The Spectrum of Chest CT-Scans in the Hospitalized Patients with the Coronavirus Disease

Background: Coronaviruses are a large family of RNA viruses, which range from the common cold virus to the causative agent of more severe diseases. Coronavirus was declared a pandemic in December 2019 in Wuhan, China. Iran has been an endemic zone for the spread of the coronavirus since the outset of this global epidemic and has remained among the countries largely affected by high rates of the disease. Objectives: The present study aimed to investigate the range of the chest computed tomography (CT) scan findings among the hospitalized patients with COVID-19 in Kermanshah, Iran during March-April 2020 to contribute to the accurate diagnosis of the infected patients. Methods: The sample population consisted of 286 hospitalized patients diagnosed with or suspected of the coronavirus disease. Chest CT-scan images and clinical data were reviewed, and their correlation was analyzed. Results: In total, 176 patients (61.53%) were male, and 110 (38.47%) were female. The mean age of the patients was 56 years. Polymerase chain reaction (PCR) results showed that 35.31% of the cases had coronavirus, while the results were negative in 64.69% of the cases. In addition, the CT-scan findings indicated 77.27% abnormal and 22.73% normal chest CT-scans. Among the patients, 75.87% recovered completely, and 18.53% died. The major CT abnormalities were diffuse ground-glass opacification (35.66%), peripheral ground-glass opacification (bilateral; 21.33%), and a combination of diffuse and peripheral ground-glass lesions (18.88%). The consolidation lesion of one lobe was detected in 16 patients, and the consolidation lesion of more than one lobe was observed in 40 patients. Conclusions: According to the results, the most common chest CT-scan findings in COVID-19 include diffuse ground-glass opacification, peripheral ground-glass opacification (bilateral), central ground-glass opacification (bilateral), a combination of diffuse and peripheral ground-glass opacification, a combination of central and peripheral ground-glass opacification, the consolidation lesion of one lobe, and the consolidation lesion of more than one lobe. Furthermore, significant correlations were observed between the CT-scans and the main clinical symptoms, while no significant correlations were denoted between the chest CT-scan and PCR results.

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538. The Role of N-acetylcysteine on Post Covid-19 Pulmonary Fibrosis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.737 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S370-S371

Author(s):

Bernard Demot ◽

Kristin Ivan Mark Hizon

Keyword(s):

Pulmonary Fibrosis ◽

Ct Scan ◽

Chest Ct ◽

Ct Scans ◽

Ground Glass ◽

Nasopharyngeal Swab ◽

High Dose ◽

Pulmonary Consolidation ◽

Chest Ct Scan

Abstract Background Covid 19 have long lasting complications, from myalgia, body weakness to life debilitating strokes, and pulmonary fibrosis. Several mechanisms had been described but mostly viral or autoimmune which causes damages which leads to Acute respiratory distress syndrome. There is no approved treatment as of this time. Antifibrotic drugs use had been limited due to hepatoxicity, on top of Covid 19 hepatopathy. This study aims to describe the role of N-acetylcysteine on Post COVID 19 pulmonary fibrosis as an alternative treatment. Methods Patients are admitted at Baguio General Hospital and Medical Center at the COVID wards. Patients are COVID confirmed by RT PCR nasopharyngeal swab. Patient who are classified as severe were given Dexamethasone, Enoxaparin and Remdesivir for 5-10 days. Patients who are not weaned off from O2 support underwent Chest CT scan. Patients with Extensive Fibrosis were then consented to undergo High Dose IV Infusion of N-acetylcysteine. (150mg/kg in 1st hour, 50mg/kg next 4 hours and 100mg/kg last 20 hours). Repeat Chest CT Scan was done. Results Peripheral Bilateral Ground Glass Opacities and Pulmonary Consolidation was seen on pre-treatment CT Scans. Repeat CT scans showed significant regression of Ground Glass Opacities and Pulmonary Consolidation. CT SCAN pre and post treatment Conclusion High dose N-acetylcysteine showed promising results on Post COVID 19 Pulmonary Fibrosis. Disclosures All Authors: No reported disclosures

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The diagnostic value of chest X-ray in coronavirus disease 2019: A comparative study of X-ray and CT

Science Progress ◽

10.1177/00368504211016204 ◽

2021 ◽

Vol 104 (3) ◽

pp. 003685042110162

Author(s):

Fengxia Zeng ◽

Yong Cai ◽

Yi Guo ◽

Weiguo Chen ◽

Min Lin ◽

...

Keyword(s):

Clinical Symptoms ◽

Diagnostic Value ◽

Rapid Identification ◽

Chest Ct ◽

Ct Scans ◽

Ground Glass ◽

X Ray ◽

Chest X Ray ◽

Laboratory Examinations ◽

Sensitivity Specificity

As the coronavirus disease 2019 (COVID-19) epidemic spreads around the world, the demand for imaging examinations increases accordingly. The value of conventional chest radiography (CCR) remains unclear. In this study, we aimed to investigate the diagnostic value of CCR in the detection of COVID-19 through a comparative analysis of CCR and CT. This study included 49 patients with 52 CT images and chest radiographs of pathogen-confirmed COVID-19 cases and COVID-19-suspected cases that were found to be negative (non-COVID-19). The performance of CCR in detecting COVID-19 was compared to CT imaging. The major signatures that allowed for differentiation between COVID-19 and non-COVID-19 cases were also evaluated. Approximately 75% (39/52) of images had positive findings on the chest x-ray examinations, while 80.7% (42/52) had positive chest CT scans. The COVID-19 group accounted for 88.4% (23/26) of positive chest X-ray examinations and 96.1% (25/26) of positive chest CT scans. The sensitivity, specificity, and accuracy of CCR for abnormal shadows were 88%, 80%, and 87%, respectively, for all patients. For the COVID-19 group, the accuracy of CCR was 92%. The primary signature on CCR was flocculent shadows in both groups. The shadows were primarily in the bi-pulmonary, which was significantly different from non-COVID-19 patients ( p = 0.008). The major CT finding of COVID-19 patients was ground-glass opacities in both lungs, while in non-COVID-19 patients, consolidations combined with ground-glass opacities were more common in one lung than both lungs ( p = 0.0001). CCR showed excellent performance in detecting abnormal shadows in patients with confirmed COVID-19. However, it has limited value in differentiating COVID-19 patients from non-COVID-19 patients. Through the typical epidemiological history, laboratory examinations, and clinical symptoms, combined with the distributive characteristics of shadows, CCR may be useful to identify patients with possible COVID-19. This will allow for the rapid identification and quarantine of patients.

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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

Iranian Journal of Radiology ◽

10.5812/iranjradiol.106339 ◽

2021 ◽

Vol 18 (2) ◽

Author(s):

Sara Besharat ◽

Fatemehsadat Rahimi ◽

Siamak Afaghi ◽

Farzad Esmaeili Tarki ◽

Fatemeh Pourmotahari ◽

...

Keyword(s):

Pleural Effusion ◽

Ct Scan ◽

Chest Ct ◽

Ct Scans ◽

Early Management ◽

Ct Findings ◽

Imaging Characteristics ◽

Significant Difference ◽

Chest Ct Scan ◽

Lung Lobes

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, 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 < 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.

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Correlations of CT scan with high-sensitivity C-reactive protein and D-dimer in patients with coronavirus disease 2019

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.6.2961 ◽

2020 ◽

Vol 36 (6) ◽

Author(s):

Jin Zhu ◽

Cheng Chen ◽

Rongshu Shi ◽

Bangguo Li

Keyword(s):

Ct Scan ◽

High Sensitivity ◽

Chest Ct ◽

Ground Glass ◽

C Reactive Protein ◽

Reactive Protein ◽

Group 2 ◽

Chest Ct Scan ◽

D Dimer ◽

Group 1

Objectives: To study the correlations of CT scan with high-sensitivity C-reactive protein (hs-CRP) and D-dimer in patients with coronavirus disease 2019 (COVID-2019). Methods: From January to March 2020, COVID-19 patients were divided into two groups according to the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (trial version 7), with mild and ordinary cases as Group-1 and critical and severe cases as Group-2. The chest CT scan results, hs-CRP, D-dimmer levels of the two groups from admission to discharge were compared by the c2 test or Fisher’s exact test. The quantitative data were represented as mean ± standard deviation (±s). Intergroup comparisons were performed by the independent samples t test, and the ineligible data were subjected to the nonparametric rank sum test. Binary logistic regression model was used for multivariate correlation analysis, using independent variables that were significant in univariate analysis. The correlations between the above indices were analyzed. Results: In Group-1, there were two cases of normal chest CT scan results, one case of fibrosis, and 25 cases of abnormalities during the first diagnosis, mainly manifested as single or scattered ground-glass shadows. After treatment, the CT scan results became normal. The chest CT scan of Group-2 showed abnormalities, including 21 cases of multiple ground-glass shadows, and six cases of multiple consolidations accompanied by ground-glass shadows, who were critically ill and died. In addition, there were 16 cases of multiple ground glass shadows with partial consolidation, and the CRP and D-dimer levels of Group-2 were significantly higher than those of Group-1. Chest CT scan results were significantly positively correlated with CRP and D-dimer levels (P<0.05). Conclusion: The chest CT scan results of COVID-19 patients are characteristic, being correlated with CRP and D-dimer levels. D-dimer and CRP levels significantly increase in most severe and critical patients, which are closely related to their prognosis. The indices may play predictive roles in clinical treatment and prognosis evaluation. doi: https://doi.org/10.12669/pjms.36.6.2961 How to cite this:Zhu J, Chen C, Shi R, Li B. Correlations of CT scan with high-sensitivity C-reactive protein and D-dimer in patients with coronavirus disease 2019. Pak J Med Sci. 2020;36(6):1397-1401. doi: https://doi.org/10.12669/pjms.36.6.2961 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Agreement between low-dose and ultra-low-dose chest CT for the diagnosis of viral pneumonia imaging patterns during the COVID-19 pandemic

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00689-6 ◽

2022 ◽

Vol 53 (1) ◽

Author(s):

Hooman Bahrami-Motlagh ◽

Yashar Moharamzad ◽

Golnaz Izadi Amoli ◽

Sahar Abbasi ◽

Alireza Abrishami ◽

...

Keyword(s):

Radiation Dose ◽

Ct Scan ◽

Predictive Value ◽

Low Dose ◽

Ground Glass Opacity ◽

Chest Ct ◽

Viral Pneumonia ◽

Ct Scans ◽

Low Dose Ct ◽

Chest Ct Scan

Abstract Background Chest CT scan has an important role in the diagnosis and management of COVID-19 infection. A major concern in radiologic assessment of the patients is the radiation dose. Research has been done to evaluate low-dose chest CT in the diagnosis of pulmonary lesions with promising findings. We decided to determine diagnostic performance of ultra-low-dose chest CT in comparison to low-dose CT for viral pneumonia during the COVID-19 pandemic. Results 167 patients underwent both low-dose and ultra-low-dose chest CT scans. Two radiologists blinded to the diagnosis independently examined ultra-low-dose chest CT scans for findings consistent with COVID-19 pneumonia. In case of any disagreement, a third senior radiologist made the final diagnosis. Agreement between two CT protocols regarding ground-glass opacity, consolidation, reticulation, and nodular infiltration were recorded. On low-dose chest CT, 44 patients had findings consistent with COVID-19 infection. Ultra-low-dose chest CT had sensitivity and specificity values of 100% and 98.4%, respectively for diagnosis of viral pneumonia. Two patients were falsely categorized to have pneumonia on ultra-low-dose CT scan. Positive predictive value and negative predictive value of ultra-low-dose CT scan were respectively 95.7% and 100%. There was good agreement between low-dose and ultra-low-dose methods (kappa = 0.97; P < 0.001). Perfect agreement between low-dose and ultra-low-dose scans was found regarding diagnosis of ground-glass opacity (kappa = 0.83, P < 0.001), consolidation (kappa = 0.88, P < 0.001), reticulation (kappa = 0.82, P < 0.001), and nodular infiltration (kappa = 0.87, P < 0.001). Conclusion Ultra-low-dose chest CT scan is comparable to low-dose chest CT for detection of lung infiltration during the COVID-19 outbreak while maintaining less radiation dose. It can also be used instead of low-dose chest CT scan for patient triage in circumstances where rapid-abundant PCR tests are not available.

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Use of Low-dose Chest CT Scan in the Evaluation of Breast Composition According to the Recommendations of BI-RADS Atlas-Fifth Edition

Iranian Journal of Radiology ◽

10.5812/iranjradiol.96718 ◽

2020 ◽

Vol 17 (2) ◽

Author(s):

Feng Ao ◽

Xueguo Liu ◽

Mingzhu Liang ◽

Jiebing Gao

Keyword(s):

Lung Cancer ◽

Ct Scan ◽

Low Dose ◽

Chest Ct ◽

Dense Breast ◽

Ct Scans ◽

Low Dose Ct ◽

Dense Breasts ◽

Breast Tissues ◽

Chest Ct Scan

Background: Breast cancer and lung cancer are the leading causes of cancer-related mortality in women. Computed tomography (CT) plays an important role in lung cancer examination but an unidentified role in breast examination. Objectives: To investigate the feasibility of breast composition categorization according to the fifth edition of Breast Imaging-Reporting and Data System (BI-RADS) atlas in low-dose CT screening. Patients and Methods: This was a cross-sectional study completed in The 5th Affiliated Hospital of Sun Yat-sen University, Zhuhai, China. We collected the imaging data of 57 women, who underwent low-dose chest CT scan and mammography within one week from 1st October 2013 to 31st March 2015. Two radiologists independently interpreted the mammograms and chest CT scans and classified the breast composition into categories a, b, c, and d. We also summarized the distribution of breast composition categories by collecting, observing, and classifying the chest CT scans from 1916 female examinees from 1st October 2013 to 31st March 2016. Results: Excellent agreement was observed between the two radiologists, using both low-dose CT scan (κ = 0.91) and mammography (κ = 0.86). Agreement between low-dose chest CT scan and mammography was moderate for radiologist A (κ = 0.50) and radiologist B (κ = 0.43). More breasts were classified in categories a and b on the chest CT scan compared to mammography according to both radiologist A (P < 0.01) and radiologist B (P < 0.01). The proportion of non-dense breast tissues (categories a & b) increased with advancing age, while the proportion of dense breast tissues (categories c & d) decreased (P < 0.05). With advancing age, the probability of non-dense breasts increased, while the probability of dense breasts decreased. Conclusions: Based on the findings, it is feasible to categorize breast composition using low-dose chest CT. In the older age group, the probability of non-dense breasts increased.

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Spectrum of Ground Glass Opacities in Chest CT of COVID-19 Patients in Karbala, Iraq

Journal of Contemporary Medical Sciences ◽

10.22317/jcms.v6i3.769 ◽

2020 ◽

Vol 6 (3) ◽

Author(s):

Dhia Mahdey Alghazali ◽

Maytham A Maamera ◽

Haider Fadel Alkazraji ◽

Ali A Abutiheen

Keyword(s):

Ct Scan ◽

Cross Sectional Study ◽

Chest Ct ◽

Ground Glass ◽

P Value ◽

Late Time ◽

Chi Square ◽

Cross Sectional ◽

Male Predominance ◽

Chest Ct Scan

Objective: To describe the ground-glass opacities (GGO) seen in chest CT scans of COVID-19 patients and to estimate the association between these opacities and the time of clinical presentation. Patients and methods: A cross-sectional study involving 81 COVID-19 confirmed patients in Imam Al-Hussein Medical city in Karbala-Iraq during the period from March 1st to April 20, 2020. Chest CT scan findings were evaluated by 2 radiologists and categorized accordingly. Chi-square test was used for statistical analysis and a P value of less than 0.05 was considered statistically significant. Results: The mean age ± standard deviation of patients was 53.5 ± 17.1 years, with male predominance as 63 (77.8%) of cases were males. Nearly half of the patients were presented within the second week of starting the sign and symptoms. GGO was present in 79 scans (97.5%), followed by consolidation opacity in 29 patients (35.8%). Four types of GGO were described. Bilateral multiple subpleural GGO was the most prevalent type. There was a significant association between late time of patient presentation and more extensive GGO type. Conclusion: Chest CT scan is valuable in the diagnosis and management of COVID-19 cases. The presence of GGO in CT scan of a patient that previously had no chest illness is highly suggestive of COVID-19 disease, different types of GGO were seen. Bilateral confluent type of GGO is associated with more serious and delayed status and warns the need for intensive care unit admission.

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Clinical Characteristics Analysis of the “Re-positive” Discharged COVID-19 Pneumonia Patients in Wuhan, China

10.21203/rs.3.rs-28667/v1 ◽

2020 ◽

Author(s):

Shengyang He ◽

Wenwu Sun ◽

Kefu Zhou ◽

Mengyun Hu ◽

Chun Liu ◽

...

Keyword(s):

Ct Scan ◽

Clinical Characteristics ◽

Clinical Symptoms ◽

Chest Ct ◽

Apache Ii ◽

Laboratory Results ◽

Characteristics Analysis ◽

Positive Rate ◽

Chest Ct Scan ◽

Demographic Features

Abstract Background: To analyze the clinical characteristics of the re-positive discharged COVID-19 patients and find markers to distinguish them.Methods：The demographic features, clinical symptoms, laboratory results, comorbidities, co-infections, treatments, illness severities and chest CT scan results of 267 patients were collected during 1st January and 15th February 2020. COVID-19 was diagnosed by RT-PCR. The subsequent clinical symptoms and nucleic acid test results was obtained during the 14 days post-hospitalization quarantine.Results: 30 out of 267 COVID-19 patients were detected re-positive during the post-hospitalization quarantine. Re-positive patients couldn’t be distinguished by demographic features, clinical symptoms, laboratory results, comorbidities, co-infections, treatments, chest CT scan results or subsequent clinical symptoms. However, the re-positive rate were found illness severity correlated, along with APACHE II and CURB-65.Conclusion: Common clinical characteristics arn’t able to distinguish re-positive patients. However, severe and critical cases with high APACHE II and CURB-65 scores are more likely to turn re-positive after discharge.Authors Shengyang He, Wenwu Sun, Kefu Zhou contributed equally to this work.

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Outcome of Pulmonary Spherical Ground-glass Opacities on Ct in Patients With Coronavirus Disease 2019 (Covid-19): A Retrospective Analysis

10.21203/rs.3.rs-30665/v1 ◽

2020 ◽

Author(s):

Wangjia Li ◽

Liangbo Hu ◽

Junhao Huang ◽

Fajin Lv ◽

Binjie Fu ◽

...

Keyword(s):

Retrospective Study ◽

Ct Scan ◽

Retrospective Analysis ◽

Ct Images ◽

Chest Ct ◽

Ground Glass ◽

Direct Absorption ◽

Simultaneous Decrease ◽

Chest Ct Scan

Abstract Background: Pulmonary spherical ground-glass opacities (GGOs) are commonly detected on initial chest CT scan in patients with coronavirus disease 2019 (COVID-19).We aimed to investigate the evolution of spherical GGOs to better understand their clinical significance.Materials and Methods:A retrospective study of 33 consecutive patients with confirmed COVID-19 and pulmonary spherical GGOs was performed from January 21, 2020, to March 6, 2020. The initial and follow-up CT images and clinical data were reviewed. The initial CT manifestations of spherical GGOs and their subsequent changes were mainly evaluated. Results:A total of 101 pulmonary spherical GGOs, including 38 with and 63 without consolidation, were found in 33 patients. Of the 101 spherical GGOs, 71 (70.3%) and 30 (29.7%) showed progression and direct absorption on follow-up CT images, respectively. GGOs with consolidation were more likely to progress than those without (84.2% vs. 61.9%, p = 0.017). The 71 progressed lesions mainly showed an increase in size and/or density and most (70.4%) of them extended toward the pleura and developed from spherical to patchy. Internal consolidation appeared and increased in 18 (25.4%) and 22 (31.0%) lesions, respectively. During absorption, all the previous progressed and directly absorbed lesions exhibited a simultaneous decrease in size and density. On each patient’s final CT, more lesions with progression had a residual mixed GGO (40.8% vs. 6.7%, p = 0.002) and fewer had pure GGO (39.4% vs. 60.0%, p = 0.016) than those with direct absorption.Conclusion: In patients with COVID-19, most pulmonary spherical ground-glass opacities would progress, especially those with consolidation, and develop into patchy, subpleural lesions.

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Chest CT-Scan Findings of an Iraqi Patient with Symptomatic Covid-19 Disease

Journal of Clinical Surgery and Research ◽

10.31579/2768-2757/025 ◽

2021 ◽

Vol 2 (4) ◽

pp. 01-04

Author(s):

Aamir Jalal Al Mosawi

Keyword(s):

Ct Scan ◽

School Teacher ◽

Chest Ct ◽

Ground Glass ◽

Ministry Of Health ◽

Chest Ct Scan

Background: On the first of June, 2021, 1,201,352 cases of covid-19 were reported by the Iraqi Ministry of Health, and 16375 patients died because of the disease. The aim of this paper is to describe chest CT-scan findings of an Iraqi patient who was observed early during June, 2021, and had symptomatic covid-19, but he didn’t need hospitalization. Patients and methods: A forty-year old school teacher developed covid-19 disease with fever, fatigue, anorexia, and cough. The patient recovered after about two weeks. Results: Chest CT-scan performed during first week of illness showed: (1) Multiple bilateral ground glass opacities. (2) Atelectatic bands. (3) Thickening of the interlobular septa. (4) Vascular thickening. Conclusion: The chest CT-scan findings in this Iraqi patient was rather typical of covid-19 disease and included the most commonly reported abnormality of ground-glass shadows.

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