glass ◽

Ct Findings ◽

Lung Abnormalities ◽

Discharged Patients

Abstract Background: Chest computed tomography (CT) has been used to be a monitoring measure to assess the severity of lung abnormalities in corona virus disease 19 (COVID-19). Up to date, there has been no reports about follow-up chest CT findings from discharge patients with severe COVID-19. This study aims to describe the change pattern of radiological abnormalities from admission, to discharge, and to the last chest CT follow-up through an 83-day retrospective observation, and focuses on follow-up chest CT findings in discharged patients with severe COVID-19.Methods: Twenty-nine discharged patients (17 males, 12 females; median age, 56 years, IQR, 47-67) confirmed with severe COVID-19 from 13 January to 15 February were enrolled in this study. A total of 80 chest CT scans was performed from admission to the last follow-up. Images were mainly evaluated for ground-glass opacity, consolidation, parenchymal bands, and crazy-paving pattern. A semi-quantitative CT scoring system was used for estimating lung abnormalities of each lobe.Results: All patients received nasal cannula or/and high-flow mask oxygen therapy. Admission occurred 9 days (IQR, 5-13) after symptom onset. The median in-hospital period was 18 days (IQR, 11-26). The last follow-up chest CT was performed 66 days (IQR, 61-77) after symptom onset. Total CT scores in follow-up decreased significantly compared to that of performed in-hospital ([3, IQR, 0-5] to [13, IQR, 10-16], P < 0.001). Predominant patterns on follow-up chest CT performed 64 days after symptom onset were subpleural parenchymal bands (47%, 9/19) and complete radiological resolution (37%, 7/19). Consolidation absorbed earlier than ground-glass opacity did, and subpleural parenchymal bands were the longest-lasting feature during radiological resolution.Conclusions: Radiological abnormalities in patients of severe COVID-19 could be completely absorbed with no residual lung injury in more than two months’ follow-up. Serial chest CT scans could be used as a monitoring modality to help clinician better understand the disease course.

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Cross-sectional analysis of follow-up chest MRI and chest CT scans in patients previously affected by COVID-19

La radiologia medica ◽

10.1007/s11547-021-01390-4 ◽

2021 ◽

Author(s):

Martina Pecoraro ◽

Stefano Cipollari ◽

Livia Marchitelli ◽

Emanuele Messina ◽

Maurizio Del Monte ◽

...

Keyword(s):

Chest Ct ◽

Ct Scans ◽

Imaging Biomarker ◽

Cross Sectional ◽

Mri Scans ◽

Magnetic Resonance Imaging Mri ◽

Sectional Analysis ◽

Ct And Mri ◽

Interlobular Septal Thickening

Abstract Purpose The aim of the study was to prospectively evaluate the agreement between chest magnetic resonance imaging (MRI) and computed tomography (CT) and to assess the diagnostic performance of chest MRI relative to that of CT during the follow-up of patients recovered from coronavirus disease 2019. Materials and methods Fifty-two patients underwent both follow-up chest CT and MRI scans, evaluated for ground-glass opacities (GGOs), consolidation, interlobular septal thickening, fibrosis, pleural indentation, vessel enlargement, bronchiolar ectasia, and changes compared to prior CT scans. DWI/ADC was evaluated for signal abnormalities suspicious for inflammation. Agreement between CT and MRI was assessed with Cohen’s k and weighted k. Measures of diagnostic accuracy of MRI were calculated. Results The agreement between CT and MRI was almost perfect for consolidation (k = 1.00) and change from prior CT (k = 0.857); substantial for predominant pattern (k = 0.764) and interlobular septal thickening (k = 0.734); and poor for GGOs (k = 0.339), fibrosis (k = 0.224), pleural indentation (k = 0.231), and vessel enlargement (k = 0.339). Meanwhile, the sensitivity of MRI was high for GGOs (1.00), interlobular septal thickening (1.00), and consolidation (1.00) but poor for fibrotic changes (0.18), pleural indentation (0.23), and vessel enlargement (0.50) and the specificity was overall high. DWI was positive in 46.0% of cases. Conclusions The agreement between MRI and CT was overall good. MRI was very sensitive for GGOs, consolidation and interlobular septal thickening and overall specific for most findings. DWI could be a reputable imaging biomarker of inflammatory activity.

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Analysis of Chest CT Results of Coronavirus Disease 2019 (COVID-19) Patients at First Follow-Up

Canadian Respiratory Journal ◽

10.1155/2020/5328267 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Lingshan Zhong ◽

Shuo Zhang ◽

Jigang Wang ◽

Xinqian Zhao ◽

Kai Wang ◽

...

Keyword(s):

Ground Glass Opacity ◽

Chest Ct ◽

Ground Glass ◽

Imaging Data ◽

Exclusion Criteria ◽

Pulmonary Lesions ◽

Normal Chest ◽

Time Of Admission ◽

Better Than

Objective. To investigate the dissipation and outcomes of pulmonary lesions at the first follow-up of patients who recovered from moderate and severe cases of COVID-19. Methods. From January 21 to March 3, 2020, a total of 136 patients with COVID-19 were admitted to our hospital. According to inclusion and exclusion criteria, 52 patients who recovered from COVID-19 were included in this study, including 33 moderate cases and 19 severe cases. Three senior radiologists independently and retrospectively analyzed the chest CT imaging data of 52 patients at the last time of admission and the first follow-up after discharge, including primary manifestations, concomitant manifestations, and degree of residual lesion dissipation. Results. At the first follow-up after discharge, 16 patients with COVID-19 recovered to normal chest CT appearance, while 36 patients still had residual pulmonary lesions, mainly including 33 cases of ground-glass opacity, 5 cases of consolidation, and 19 cases of fibrous strip shadow. The proportion of residual pulmonary lesions in severe cases (17/19) was statistically higher than in moderate cases (19/33) ( χ 2 = 5 . 759 , P < 0.05 ). At the first follow-up, residual pulmonary lesions were dissipated to varying degrees in 47 cases, and lesions remained unchanged in 5 cases. There were no cases of increased numbers of lesions, enlargement of lesions, or appearance of new lesions. The dissipation of residual pulmonary lesions in moderate patients was statistically better than in severe patients (Z = −2.538, P < 0.05 ). Conclusion. Clinically cured patients with COVID-19 had faster dissipation of residual pulmonary lesions after discharge, while moderate patients had better dissipation than severe patients. However, at the first follow-up, most patients still had residual pulmonary lesions, which were primarily ground-glass opacity and fibrous strip shadow. The proportion of residual pulmonary lesions was higher in severe cases of COVID-19, which required further follow-up.

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The halo sign: HRCT findings in 85 patients

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562015000000029 ◽

2016 ◽

Vol 42 (6) ◽

pp. 435-439 ◽

Cited By ~ 12

Author(s):

Giordano Rafael Tronco Alves ◽

◽

Edson Marchiori ◽

Klaus Irion ◽

Carlos Schuler Nin ◽

...

Keyword(s):

Immune Status ◽

Ground Glass Opacity ◽

Diagnostic Value ◽

Chest Ct ◽

Ct Scans ◽

Pulmonary Lesions ◽

Halo Sign ◽

Immunosuppressed Patients ◽

Primary Neoplasm ◽

Immunocompetent Patients

ABSTRACT Objective: The halo sign consists of an area of ground-glass opacity surrounding pulmonary lesions on chest CT scans. We compared immunocompetent and immunosuppressed patients in terms of halo sign features and sought to identify those of greatest diagnostic value. Methods: This was a retrospective study of CT scans performed at any of seven centers between January of 2011 and May of 2015. Patients were classified according to their immune status. Two thoracic radiologists reviewed the scans in order to determine the number of lesions, as well as their distribution, size, and contour, together with halo thickness and any other associated findings. Results: Of the 85 patients evaluated, 53 were immunocompetent and 32 were immunosuppressed. Of the 53 immunocompetent patients, 34 (64%) were diagnosed with primary neoplasm. Of the 32 immunosuppressed patients, 25 (78%) were diagnosed with aspergillosis. Multiple and randomly distributed lesions were more common in the immunosuppressed patients than in the immunocompetent patients (p < 0.001 for both). Halo thickness was found to be greater in the immunosuppressed patients (p < 0.05). Conclusions: Etiologies of the halo sign differ markedly between immunocompetent and immunosuppressed patients. Although thicker halos are more likely to occur in patients with infectious diseases, the number and distribution of lesions should also be taken into account when evaluating patients presenting with the halo sign.

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The Pulmonary Sequalae in Discharged Patients With COVID-19:A Short-term Observational Study

10.21203/rs.3.rs-21985/v2 ◽

2020 ◽

Author(s):

Dehan Liu ◽

Wanshu Zhang ◽

Feng Pan ◽

Lin Li ◽

Lian Yang ◽

...

Keyword(s):

Chest Ct ◽

Ct Scans ◽

Optimal Time ◽

Imaging Features ◽

Short Term ◽

Lung Lesions ◽

Cumulative Percentage ◽

Time Points ◽

Time Point

Abstract Background: A cluster of patients with coronavirus disease 2019 (COVID-19) pneumonia were discharged from hospitals in Wuhan, China. We aimed to determine the cumulative percentage of complete radiological resolution at each time point, to explore the relevant affecting factors, and to describe the chest CT findings at different time points after hospital discharge.Methods: Patients with COVID-19 pneumonia confirmed by RT-PCR who were discharged consecutively from the hospital between 5 February 2020 and 10 March 2020 and who underwent serial chest CT scans on schedule were enrolled. The radiological characteristics of all patients were collected and analysed. The total CT score was the sum of non-GGO involvement determined at discharge. Afterwards, all patients underwent chest CT scans during the 1st, 2nd, and 3rd weeks after discharge. Imaging features and distributions were analysed across different time points.Results: A total of 149 patients who completed all CT scans were evaluated; there were 67 (45.0%) men and 82 (55.0%) women, with a median age of 43 years old (IQR 36-56). The cumulative percentage of complete radiological resolution was 8.1% (12 patients), 41.6% (62), 50.3% (75), and 53% (79) at discharge and during the 1st, 2nd, and 3rd weeks after discharge, respectively. Patients ≤44 years old showed a significantly higher cumulative percentage of complete radiological resolution than patients >44 years old at the 3-week follow-up. The predominant patterns of abnormalities observed at discharge were ground-glass opacity (GGO) (65 [43.6%]), fibrous stripe (45 [30.2%]), and thickening of the adjacent pleura (16 [10.7%]). Lung lesions showed obvious resolution from 2 to 3 weeks after discharge, especially in terms of GGO and fibrous stripe. “Tinted” sign and bronchovascular bundle distortion as two special features were discovered during the evolution.Conclusion: Lung lesions in COVID-19 pneumonia patients can be absorbed completely during short-term follow-up with no sequelae. Three weeks after discharge might be the optimal time point for early radiological estimation.

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Outcomes of Recovered COVID-19 Patients: 6 Months of Sequential Observations at a Designated Tertiary Center

10.21203/rs.3.rs-203424/v1 ◽

2021 ◽

Author(s):

Jie Cao ◽

Wei Wei ◽

Xianmeng Chen ◽

Jay H. Ryu ◽

Xiaowen Hu

Keyword(s):

Pulmonary Function ◽

Hospital Discharge ◽

Chest Ct ◽

Long Term Outcomes ◽

Global Pandemic ◽

Tertiary Center ◽

Pulmonary Impairment ◽

Discharged Patients

Abstract Objectives: An ongoing global pandemic of coronavirus disease 2019 (COVID-19) has affecting almost 100,000,000 cases with 2,100,000 deaths worldwide. However, the long-term outcomes of recovered patients remain to be defined.Methods: This is a prospective observational study of patients with COVID-19 using sequential assessments after hospital discharge from a designated tertiary center in Hefei, China. We examined clinical symptom, chest CT imaging, pulmonary function, and 6-min walk distance (6-MWD).Results: There were 62, 61 and 51 discharged patients enrolled the 1-month, 3-month and 6-month observations, respectively. Symptoms persisted in 24 (39%), 25 (41%) and 5 (10%) patients, mainly cough in 31%, 15% and 8% of them, respectively. Mild restrictive pulmonary impairment was detected in 11%, 10%, 12% of patients at 1, 3, 6-month follow-up. Although chest CT scores were overall gradually improved at 1 month (5.0±5.1), 3 months (3.0±4.5) and 6 months (2.0±3.3) compared with that during hospitalization (11.0±6.8), residual CT abnormalities were seen in 73%, 54% and 43% of them at 1, 3, 6 months. At 6-month follow-up, the 6MWD was 541±59 m in these recovered patients, which was significantly lower compared to healthy controls (589±75 m，p<0.01). Only the steroid treatment during hospitalization (p=0.009, OR 12.091, 95% CI 1.882 to 77.678) was associated with abnormal CT score at 6 months.Conclusions: At 6 months after hospital discharge, respiratory symptoms and pulmonary function were improved in most COVID-19 patients while residual impairments were still present in both chest CT images and exercise capacity.

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Rare pulmonary tumors and carcinoma mimickers; experience from an interventional radiology unit with radiologic-pathologic correlation-A pictoral essay

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405617666210420105624 ◽

2021 ◽

Vol 17 ◽

Author(s):

Emre Ünal ◽

Sevtap Arslan ◽

Gulnar Aghayeva ◽

Yasin Sarıkaya ◽

Türkmen Çiftçi ◽

...

Keyword(s):

False Negative ◽

Clinical History ◽

Ct Scans ◽

Pulmonary Lesions ◽

Pathologic Correlation ◽

Pet Ct ◽

Malignant Lesions ◽

Slow Growing ◽

Pulmonary Tumors

Background: Although imaging findings along with patients’ clinical history may give clue for the etiology of a pulmonary lesion, the differentiation of benign pulmonary lesions from lung cancer could be challenging. Objective: The aim of this review article was to increase the awareness of the carcinoma mimicking lung lesions. Methods: This paper was designed to illustrate rare pulmonary tumors and carcinoma mimickers with emphasis on radiologic-pathologic correlation. Pitfalls encountered on CT images and also false positivity of PET-CT scans were also presented. Conclusion: Several benign pulmonary lesions may grow in size on follow-up and some may show pathologic FDG (18F-fluorodeoxyglucose) uptake, which makes them indistinguishable from lung carcinoma by imaging. In addition, some slow-growing malignant lesions, such as carcinoid, may be false-negative on PET/CT scans.

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Solid Indeterminate Pulmonary Nodules Less Than or Equal to 250 mm3: Application of the Updated Fleischner Society Guidelines in Clinical Practice

Radiology Research and Practice ◽

10.1155/2019/7218258 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Andrea Borghesi ◽

Silvia Michelini ◽

Giorgio Nocivelli ◽

Mario Silva ◽

Alessandra Scrimieri ◽

...

Keyword(s):

Doubling Time ◽

Pulmonary Nodules ◽

Chest Ct ◽

Ct Scans ◽

Inclusion Criteria ◽

Histologic Diagnosis ◽

Indeterminate Nodules ◽

Risk Patients ◽

New Guidelines

Background. The latest version of the Fleischner Society guidelines for management of incidental pulmonary nodules was published in 2017. The main purpose of these guidelines is to reduce the number of unnecessary computed tomography (CT) examinations during the follow-up of small indeterminate nodules. Objective. The present study aimed to evaluate the performance of these guidelines for management of solid indeterminate pulmonary nodules (SIPNs) ≤ 250 mm3. Materials and Methods. During a 7-year period, we retrospectively reviewed the chest CT scans of 672 consecutive patients with SIPNs. The study sample was selected according to the following inclusion criteria: solitary SIPN; diameter ≥ 3 mm; volume ≤ 250 mm3; two or more CT scans performed with the same scanner and same acquisition/reconstruction protocol; thin-section 1-mm images in DICOM format; histologic diagnosis or follow-up ≥ 2 years; and no oncological history. Applying these criteria, a total of 27 patients with single SIPNs ≤ 250 mm3 were enrolled. For each SIPN, the volume and doubling time were calculated using semiautomatic software throughout the follow-up period. For each SIPN, we applied the Fleischner Society guidelines, and the recommended management was compared to what was actually done. Results. A significant volumetric increase was detected in 5/27 (18.5%) SIPNs; all growing nodules were observed in high-risk patients. In these SIPNs, a histologic diagnosis of malignancy was obtained. Applying the Fleischner Society recommendations, all five malignant nodules would have been identified. None of the SIPNs < 100 mm3 in low-risk patients showed significant growth during the follow-up period. The application of the new guidelines would have led to a significant reduction in follow-up CT examinations (Hodges-Lehmann median difference, -2 CT scans; p = 0.0001). Conclusion. The application of the updated Fleischner Society guidelines has been shown to be effective in the management of SIPNs ≤ 250 mm3 with a significant reduction in radiation dose.

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