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CT imaging features of 4121 patients with COVID-19: A meta-analysis
Abstract
Objective
We systematically reviewed the CT imaging features of COVID‐19 in order to provide reference for clinical practice.
Methods
Our article comprehensively searched PubMed, FMRS, EMbase, CNKI,WanFang databases and VIP databases to collect literatures about the CT imaging features of COVID‐19 from 1 January 2020 to 16 March 2020. Three reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, and then, this meta‐analysis was performed by using Stata12.0 software.
Results
34 retrospective studies involving a total of 4 121 COVID‐19 patients were included. The results of meta‐analysis showed that most patients presented bilateral lung involvement (73.8%, 95%CI: 65.9%‐81.1%) or multilobar involvement (67.3%,95%CI: 54.8%‐78.7 %) and just a little patients showed normal CT findings (8.4%). We found that the most common changes in lesion density was ground‐glass opacities (68.1%,95%CI: 56.9%‐78.2%). Other changes in density included air bronchogram sign(44.7%), crazy‐paving pattern (35.6%) and consolidation (32.0%). Patchy (40.3%), spider web sign (39.5%), cord‐like (36.8%) and nodular (20.5%) were common lesion shapes in COVID‐19 patients. Pleural thickening (27.1%) was found in some patients. Lymphadenopathy(5.4%) and pleural effusion (5.3%) were rare.
Conclusion
The lung lesions of patients with COVID‐19 were mostly bilateral lungs or multilobar involved. The most common chest CT findings were patchy and ground‐glass opacities. Some patients had air bronchogram, spider web sign and cord‐like. Lymphadenopathy and pleural effusion were rare.
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... Thoracic computed tomography (CT) plays an essential role in the diagnosis, treatment, and postdischarge follow-up of novel coronavirus-2019 (COVID-19) pneumonia. [1] Additionally, it can show typical COVID-19 pneumonia lesions in the lungs before the definitive diagnosis as evidenced by nucleic acid tests through realtime reverse transcriptase-polymerase chain reaction (RT-PCR). [1] The typical manifestations of COVID-19 pneumonia on a CT scan include ground-glass opacities, air bronchogram sign, crazy-paving pattern, consolidation, multiple small patchy shadows, spider web sign, cord-like, nodular, pleural thickening, lymphadenopathy, and pleural effusion predominantly distributed in the peripheral third of the lungs. ...
... [1] Additionally, it can show typical COVID-19 pneumonia lesions in the lungs before the definitive diagnosis as evidenced by nucleic acid tests through realtime reverse transcriptase-polymerase chain reaction (RT-PCR). [1] The typical manifestations of COVID-19 pneumonia on a CT scan include ground-glass opacities, air bronchogram sign, crazy-paving pattern, consolidation, multiple small patchy shadows, spider web sign, cord-like, nodular, pleural thickening, lymphadenopathy, and pleural effusion predominantly distributed in the peripheral third of the lungs. [1] Although cavitary lung lesions are usually related to mycobacterial, parasitic, fungal, autoimmune, or neoplastic disease, lung cavitation following pulmonary embolism/infarction or inaccurate healing of the lesions has been described previously in COVID-19 patients. ...
... [1] The typical manifestations of COVID-19 pneumonia on a CT scan include ground-glass opacities, air bronchogram sign, crazy-paving pattern, consolidation, multiple small patchy shadows, spider web sign, cord-like, nodular, pleural thickening, lymphadenopathy, and pleural effusion predominantly distributed in the peripheral third of the lungs. [1] Although cavitary lung lesions are usually related to mycobacterial, parasitic, fungal, autoimmune, or neoplastic disease, lung cavitation following pulmonary embolism/infarction or inaccurate healing of the lesions has been described previously in COVID-19 patients. [2] In this article, we report a case of cavitary lesions and bilateral multilobar involvement in the late period of COVID-19 pneumonia. ...
The typical manifestations of novel coronavirus-2019 (COVID-19) pneumonia on computed tomography include ground‐glass opacities, air bronchogram sign, crazy‐paving pattern, consolidation, multiple small patchy shadows, spider web sign, cord‐like, nodular, pleural thickening, lymphadenopathy, and pleural effusion. Herein, we report a case of cavitary lesions and bilateral multilobar involvement in the late period of COVID-19 pneumonia.
... Ground glass opacity has been depicted pictorially in [ Figures 1-3]. [11][12][13][14] ...
... Reverse batwing sign can be seen pictorially in Figure 9. [34] Pulmonary target sign The sign has been described as a central high attenuation focus surrounded by one or more dense complete or incomplete ring-like consolidation, forming one or more circles on chest CT in patients with COVID-19 pneumonia. [35] The Bao et al. [11] 83.31 Zhu et al. [12] 68.1 Ng et al. [13] 86 Guan et al. [14] 100 GGOs: Ground-glass opacities pathophysiology of this sign is that it is a manifestation of organizing pneumonia (OP). [36,37] The pulmonary target sign usually coexists with other typical OP features including the reverse halo or halo sign. ...
... Spider web sign is a common sign of COVID-19 pneumonia which represents subpleural, triangular residual opacity of resolving GGO with web-like thickening of the interlobular septa and thickened retraction adjacent pleura. [12,13] Spider web sign was reported from 39 to 45% of patients in various studies. Spider web sign has been shown in Figure 14. ...
... Particularly, the GGO was reported to be 77.2% [29], 83.3% [30], 78.0% [31], 68.1% [32], 68.0% [33], 71.7% [34], 79.0% [35], and 71.5% [36] in different meta-analyses. ...
... The consolidation pattern resulted similarly to the meta-analysis of Zhou et al. who reported a value of prevalence of consolidation pattern of 18% [33]. Instead, the other principal meta-analyses considered described a major prevalence between 33 and 44% [29][30][31][32][33][34][35][36]. ...
... This difference in the consolidation pattern might be due to the establishment of a "prevalent pattern," thanks to the segmentation. While the principal meta-analyses were often considered a "mixed-pattern" or coexistence of patterns [29][30][31][32][33][34]36], in this study the segmentation allowed a better pneumonia classification with the pattern mutual exclusion. ...
The National Health Systems have been severely stressed out by the COVID-19 pandemic because 14% of patients require hospitalization and oxygen support, and 5% require admission to an Intensive Care Unit (ICU). Relationship between COVID-19 prognosis and the extent of alterations on chest CT obtained by both visual and software-based quantification that expresses objective evaluations of the percentage of ventilated lung parenchyma compared to the affected one has been proven. While commercial applications for automatic medical image computing and visualization are expensive and limited in their spread, the open-source systems are characterized by not enough standardization and time-consuming troubles. We analyzed chest CT exams on 246 patients suspected of COVID-19 performed in the Emergency Department CT room. The lung parenchyma segmentation was obtained by a threshold-based method using the open-source 3D Slicer software and software tools called “Segment Editor” and “Segment Quantification.” For the three main characteristics analyzed on lungs affected by COVID-19 pneumonia, a specifical densitometry value range was defined: from − 950 to − 700 HU for well-aerated parenchyma; from − 700 to − 250 HU for interstitial lung disease; from − 250 to 250 HU for parenchymal consolidation. For the well-aerated parenchyma and the interstitial alterations, the procedure was semi-automatic with low time consumption, whereas consolidations’ analysis needed manual interventions by the operator. After the chest CT, 13% of the sample was admitted to intensive care, while 34% of them to the sub-intensive care. In patients moved to intensive care, the parenchyma analysis reported a higher crazy paving presentation. The quantitative analysis of the alterations affecting the lung parenchyma of patients with COVID-19 pneumonia can be performed by threshold method segmentation on 3D Slicer. The segmentation could have an important role in the quantification in different COVID-19 pneumonia presentations, allowing to help the clinician in the correct management of patients.
... More recently, Rapid Diagnostic Test (RPT) was used for detecting the corona virus antigens with artificial antibodies. They show sensitivity between 34-80% and take less than 30 min [4] . But cases inadequate antigen traces in the nasal samples can go undetected on RPT. ...
... All rights reserved. jects involving 4121 COVID-19 patients, CT scans for 91.4% of them had presented with bilateral lung involvement that is suggestive of COVID-19 [4] . Guan et al. observed abnormal CT findings of Ground Glass Opacity (GGO) and bilateral patchy shadowing in 86.2% COVID-19 cases [5] . ...
... with severe symptoms), interlobular septal thickening, air bronchogram are likely to occur [3] . Crazy paving patterns, reverse 'halo' signs are also reported as CT features for COVID-19 detection [4] . AI-based analysis can help localize regions on chest CT that can potentially be a COVID-19 infection. ...
Accurate detection of COVID-19 is one of the challenging research topics in today's healthcare sector to control the coronavirus pandemic. Automatic data-powered insights for COVID-19 localization from medical imaging modality like chest CT scan tremendously augment clinical care assistance. In this research, a Contour-aware Attention Decoder CNN has been proposed to precisely segment COVID-19 infected tissues in a very effective way. It introduces a novel attention scheme to extract boundary, shape cues from CT contours and leverage these features in refining the infected areas. For every decoded pixel, the attention module harvests contextual information in its spatial neighborhood from the contour feature maps. As a result of incorporating such rich structural details into decoding via dense attention, the CNN is able to capture even intricate morphological details. The decoder is also augmented with a Cross Context Attention Fusion Upsampling to robustly reconstruct deep semantic features back to high-resolution segmentation map. It employs a novel pixel-precise attention model that draws relevant encoder features to aid in effective upsampling. The proposed CNN was evaluated on 3D scans from MosMedData and Jun Ma benchmarked datasets. It achieved state-of-the-art performance with a high dice similarity coefficient of 85.43% and a recall of 88.10%.
... In our present study, we focused on investigating the disagreement of typical chest CT characteristics between Regarding bilateral or unilateral lung involvement, we discovered several intriguing results. The pooled incidence rates of bilateral lung involvement in all patients were 78% and indicated that COVID-19 infection most commonly affected bilateral lungs, which was consistent with the results of 78.2% by Bao et al. (63) and 73.8% by Zhu et al. (64). For subgroup analyses, we found that the incidence rates of unilateral lung involvement for patients in mainland China were significantly higher than those outside (15 vs. 7%) and the incidence rates of bilateral lung involvement were significantly low (75 vs. 84%). ...
... We also demonstrated that all CT features and corresponding pooled incidence rates were in accordance with previous meta-analyses (63,64); however, large gaps in the incidence rates of CT features between patients from within and outside mainland China were striking and all differences reached statistical significance. These results that CT patterns of patients with COVID-19 from within mainland China may not reflect those outside mainland China should be interpreted with caution, and the evidence provided to elucidate why features differ between those from within and outside mainland China is indirect and even anecdotal. ...
Background
Chest computerized tomography (CT) plays an important role in detecting patients with suspected coronavirus disease 2019 (COVID-19), however, there are no systematic summaries on whether the chest CT findings of patients within mainland China are applicable to those found in patients outside.
Methods
Relevant studies were retrieved comprehensively by searching PubMed, Embase, and Cochrane Library databases before 15 April 2022. Quality assessment of diagnostic accuracy studies (QUADAS) was used to evaluate the quality of the included studies, which were divided into two groups according to whether they were in mainland China or outside. Data on diagnostic performance, unilateral or bilateral lung involvement, and typical chest CT imaging appearances were extracted, and then, meta-analyses were performed with R software to compare the CT features of COVID-19 pneumonia between patients from within and outside mainland China.
Results
Of the 8,258 studies screened, 19 studies with 3,400 patients in mainland China and 14 studies with 554 outside mainland China were included. Overall, the risk of quality assessment and publication bias was low. The diagnostic value of chest CT is similar between patients from within and outside mainland China (93, 91%). The pooled incidence of unilateral lung involvement (15, 7%), the crazy-paving sign (31, 21%), mixed ground-glass opacities (GGO) and consolidations (51, 35%), air bronchogram (44, 25%), vascular engorgement (59, 33%), bronchial wall thickening (19, 12%), and septal thickening (39, 26%) in patients from mainland China were significantly higher than those from outside; however, the incidence rates of bilateral lung involvement (75, 84%), GGO (78, 87%), consolidations (45, 58%), nodules (12, 17%), and pleural effusion (9, 15%) were significantly lower.
Conclusion
Considering that the chest CT features of patients in mainland China may not reflect those of the patients abroad, radiologists and clinicians should be familiar with various CT presentations suggestive of COVID-19 in different regions.
... Consequently, an alternative modality such as CT imaging for detection and diagnosis may prove to be very valuable for treatment purposes and more importantly, limiting and controlling the spread of COVID-19. Chest CT imaging has the potential to both detect infection and determine its severity according to a series of studies [5]. This alternative method of detection is especially useful in the case of an ambiguous or false-negative RT-PCR result and help validate true-positive results, demonstrated by a study that found 5 of 167 patients with positive chest CT and negative RT-PCR results test positive for COVID-19 days later [6]. ...
... This study also categorized the lesions by shape, where patchy was the most common, followed by spider web sign, cord-like, and nodular, seen in this patient. Other radiological signs that accompanied these lesions were pleural thickening, followed by more rare signs of lymphadenopathy and pleural effusion [5]. ...
Diagnosis of COVID-19 is an increasingly challenging task during a pandemic where symptoms are beguiling due to a wide array of symptomatology. Radiologic diagnosis plays a vital role not only in diagnosis but in early assessment and triage of suspected patients with COVID-19 pneumonia. Typically, bilateral ground-glass opacities are considered high-risk and pathognomonic findings for diagnosis. However, COVID-19 is notorious for varying radiologic presentation as well. We describe a case of cannonball appearance of COVID-19 pneumonia which has not been described previously in the literature and is a novel finding.
... Typical patterns seen in patients with COVID-19 pneumonia on chest CT are ground-glass opacities (GGO), consolidation, and crazy paving pattern (CP). The distribution of these patterns is bilateral and multifocal, where the changes predominantly occur in the peripheral and posterior parts of the lungs (8,(36)(37)(38)(39). Numerous studies have shown that changes in the lung parenchyma accompany certain stages of the disease, which are also accompanied by changes that can be seen on a chest CT. ...
Coronavirus disease 2019 (COVID-19) is a multi-systemic disease caused by Severe acute respiratory syndrome coronavirus 2, SARS-CoV-2. Since the onset of the pandemic, understanding the pathophysiological mechanisms of this disease has posed a significant challenge, with the intent to determine its progression and implement appropriate treatment strategies. The heightened severity and mortality associated with SARS-CoV-2 infection can be attributed, in part, to a phenomenon known as cytokine storm. This refers to an uncontrolled systemic inflammatory response characterized by elevated proinflammatory cytokines and chemokines, leading to an overproduction of free radicals. The aforementioned cytokine storm is accompanied by the excessive generation of reactive oxygen species and affects the virus and directly damages the host's cells. Given that the SARS-CoV-2 virus primarily targets respiratory cells, pneumonia is a common manifestation of the disease. Consequently, chest multidetector computed tomography (MDCT) plays a crucial role in evaluating lung tissue inflammation, determining disease severity, making decisions regarding hospitalization, and assessing the necessity of intensive care unit treatment. Assessing the level of oxidative stress can be accomplished by measuring the products resulting from damage to lipids, proteins, and DNA - whereas the inflammatory and multiorgan impairment biomarkers can be procured from routine laboratory practice. Due to the established association of a cytokine storm with a free radical storm, it might be postulated that during the acute phase of COVID-19 pneumonia the redox biomarkers might correlate with inflammatory and multiorgan impairment biomarkers, as well as chest MDCT findings.
... However, it is still unclear whether angiotensin II blockade that arises from ACEIs is associated with an improved clinical outcome in patients with COVID- 19. In previous studies, it was reported that mostly bilateral or multilobar lung involvement was detected during the admission of COVID-19 patients (24). In a study conducted with 102 patients with a confirmed diagnosis of COVID-19, the findings showed that the number of lung lobes affected by COVID-19 was associated with mortality (25). ...
... Apparition nombreuses images parenchymateuses linéaires et des opacités en bande curvilignes sous pleurales.5. Classifications scanographiques de la pneumonie à COVID-195.1 Evaluation de la probabilité de pneumonie à COVID-19 : classification CO-RADS De nombreuses méta-analyses ont établi l'association entre la fréquence de certains lésions thoraciques au scanner et l'infection à covid-19[10,[17][18][19]. ...
The SARS-COV 2 infection known as COVID-19 (Coronavirus Disease 2019) continues to affect the world population with successive epidemic waves. Among the many manifestations of this systemic disease, pulmonary involvement is one of the most frequent and serious with considerable mortality in patients at risk. Since the scanner has established itself as an effective tool in the diagnosis and evaluation of SARS-COV 2 pneumonia, radiologists need to know how to use it optimally in the management of this pathology. In this iconographic review, we recall the histopathological bases of SARS-COV 2 pneumonia and their translation into CT lesions. We also present the different typical and atypical CT aspects of this pathology as well as the associated lesions and the differential diagnoses that can be evoked. RESUME L’infection à SARS-COV 2 baptisée COVID-19 (Coronavirus Disease 2019) continue d’affecter la population mondiale avec des vagues épidémiques successives. Parmi les nombreuses manifestations de cette maladie systémique, l’atteinte pulmonaire est l’une des plus fréquentes et des plus graves avec une mortalité considérable chez des patients à risque. Le scanner s’étant imposé comme un outil efficace dans le diagnostic et l’évaluation de la pneumonie à SARS-COV 2, il est nécessaire que les radiologues sachent l’utiliser de manière optimale dans la prise en charge de cette pathologie. Dans cette revue iconographique, nous rappelons les bases histopathologiques de la pneumonie à SARS-COV 2 et leur traduction en lésions scanographiques. Nous exposons, par ailleurs, les différents aspects scanographiques typiques et atypiques de cette pathologie ainsi que les lésions associées et les diagnostics différentiels qui peuvent être évoqués.
... Lung imaging has played an invaluable role during the pandemic in being able to identify and manage individuals in the early stage of the disease [110]. Chest CT imaging has been demonstrated to be the most accurate in detecting the severity of acute manifestations of the lung [111]. Many studies have made the base models more effective by tackling different problems that AI techniques may come across. ...
During the coronavirus disease 2019 (COVID-19) pandemic, artificial intelligence (AI) based software on chest computed tomography (CT) imaging has proven to have a valuable role in accelerating diagnosis and screening. The proposed AI-based tools proved to be rapid and reproducible techniques to guide patient management and treatment protocols. Although no specific guidelines exist, CT-imaging and clinical features are used for patient staging. To shed light on the role of AI techniques that have been developed in fighting COVID-19, in this review, studies investigating the usage of commonly used AI models on chest CT imaging for disease quantification and prognostication are collected.
... In contrast to these findings, the role of PE in Covid 19 has not been established yet. Moreover, in large meta analyses, PE was defined as an atypical finding in Covid 19 with a low prevalence (15)(16)(17). In fact, in the meta analysis of Zhu In our study, the prevalence of PE was 13.3%. ...
Rationale and Objectives: The prognostic role of pericardial effusion (PE) in Covid 19 is unclear. The aim of the present study was to estimate the prognostic role of PE in patients with Covid 19 in a large multicentre setting. Materials and Methods: This retrospective study is a part of the German multicenter project RACOON (Radiological Cooperative Network of the Covid 19 pandemic). The acquired sample comprises 1197 patients, 363 (30.3%) women and 834 (69.7%) men. In every case, chest computed tomography was analyzed for PE. Data about 30-day mortality, need for mechanical ventilation and need for intensive care unit (ICU) admission were collected. Data were evaluated by means of descriptive statistics. Group differences were calculated with Mann-Whitney test and Fisher exact test. Uni-and multivariable regression analyses were performed. Results: Overall, 46.4% of the patients were admitted to ICU, mechanical lung ventilation was performed in 26.6% and 30-day mortality was 24%. PE was identified in 159 patients (13.3%). The presence of PE was associated with 30-day mortality: HR = 1.54, CI 95% (1.05; 2.23), p = 0.02 (univariable analysis), and HR = 1.60, CI 95% (1.03; 2.48), p = 0.03 (multivariable analysis). Furthermore, density of PE was associated with the need for intubation (OR = 1.02, CI 95% (1.003; 1.05), p = 0.03) and the need for ICU admission (OR = 1.03, CI 95% (1.005; 1.05), p = 0.01) in univariable regression analysis. The presence of PE was associated with 30-day mortality in male patients, HR = 1.56, CI 95%(1.01-2.43), p = 0.04 (multivariable analysis). In female patients, none of PE values predicted clinical outcomes. Conclusion: The prevalence of PE in Covid 19 is 13.3%. PE is an independent predictor of 30-day mortality in male patients with Covid 19. In female patients, PE plays no predictive role.
... A proposed pathological mechanism for early peripheral involvement may be related to the behavior of the virus itself in According to reports, numerous bilateral ground-glass opacities (GGOs) with a predominately peripheral distribution are the typical chest CT finding of COVID-19 infection. Although these imaging features are thought to represent the majority of COVID-19 cases, different CT findings have been reported [25][26][27]. ...
The respiratory system is the primary target of the SARS-CoV-2 virus, leading to clinical manifestations such as dry cough, fever, and shortness of breath. Other reported manifestations include generalized weakness, dizziness, headache, vomiting, and diarrhea. A chest CT scan is one of the best imaging tools to screen and diagnose COVID-19. This prospective observational study was conducted at Al-Diwaniyah Teaching Hospital in the mid-Euphrates region of Iraq to assess the prognostic role of chest CT examinations in COVID-19 patients between February 2020 and July the 15th, 2020. The study included 100 patients suspected of COVID-19 based on clinical features and microbiological investigations, comprising 72 males and 28 females aged between 30 and 55. All patients were SARS-CoV-2 PCR positive and had no history of chronic lung disease. We categorized patients into two groups based on changes in density and lesion area: patients with changes (n=55) and patients without changes (n=45). Furthermore, we divided all patients into three groups according to treatment requirements and symptom severity: group 1 included patients with severe symptoms who required CPAP and admission to the Respiratory Care Unit, group 2 consisted of patients with moderate symptoms who needed oxygen therapy and hospital admission, and group 3 comprised patients with mild symptoms who were treated as outpatients with medication. Upon correlating the change in density and lesion area with these groups, we observed that most patients with no changes were in group 1, while patients with changes were predominantly seen in group 2. Additionally, the ratio of lesion area in the mediastinal CT window to lung CT was identified as a potential prognostic factor for COVID-19 patients.
... Similarly, bilateral and multi-lobar involvement was the most common distribution noted in a systemic review by Zhu J et al 66 . Finally, in another meta-analysis by Yang H et al 22 ; bilateral (83%), multi-focal (57%) and peripheral (74%) distribution was most commonly noted. This peripheral and lower lobe predilection may be due to the ability of the virus to reach the terminal bronchioles and alveoli 23 . ...
Introduction: Chest CT is an important diagnostic, prognostic and follow up technique used for COVID 19 infections. It can detect ground glass opacities (GGO) as early as 5th day following symptoms with maximum CT findings at around 10 days of symptoms. Initially detected as unilateral lesions, it acutely progresses bilaterally. Hence, in this study, we evaluated the CT findings in COVID 19 illness, and correlated the same with severity. Methodology: It is a hospital based ambispective cross-sectional study conducted among 1544 patients attending the Department of Radio-diagnosis with symptomatic COVID-19 infections. Sociodemographic characteristics were taken, followed by history and HRCT imaging. This was followed by reporting of CT imaging with CO-RADS staging and CT severity scoring. Results: The most common lesions noted were ground glass opacities (87.7%), consolidation (44.2%), hilar/mediastinal lymphadenopathy (20.1%), reticular opacities (14.3%), septal thickening (9.1%), pleural effusion (4.5%), bronchiectasis (4.5%), emphysematous changes (1.3%), pleural thickening (2, 1.6%) and reticulonodular opacities (0.6%). Conclusion: Bilateral, multifocal, and peripheral distribution of lesions are common in HRCT of symptomatic COVID cases. GGO is the most common lesion noted.
... La lésion radiologique la plus fréquente est la lésion dite " ground glass " (68 à 83% des cas) qui se matérialise par des zones floues et grises. On parle d'opacification en verre dépoli (GOO) ou de superposition de consolidation sur de nombreuses GOO [1][2][3][4]. ...
Covid-19 est un syndrome respiratoire hautement contagieux, a été officiellement déclaré pandémie mondiale le 11 mars 2020. En raison de sa propagation rapide et de l'augmentation exponentielle du nombre de patients infectés et décédés, le diagnostic manuel dans le secteur de la santé est insuffisant pour prendre en charge chaque patient individuellement, même l'évaluation des lésions par les cliniciens est approximative. De plus, à ce jour, aucun outil de bout en bout n'est proposé pour la quantification volumétrique automatique des lésions de Covid. D'où dans cet article nous rapportons la mise en place d'une chaîne complète d'évaluation automatique du degré de lésions du Covid-19. Elle comprend (i) la préparation de la base de données privée, (ii) le prétraitement des images, (iii) l'augmentation des données, (iv) la segmentation automatique basée sur U-NET et l'évaluation de ses résultats par les métriques usuelles, (v) la reconstruction 3D et enfin (vi) la quantification volumétrique des lésions de Covid-19 en utilisant les images CT en entrée. Pour la validation, le processus est appliqué à notre propre base de données privée que nous avons créée à cet effet. Les résultats obtenus sont très encourageants. L'évaluation de la segmentation pour le poumon par les métriques DICE, IOU, Précision, et Rappel a permis d'obtenir respectivement : 0,87, 0,93, 0,96 et 0,89. De même pour les lésions ces valeurs sont de : 0,85, 0,90, 0,94 et 0,86 respectivement.
... The most typical manifestation of chest CT was ground-glass opacities (68.1%). (84) In another article Rami M. Elshazli et al. studied the diagnosis and prognosis of 6320 patients. The results of the cohorts showed that patients with high IL-6, CRP, D-dimer and neutrophils had a higher probability of mortality. ...
The SARS-CoV-2 virus is the main cause of the pandemic viral pneumonia known as COVID-19. Some studies suggest that, in this disease, lymphopenia is the most common sign of infection, as well as increased CRP and IL-6 caused by a cytokine storm directed at the lungs. Therefore, the hypothesis of the study is to make a systematic revision of scientific studies linked to the immunological phenomenon known as COVID-19. Objectives: The main aim is to study the cytokine storm of COVID-19, as well as to determine the role of IL-6 and T-lymphocytes.Methods: A search strategy was made through the PICOS questions, based on the PRISMA method. The MeSH terms were looked up on PubMed, Google Scholar and SciELO (2019-2021). The level of quality was sought according to the ranking of Scimago institutions, and the H index of the journals was assessed. Results: 43 articles were included, and clinic, diagnosis, treatment, and pathogenesis were compared. A decrease in TCD4 / CD8 lymphocytes was shown in patients with severe disease, as well as an increase in IL-6 and CRP.Conclusions: The immunological phenomenon known as COVID-19 is characterized by lymphopenia and an increase in IL-6 amongst critically ill patients. Monitoring those parameters could help to understand the progression of the COVID-19 disease.
... CT images of the lungs of patients with COVID-19 show patchy or ground glass shadows [14]. As the disease progresses, the severity of the lung lesions may become more significant, and pulmonary fibrosis may develop, with a white coloration of both lungs detected by CT lung examination [15,16]. Therefore, it is crucial to display information about the lungs of COVID-19 cases through CT. ...
The coronavirus disease 2019 (COVID-19) rapidly spread around the world, and resulted in a global pandemic. Applying artificial intelligence to COVID-19 research can produce very exciting results. However, most research has focused on applying AI techniques in the study of COVID-19, but has ignored the security and reliability of AI systems. In this paper, we explore adversarial attacks on a deep learning system based on COVID-19 CT images with the aim of helping to address this problem. Firstly, we built a deep learning system that could identify COVID-19 CT images and non-COVID-19 CT images with an average accuracy of 76.27%. Secondly, we attacked the pretrained model with an adversarial attack algorithm, i.e., FGSM, to cause the COVID-19 deep learning system to misclassify the CT images, and the classification accuracy of non-COVID-19 CT images dropped from 80% to 0%. Finally, in response to this attack, we proposed how a more secure and reliable deep learning model based on COVID-19 medical images could be built. This research is based on a COVID-19 CT image recognition system, which studies the security of a COVID-19 CT image-based deep learning system. We hope to draw more researchers’ attention to the security and reliability of medical deep learning systems.
... The morphological pattern in the lungs observed on a CT scan is associated with the progression and severity of COVID-19 infection. Ground-glass opacities (GGOs), air bronchogram, consolidation, crazy paving pattern, and interlobular septal thickening with bilateral and multilobe involvement are the most common radiological features associated with COVID-19 observed in chest CT scans (10)(11)(12)(13). The CT-Severity Score (CTSS) is used to determine the severity of lung involvement depending on the percentage of lung parenchyma affected. ...
Background:
The COVID-19 pandemic has claimed numerous lives in the last three years. With new variants emerging every now and then, the world is still battling with the management of COVID-19.
Purpose:
To utilize a deep learning model for the automatic detection of severity scores from chest CT scans of COVID-19 patients and compare its diagnostic performance with experienced human readers.
Methods:
A deep learning model capable of identifying consolidations and ground-glass opacities from the chest CT images of COVID-19 patients was used to provide CT severity scores on a 25-point scale for definitive pathogen diagnosis. The model was tested on a dataset of 469 confirmed COVID-19 cases from a tertiary care hospital. The quantitative diagnostic performance of the model was compared with three experienced human readers.
Results:
The test dataset consisted of 469 CT scans from 292 male (average age: 52.30) and 177 female (average age: 53.47) patients. The standalone model had an MAE of 3.192, which was lower than the average radiologists' MAE of 3.471. The model achieved a precision of 0.69 [0.65, 0.74] and an F1 score of 0.67 [0.62, 0.71], which was significantly superior to the average reader precision of 0.68 [0.65, 0.71] and F1 score of 0.65 [0.63, 0.67]. The model demonstrated a sensitivity of 0.69 [95% CI: 0.65, 0.73] and specificity of 0.83 [95% CI: 0.81, 0.85], which was comparable to the performance of the three human readers, who had an average sensitivity of 0.71 [95% CI: 0.69, 0.73] and specificity of 0.84 [95% CI: 0.83, 0.85].
Conclusion:
The AI model provided explainable results and performed at par with human readers in calculating CT severity scores from the chest CT scans of patients affected with COVID-19. The model had a lower MAE than that of the radiologists, indicating that the CTSS calculated by the AI was very close in absolute value to the CTSS determined by the reference standard.
... the frequency of lymphadenopathy was found to be 3.38% in the general COVID-19 disease group [10]. In the study of Zhu, et al. the rate of lymphadenopathy among 4100 COVID-19 patients was found to be 5.4% [11]. In a study conducted on ...
Mediastinal lymphadenopathy is rare in Coronavirus Disease-2019 (COVID-19) patients with mild clinical course. The frequency of lymphadenopathy increases in COVID-19 patients who develop Acute Respiratory Distress Syndrome (ARDS). In a 38-year-old male patient, mediastinal lymphadenopathy and asymptomatic pulmonary embolism were detected during the third week of COVID-19 infection at home. Sarcoidosis was diagnosed with a finding of non-caseating granulomas. Even if it is asymptomatic, pulmonary embolism should be considered, especially in COVID-19 patients with high C - Reactive Protein (CRP) and D-dimer levels. If mediastinal lymphadenopathy is detected in mild COVID-19 cases, systemic diseases should be investigated. In severe COVID-19 cases, if lymphadenopathy continues despite a COVID-19 recovery, further investigation is required.
... The coronavirus disease 2019 (COV-ID-19), caused by a novel corona virus named SARS-CoV-2, has emerged as a global pandemic (1,2). Infected patients typically present with fever and respiratory symptoms in addition to showing interstitial inflammation upon computed tomography (CT) scanning (3,4). The associated pneumonia tends to progress with a remarkable speed, leading to diffuse alveolar damage or acute respiratory distress syndrome via hyperinflammation. ...
... [9] The early stage of COVID-19 is characterized by dilatation of capillaries and engorgement of vessels, mild fluid exudates in the alveoli, and interstitial edema, resulting in single or multiple patchy ground-glass opacities which are mostly peripheral, basal and subpleural. [21,22] Next is the advanced stage in which the lesions increase in density and size, forming a mixed pattern of GGO and consolidation with or without air bronchograms. The cause of this appearance is said to be the exudation into the alveolar space and the lung interstitium. ...
Background
Computed tomography (CT) of the chest is a useful diagnostic adjunct in the management of COVID-19. It has proven useful in areas where ready access to real-time reverse transcriptase polymerase chain reaction (PCR) is not readily available.
Objectives
This study sought to evaluate the chest CT findings of patients suspected with having COVID-19 on presenting at the emergency room.
Materials and Methods
This is a retrospective study done in Cedarcrest Hospitals, Abuja, with patient information pooled from patients' electronic medical records from April to December 2020. Patients were selected based on suspicion of COVID-19 infection. Suspicion was stratified into high, moderate, and low using an in-house clinical suspicion score called the Cedarcrest Emergency COVID-19 Risk Assessment Tool. Patients with background pulmonary pathology or chest trauma were excluded. Plain chest CT scans were performed to evaluate for COVID-19 pneumonia.
Results
CT imaging increased the clinical suspicion of COVID-19. However, no statistically significant relationship was found between the positive CT findings and the PCR results.
Conclusion
Chest CT should be correlated with clinical findings and laboratory results for patient evaluation.
... La lésion radiologique la plus fréquente est celle dite ≪ en verre dépoli≫ (plus de 68% des cas) se matérialisant par des zones floues et grises. C'est ce qu'on appelle l'opacification du verre dépoli (GGO) ou la superposition d'une consolidation sur de nombreux GGO [1][2][3][4]. ...
CITATIONS 0 READS 24 7 authors, including: Some of the authors of this publication are also working on these related projects: Compression View project Hardware architectures of reconfigurable neural networks using NoC View project Hanene Abdelali University of Monastir 1 PUBLICATION 0 CITATIONS SEE PROFILE Résumé Dans cet article, nous rapportons la mise en place d'une chaîne complète d'évaluation automatique du degré des lésions Covid-19. Elle comporte (i) la préparation de la base de données privée, (ii) le prétraitement des images, (iii) la segmentation automatique basée sur U-NET et l'évaluation de ses résultats par les métriques usuelles, (iv) la reconstruction 3D et enfin (v) la quantification volumique des lésions covid-19 en utilisant des images scan comme entrée. Pour la validation, l'approche est appliquée sur notre propre base de données privée crééeà cet effet. Les résultats obtenus sont très encourageants. L'évaluation de la segmentation pour le poumon par les métriques DICE, IOU, Précision, Recall, et Accuracy ont permis d'obtenir : 0.81, 0.90, 0.93, 0.82 et 0.92 respectivement. De même pour les lésions ces valeurs sont : 0.89, 0.93, 0.93, 0.81 et 0.93 respectivement. Mots clés : Deep Learning. Segmentation. U-Net. Reconstruction 3D. Calcul volumique. Taux d'infection. Abstract In this article, we report the implementation of a complete chain for the automatic evaluation of the degree of Covid-19 lesions. It includes (i) the preparation of the private database, (ii) the preprocessing of the images, (iii) the automatic segmentation based on U-NET and the evaluation of its results by the usual metrics, (iv) the reconstruction 3D and finally (v) volumetric quantification of covid-19 lesions using scan images as input. For validation, the approach is applied on our own private database that we have created for this purpose. The results obtained are very encouraging. The evaluation of the segmentation for the lung by the metrics DICE, IOU, Precision, Recall, and Accuracy made it possible to obtain: 0.81, 0.90, 0.93, 0.82 and 0.92 respectively. Similarly for lesions these values are: 0.89, 0.93, 0.93, 0.81 and 0.93 respectively.
... In our research, the imaging manifestations, including morphological characteristics and distribution characteristics, of hospitalized patients with omicron infection showed no signi cant difference from those of the other types COVID-19 infection, but the range of involvement was signi cantly lower than previous studies, and the positive CT manifestations were signi cantly lower than those of non-Omicron infection in previous study [24].The percentage of laboratory abnormalities in omicron infected patients was also lower than in other types infected patients, the levels of CRP, LDH, procalcitonin (PCT) and interleukin 6 (IL-6) were signi cantly lower than those in non-omicron infection, previous studies have proved that elevated IL-6, CRP and LDH levels are indicators of poor prognosis in COVID-19 patients [25,26], the elevation of PCT usually indicates severe transformation. Lan et al. found a correlation between laboratory abnormalities and radiographic abnormalities [27], but the sample size of the study was small, may have an impact on the conclusions drawn. ...
Background
The protective effect of the inactivated vaccine against the omicron variant of COVID-19 is unclear. The purpose of this study was to investigate the protective effect of different vaccination status on omicron infection.
Methods
In this retrospective study, we analyzed patients over 14 years old, and were diagnosed with immune breakthrough Omicron-variant infection between December 2021 and February 2022 in Tianjin, China, as well as data from several previous study infected by other types of SARS-CoV-2. The data were subdivided into three groups: patients with fully, partially and unvaccine. Differences of clinical and imaging characteristics were compared based on the different vaccination status using Pearson Chi-square test, Fisher's accuracy test and non-parametric test. All of the data were also compared with other types of SARS-CoV-2. Logistic regression and mediation effect analysis were used to assess the association between vaccination status and pneumonia progression during hospitalization.
Results
Among the 314 cases of immune breakthrough Omicron-variant infected patients, 21(7%) patients were unvaccinated, 134 (43%) were partially vaccinated, and 159 (50%) were full vaccinated. Among fully vaccinated patients, the proportion of patients with positive CT findings (32%) and CT score 2 (6%) was significantly lower than that of partially vaccinated (46%, 14%) and unvaccinated patients (67%, 19%) (P < 0.05). CT score by vaccination status are similar between Omicron and other types, only partially vaccinated group of Omicron infected patients show lower CT score than other types infected patients (P = 0.005). Increased age and lower IgG levels were associated with the risk of disease progression. IgG level had a complete mediating effect between vaccination status/ days after vaccination and disease progression.
Conclusion
The inactivated vaccine provided similar protection against Omicron infection of SARS-CoV-2, compared to the patients who received other types vaccines. Compared with partially vaccinated and unvaccinated patients, fully vaccinated patients had a higher CT negative rate and a lower rate of severe pneumonia. Vaccination status and days after vaccination affect disease progression through IgG levels.
... La lésion radiologique la plus fréquente est celle dite ≪ en verre dépoli≫ (plus de 68% des cas) se matérialisant par des zones floues et grises. C'est ce qu'on appelle l'opacification du verre dépoli (GGO) ou la superposition d'une consolidation sur de nombreux GGO [1][2][3][4]. ...
Dans cet article, nous rapportons la mise en place d'une chaîne complète d'évaluation automatique du degré des lésions Covid-19. Elle comporte (i) la préparation de la base de données privée, (ii) le prétraitement des images, (iii) la segmentation automatique basée sur U-NET et l'évaluation de ses résultats par les métriques usuelles, (iv) la reconstruction 3D et enfin (v) la quantification volumique des lésions covid-19 en utilisant des images scan comme entrée. Pour la validation, l'approche est appliquée sur notre propre base de données privée crééeà cet effet. Les résultats obtenus sont très encourageants. L'évaluation de la segmentation pour le poumon par les métriques DICE, IOU, Précision, Recall, et Accuracy ont permis d'obtenir : 0.81, 0.90, 0.93, 0.82 et 0.92 respectivement. De même pour les lésions ces valeurs sont : 0.89, 0.93, 0.93, 0.81 et 0.93 respectivement. Mots clés : Deep Learning. Segmentation. U-Net. Reconstruction 3D. Calcul volumique. Taux d'infection. Abstract In this article, we report the implementation of a complete chain for the automatic evaluation of the degree of Covid-19 lesions. It includes (i) the preparation of the private database, (ii) the preprocessing of the images, (iii) the automatic segmentation based on U-NET and the evaluation of its results by the usual metrics, (iv) the reconstruction 3D and finally (v) volumetric quantification of covid-19 lesions using scan images as input. For validation, the approach is applied on our own private database that we have created for this purpose. The results obtained are very encouraging. The evaluation of the segmentation for the lung by the metrics DICE, IOU, Precision, Recall, and Accuracy made it possible to obtain: 0.81, 0.90, 0.93, 0.82 and 0.92 respectively. Similarly for lesions these values are: 0.89, 0.93, 0.93, 0.81 and 0.93 respectively.
... CT has played a central role in the diagnosis of COVID-19 for the presence of lung parenchymal abnormalities as signs of interstitial pneumonia, mainly bilateral GGOs with a subpleural distribution [15,16]. In our analysis, we focused on the %PAL, representing ground-glass opacities and %CL representing overall lung impairment, considering the high frequency of these opacities and their persistence after the acute phase that can correlate with altered respiratory function [17,18]. ...
(1) Background: Quantitative CT analysis (QCT) has demonstrated promising results in the prognosis prediction of patients affected by COVID-19. We implemented QCT not only at diagnosis but also at short-term follow-up, pairing it with a clinical examination in search of a correlation between residual respiratory symptoms and abnormal QCT results. (2) Methods: In this prospective monocentric trial performed during the “first wave” of the Italian pandemic, i.e., from March to May 2020, we aimed to test the relationship between %deltaCL (variation of %CL-compromised lung volume) and variations of symptoms-dyspnea, cough and chest pain-at follow-up clinical assessment after hospitalization. (3) Results: 282 patients (95 females, 34%) with a median age of 60 years (IQR, 51–69) were included. We reported a correlation between changing lung abnormalities measured by QCT, and residual symptoms at short-term follow up after COVID-19 pneumonia. Independently from age, a low percentage of surviving patients (1–4%) may present residual respiratory symptoms at approximately two months after discharge. QCT was able to quantify the extent of residual lung damage underlying such symptoms, as the reduction of both %PAL (poorly aerated lung) and %CL volumes was correlated to their disappearance. (4) Conclusions QCT may be used as an objective metric for the measurement of COVID-19 sequelae.
... 6,7 Among the CT features of COVID-19 pneumonia, mediastinal lymphadenopathy is rare and has a prevalence of 3-5% according to systematic meta-analyses. 8, 9 However, in one study conducted in France, mediastinal lymphadenopathy was observed in 66% of COVID-19 patients admitted to the intensive care unit (ICU). 10 Similarly, other studies have reported that mediastinal lymphadenopathy was significantly more frequent in critically ill patients and those who died during hospitalization. ...
Background:
We analyzed the differences between clinical characteristics and computed tomography (CT) findings in patients with coronavirus disease 2019 (COVID-19) to establish potential relationships with mediastinal lymphadenopathy and clinical outcomes.
Methods:
We compared the clinical characteristics and CT findings of COVID-19 patients from a nationwide multicenter cohort who were grouped based on the presence or absence of mediastinal lymphadenopathy. Differences between clinical characteristics and CT findings in these groups were analyzed. Univariate and multivariate analyses were performed to determine the impact of mediastinal lymphadenopathy on clinical outcomes.
Results:
Of the 344 patients included in this study, 53 (15.4%) presented with mediastinal lymphadenopathy. The rate of diffuse alveolar damage pattern pneumonia and the visual CT scores were significantly higher in patients with mediastinal lymphadenopathy than in those without (P < 0.05). A positive correlation between the number of enlarged mediastinal lymph nodes and visual CT scores was noted in patients with mediastinal lymphadenopathy (Spearman's ρ = 0.334, P < 0.001). Multivariate analysis showed that mediastinal lymphadenopathy was independently associated with a higher risk of intensive care unit (ICU) admission (odds ratio, 95% confidence interval; 3.25, 1.06-9.95) but was not significantly associated with an increased risk of in-hospital death in patients with COVID-19.
Conclusion:
COVID-19 patients with mediastinal lymphadenopathy had a larger extent of pneumonia than those without. Multivariate analysis adjusted for clinical characteristics and CT findings revealed that the presence of mediastinal lymphadenopathy was significantly associated with ICU admission.
... Ground glass opacities (GGO), crazy-paving pattern (GGO with superimposed septal thickening), and consolidation are the most common chest CT findings in COVID-19 pneumonia (Fig. 1) [6]. These findings are usually bilateral and multilobar, mostly distributed in the subpleural/peripheral and posterior regions of the lungs [7], but occasionally they can show a bronchovascular distribution or a combination of both. ...
Infection with SARS-CoV-2 has dominated discussion and caused global healthcare and economic crisis over the past 18 months. Coronavirus disease 19 (COVID-19) causes mild-to-moderate symptoms in most individuals. However, rapid deterioration to severe disease with or without acute respiratory distress syndrome (ARDS) can occur within 1-2 weeks from the onset of symptoms in a proportion of patients. Early identification by risk stratifying such patients who are at risk of severe complications of COVID-19 is of great clinical importance. Computed tomography (CT) is widely available and offers the potential for fast triage, robust, rapid, and minimally invasive diagnosis: Ground glass opacities (GGO), crazy-paving pattern (GGO with superimposed septal thickening), and consolidation are the most common chest CT findings in COVID pneumonia. There is growing interest in the prognostic value of baseline chest CT since an early risk stratification of patients with COVID-19 would allow for better resource allocation and could help improve outcomes. Recent studies have demonstrated the utility of baseline chest CT to predict intensive care unit (ICU) admission in patients with COVID-19. Furthermore, developments and progress integrating artificial intelligence (AI) with computer-aided design (CAD) software for diagnostic imaging allow for objective, unbiased, and rapid assessment of CT images.
... Typical initial or follow-up chest CT imaging findings in adults with COVID-19 pneumonia have recently been reported [8, 9,21]. The most common typical findings in COVID-19 pneumonia are described as multifocal peripherally located GGO appearance accompanied by thickening of the interlobular septa, prominent vascular structures, and halo and reverse halo signs [5,19,[21][22][23]. In a study including a small number of patients (47 adults and 14 pediatric patients), ...
... Of the 47 included studies, only 13 were SRs, [10,15,18,20,22,23,26,29,[38][39][40]43,52] while 34 were meta-analyses. [9,[11][12][13][14]16,17,19,21,24,25,27,28,[30][31][32][33][34][35][36][37]41,42,[44][45][46][47][48][49][50][51][53][54][55] A total of 17 studies were published by Chinese authors, 8 by Italian authors, and 4 by American authors. Nearly half of the SRs/meta-analyses were performed by <5 authors (n = 20, 42.6%), which was comparable between SRs only (n = 6, 46.2%) and meta-analysis (n = 14, 41.2%); nevertheless, Chinese-based studies (n = 11, 64.7%) were commonly performed by 6 to 10 authors compared with nonChinese-based studies (n = 7, 23.3%). ...
During the coronavirus disease 2019 (COVID-19) pandemic, convenient accessibility and rapid publication of studies related to the ongoing pandemic prompted shorter preparation time for studies. Whether the methodological quality and reporting characteristics of published systematic reviews (SRs)/meta-analyses are affected during the specific pandemic condition is yet to be clarified. This study aimed to evaluate the epidemiology, methodological quality, and reporting characteristics of published SRs/meta-analyses related to COVID-19.
The Ovid Medline, Ovid Embase, Cochrane Library, and Web of Science electronic databases were searched to identify published SRs/meta-analyses related to the COVID-19 pandemic. Study screening, data extraction, and methodology quality assessment were performed independently by 2 authors. The methodology quality of included SRs/meta-analyses was evaluated using revised version of a measurement tool to assess SRs, and the reporting characteristics were assessed based on the preferred reporting items for SRs and meta-analyses guidelines.
A total of 47 SRs/meta-analyses were included with a low to critically low methodological quality. The median number of days from the date of literature retrieval to the date that the study was first available online was 21 days; due to the limited time, only 7 studies had study protocols, and the studies focused on a wide range of COVID-19 topics. The rate of compliance to the preferred reporting items for SRs and meta-analyses checklists of reporting characteristics ranged from 14.9% to 100%. The rate of compliance to the items of protocol and registration, detailed search strategy, and assessment of publication bias was less than 50%.
SRs/meta-analyses on COVID-19 were poorly conducted and reported, and thus, need to be substantially improved.
... El derrame pleural es el acumulo de líquido en el espacio pleural entre las capas visceral y parietal, que puede clasificarse como trasudado o exudado, la prueba de oro para su diagnóstico es la (7) radiografía de tórax . A pesar de que el derrame pleural no es un hallazgo común en pacientes con infección por SARS-CoV- (8,9) 2, algunos estudios reportan su presencia . Recientes estudios manifiestan mayor incidencia de derrame pleural asociados con la neumonía por coronavirus en pacientes críticamente enfermos o con casos graves en comparación (10,11,12) con casos simples o con síntomas leves . ...
Objetivos:
El presente trabajo tuvo como propósito describir las características físicas, citológicas y bioquímicas, así como clasificar los líquidos pleurales de pacientes con COVID-19 como exudados o trasudados.
Materiales y Métodos:
Se realizó un estudio observacional, transversal descriptivo. Se recopiló datos del examen citoquímico de muestras de líquido pleural procesadas entre los meses de abril a setiembre del 2020, en el laboratorio del Centro de Emergencias de Lima Metropolitana (CELIM).
Resultados:
Durante el periodo de estudio un total de 81 muestras de líquido pleural de pacientes con COVID-19 fueron evaluadas, de estos, 26 cumplieron con nuestros criterios de elegibilidad. Catorce líquidos (54%), tuvieron un color rojo y 18 (69%) tuvieron un aspecto turbio. Los líquidos pleurales exudativos fueron la mayoría (n = 17), las proteínas totales presentaron una media de 3.3 gr/dl (DE: 1.5), LDH una mediana de 544 U/L (RIC: 262-2016), el recuento leucocitario tuvo una mediana de 610 leucocitos/ul (RIC: 180-968) y el recuento diferencial de polimorfonucleares una mediana 29% (RIC: 15-60). En cuanto a las características clínicas, del total de exudados el 41% correspondían a neoplasias y el 23% a neumonías. Mientras que, del total de trasudados (n=9), 45% provenían de pacientes con neoplasias.
Conclusiones:
En nuestro estudio observamos que la mayoría de las muestras de líquido pleural de pacientes con COVID-19 fueron clasificadas como exudados. Estas presentaron un bajo porcentaje diferencial leucocitario de polimorfonucleares. Los valores de los parámetros bioquímicos tales como proteínas totales y LDH se relacionaron adecuadamente con la clasificación de exudados.
... Furthermore, according to the results of the reviewed articles, the extent of lung involvement varied in the studies, indicating the severity of the disease (9,(11)(12)(13)(14)(15)(16)(17)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). Pan et al. (30) reported the highest severity of lung abnormalities in chest CT about ten days after the primary inception of symptoms for recovered COVID-19 patients (without intensive respiratory distress during the disease period). ...
Context: The early detection of COVID-19 is of paramount importance for the disease treatment and control. As real-time reverse-transcription polymerase chain reaction indicates a low sensitivity, the computed tomography of patients' chest can play an effective role in the diagnosis of COVID-19, particularly for patients with false-negative RT-PCR tests. It is also effective in monitoring the clinical trends and assessing the severity of the disease. Objectives: Accordingly, this study aimed to review the different manifestations of the COVID-19 infections in High-Resolution Computed Tomography images of patients' chests and analyze the distribution of the disease in the lungs. The results can contribute to providing a comprehensive and concise reference on the appearance of various types of involvement and lung lesions and the extent of these lesions in the COVID-19 patients. Data Sources: We systematically searched four major indexing databases (namely PubMed, Science Direct, Google Scholar, and Cochrane Central) for articles published by May 2021 using the following keywords: High-Resolution Computed Tomography (HRCT), COVID-19, and Manifestations. Results: Overall, 29 studies addressing the role of HRCT in detecting and evaluating the manifestations of the COVID-19 infection in patients' lungs as Ground Glass Opacification (GGO), Consolidation, Irregular Solid Nodules, Fibrous Stripes, Crazy Paving Pattern, Air Bronchogram Sign, etc. were reviewed. Conclusions: GGO was the most common finding, as reported in 96.6% of the reviewed articles, followed by Consolidations (65.5%) and Irregular Solid Nodules (55.2%). Most patients revealed the disease process as a bilateral distribution in the peripheral areas of the lung.
... Chest computed tomography (CT) imaging plays a key role in the early diagnosis of COVID-19. [2][3][4][5] Previous studies [6][7][8][9][10] and a recent meta-analysis [11] indicated that ground-glass opacity (GGO) is the most common radiologic finding on chest CT in patients with COVID-19, but this finding is non-specific because it is found in other infectious and inflammatory conditions, which limits its clinical application. [12] practice, clinicians and radiologists are eager to understand the diagnostic accuracy of GGO in patients with COVID-19, which remains unproven. ...
OBJECTIVE
The aim of the study was to evaluate the diagnostic efficiency of ground-glass opacity (GGO) for coronavirus disease 2019 (COVID-19) in suspected patients.
MATERIALS AND METHODS
In this systematic review and meta-analysis, PubMed, Embase, Cochrane Library, Scopus, Web of Science, CNKI, and Wanfang databases were searched from November 01, 2019 to November 29, 2020. Studies providing the diagnostic test accuracy of chest computed tomography (CT) and description of detailed CT features for COVID-19 were included. Data were extracted from the publications. The sensitivity, specificity, and summary receiver operating characteristic curves were pooled. Heterogeneity was detected across included studies.
RESULTS
Eleven studies with 1618 cases were included. The pooled sensitivity, specificity and area under the curve were 0.74 (95% confidence interval [CI], 0.61–0.84), 0.52 (95% CI, 0.33–0.70), and 0.70 (95% CI, 0.66–0.74), respectively. There was obvious heterogeneity among included studies ( P < 0.05). Differences in the study region, inclusion criteria, research quality, or research methods might have contributed to the heterogeneity. The included studies had no significant publication bias ( P > 0.1).
CONCLUSIONS
COVID-19 was diagnosed not only by GGO with a medium level of diagnostic accuracy but also by white blood cell counts, epidemic history, and revers transcription-polymerase chain reaction testing.
... Thus, in the highly suspected group (Table 2), there were no patients with pleural fluid. Although cancer patients are not included, according to a meta-analysis of 4,121 patients, pleural effusion (5.3%) was reported as the rarest CTT imaging feature of COVID-19 (16). ...
Objective
There are many clinical conditions, such as lung cancer, that need to be followed up and treated during a pandemic. Providing health care for patients who are immune-suppressive requires extra care.
Method
Among 108 lung cancer patients who had been hospitalized during the COVID-19 pandemic, 18 with respiratory symptoms were evaluated retrospectively.
Results
The patients’ median age was 64±9.4 with a male predominance (male n=16, female n=2). Thirteen had non-small cell lung cancer (NSCLC), and 5 had small cell lung cancer (SCLC). Nine (50%) patients were receiving chemotherapy. The most common symptom was shortness of breath (n=14, 77.8%), followed by fever (n=10, 55.6%). The findings confirmed on computed thorax tomography (CTT) were as follows: consolidation (n=8, 44.4%), ground glass opacities (n=8, 44.4%) and thoracic tumour/mediastinal-hilar lymphadenopathy (n=3, 16.7%). Hypoxia was seen in 11 patients (61.1.%), twelve patients had an elevated LDH (median=302±197) and lymphopenia (median=1055±648), and 5 (27.7%) were highly suspected of having contracted COVID-19. None of their nasopharyngeal swaps was positive. Two of these 5 patients received COVID-19 specific treatment even though they thrice had negative reverse transcription polymerase chain reaction (RT-PCR) results. The two patients responded well to both clinical and radiological treatment. For one case with SCLC receiving immunotherapy, methylprednisolone was initiated for radiation pneumonitis after excluding COVID-19.
Conclusion
In line with a country’s health policies and the adequacy of its health system, the necessity of a multidisciplinary approach in the management and treatment of complications in patients with lung cancer has become even more important during the COVID-19 pandemic.
... COVID-19 and MERS-COV are both from the same type of β-coronavirus with the same clinical and radiologic symptoms and disease stages in both adults and children. [11,46,47] The fatality rate for COVID-19 is less than MERS. Some scholars argue the answer to this issue is within the number of studies and its populations. ...
COVID‑19 is a respiratory infection brought about by SARS‑COV‑2. Most of the
patients contaminated by this pathogen are afflicted by respiratory syndrome with multiple stages
ranging from mild upper respiratory involvement to severe dyspnea and acute respiratory distress
syndrome cases. Keeping in mind the high sensitivity of computed tomography (CT) scan in
detecting abnormalities, it became the number one modality in COVID‑19 diagnosis. A wide
diversity of CT features can be found in COVID‑19 cases, which can be observed before the onset
of clinical signs. The review article is aimed to highlight recent discrepancies in CT‑scan and chest
X‑ray (CXR) characteristics between COVID‑19 and Middle East Respiratory Syndrome (MERS).
Methods: This review study was performed in the literature from the beginning of COVID‑19 until
the middle of April 2021. For this reason, all relevant works through scientific citation websites such
as Google Scholar, PubMed, and Web of Science have been investigated in the mentioned period.
Results: COVID‑19 was more reproductive than MERS, while MERS was significantly higher in
terms of mortality rate (COVID‑19: 2.3% and MERS: 34.4%). Signs of ground‑glass opacity (GGO),
peripheral consolidation, and GGO accompanying with consolidation are the same signs CXR in
both MERS and COVID‑19. Indeed, fever, cough, headache, and sore throat are the most symptoms
in all studied patients. Conclusion: Both COVID‑19 and MERS have the same imaging signs.
The most similar chest CT findings are GGO, peripheral consolidation, and GGO superimposed
by consolidation in both studied diseases, and no statistical differences were seen among the mean
number of chest CT‑scans in MERS and COVID‑19 cases.
... There is rarely pleural effusion and lymphadenopathy. 15,16 In view of the complexity of clinical and imaging manifestations, thin-layer CT of the chest is recommended scanning combined with previous image data and dynamic observation of laboratory examination results for identification. ...
A pandemic of coronavirus diseases 2019 (COVID-19) outbreak is a major public health emergency that has spread in the fastest speed, and caused the most extensive infection world widely. Transbronchial biopsy (TBB) and computed tomography guided percutaneous needle biopsy (CTPNB) is the most common and significant method for the diagnosis of lung cancer. During the COVID-19 pandemic, the indications of TBB and CTPNB must be managed strictly. Therefore, it is extremely indispensable to perform meticulous and individualized management for lung cancer patients to protect the patients from COVID-19.
Objective
The purpose of this study was to evaluate the characteristics and meaning of the vessel wall irregularities sign, observed on computed tomography angiography of the pulmonary arteries of patients with coronavirus disease 2019 (COVID-19) pneumonia.
Materials and Methods
This retrospective study of the computed tomography pulmonary angiography findings of 65 patients diagnosed with COVID-19 included 27 women and 38 men, with a median age of 52 years (range, 20-86 years). The diagnosis of COVID-19 was established through reverse transcription-polymerase chain reaction for infection with severe acute respiratory syndrome coronavirus 2.
Results
The vessel wall irregularities sign was observed in 50 (76.9%) of the 65 patients with COVID-19. Among those 50 patients, the vascular involvement was predominantly mixed (arterial and venous) in 43 (86%), subsegmental in all 50 (100%), segmental in 13 (26%), bilateral in 46 (92%), affecting 4-5 lobes in 35 (70%), mainly in the right lower lobe in 46 (92%), and mainly in the left lower lobe in 44 (88%).
Conclusion
The vessel wall irregularities is a prevalent sign of vascular involvement in patients with COVID-19.
Objective: In this study, we aimed to evaluate thoracic computed tomography (CT) findings of pediatric patients with novel coronavirus disease 2019 (COVID-19) pneumonia according to age groups. Methods: A total of 105 patients aged between 0 and 18 years who were admitted to our clinic between April 2020 and September 2020 were retrospectively analyzed. The definitive diagnosis was established by reverse transcriptase-polymerase chain reaction (RT-PCR) testing of the combined nasopharyngeal/oropharyngeal swabs. The patients were divided into three groups according to age: 0-6, 6-12, and 12-18 years. Thoracic CT findings at the time of initial admission were evaluated. Results: Of the patients, 51 had RT-PCR positivity for COVID-19, while 54 had RT-PCR negativity. Of the RT-PCR-positive patients, 30 (58.8%) had normal CT, while lung involvement was observed in 21 patients (41.2%). The most common thoracic CT findings were bilateral lung involvement (27.5%), lower lobe involvement (31.4%), nodular involvement (31.4%), and ground-glass opacity (37.3%). In the 6-12 age group, middle lobe involvement was significantly more frequent (p=0.041). The rate of consolidation significantly decreased with the increasing age (p=0.045). Conclusion: The most common CT findings were bilateral, peripheral lower lobe involvement in pediatric COVID-19 cases. Consolidation was the most frequent lesion in the 0-6 age group, which can be attributed to the high incidence of bacterial co-infection. In the 12-18 age group, the distribution, morphology, and opacity of the lesions were comparable with those seen in adults. The lesions presented with nodular and ground-glass opacity patterns in the 6-12 and 12-18 age groups.
Since the novel coronavirus disease 2019 (COVID-19) outbreak, there has been an unprecedented increase in the number of patients undergoing chest computed tomography (CT). More than 689 million cases have been infected by COVID-19 worldwide till date, of whom many were subjected to CT scanning. Several national and international bodies recommended against the routine use of chest CT for COVID-19 cases. However, evidence points to overuse. This review attempts to briefly describe when and why a chest CT is clinically indicated for COVID-19 patients to judicious use and enhance the benefit–risk ratio.
Background
Acute kidney injury (AKI) is common among patients hospitalized with COVID-19 and associated with worse prognosis.
Objective
We aim to assess the incidence of AKI in hospitalized COVID-19 patients.
Materials and Methods
This is a retrospective cross-sectional study conducted at Merjan Teaching Hospital from May 1 to October 1, 2021. It involved a review of data of 174 hospitalized polymerase chain reaction–confirmed COVID-19 patients from hospital health records.
Results
In our hospitalized COVID-19 patients, AKI was found in 14 patients forming 8.05% of the total hospitalized patients. The age of participants with AKI was 62.64 ± 19.08 years; male patients formed the larger proportion (53.45%). More than one-third of the patients (36.21%) had a history of hypertension, and more than one-fifth of the patients had a history of diabetes mellitus (22.99%). History of ischemic heart disease was present in 4.60%, heart failure in 0.57%, asthma in 3.45%, chronic obstructive pulmonary disease in 1.15%, cerebrovascular accidents in 1.75%, and lung fibrosis in 1.15%. Patients with AKI had a significantly higher level of blood urea (22.44 ± 11.74); the level of serum creatinine was also significantly higher among patients with AKI (267.57 ± 87.27); significant relationship was observed between the outcome of the patient and the incidence of AKI.
Conclusions
The current study showed a higher risk of mortality and morbidity in COVID-19 patients with AKI. Identifying high-risk groups and earlier diagnosis of AKI in COVID-19 patients can improve results in patients and decrease mortality.
Coronavirus disease (COVID) emerged in December 2019 as an important and worldwide infectious disease caused by a previous unknown pathogen, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The ability for human-to-human transmission, mainly through respiratory droplets or aerosols, facilitated its rapid dissemination. The interventional pulmonology (IP) department is a particularly high-risk area, given the procedures performed with airway manipulation, mainly in patients with respiratory diseases and with multiple staff involved. Many changes in the IP department were necessary during the COVID-19 pandemics, in order to limit risks for both patients and health personnel.KeywordsCOVID-19 pandemicInterventional procedures changesCOVID-19 transmission during interventional pulmonary procedures
The playing activity of a football player, taking place in conditions of high-intensity loads, cannot but cause corresponding changes in the work of his organs and systems. The fatigue that arises and progresses during the competition affects the effectiveness of technical and tactical actions of the player. Significant expansion of technical and tactical actions with maximum use of playing space, universalization of players necessitates increasing the requirements for special endurance of football players during competitions. Therefore, it seems legitimate to characterize the new trends that have emerged in football and are directly related to the impact of speed-power endurance on the effectiveness of technical and tactical skills of players.
This chapter reviews the current guidelines on when to perform thoracic imaging in COVID‐19; technical considerations to minimize the risk for transmission while imaging; the appearance of COVID‐19 in the thorax on various imaging modalities, including chest radiography, thoracic computed tomography, lung ultrasound, positron emission tomography/computed tomography and thoracic magnetic resonance imaging; and current guidelines for reporting of the pulmonary findings in COVID‐19.
Spatial resolution in existing chest x-ray (CXR)-based scoring systems for coronavirus disease 2019 (COVID-19) pneumonia is low, and should be increased for better representation of anatomy, and severity of lung involvement. An existing CXR-based system, the Brixia score, was modified to increase the spatial resolution, creating the MBrixia score. The MBrixia score is the sum, of a rule-based quantification of CXR severity on a scale of 0 to 3 in 12 anatomical zones in the lungs. The MBrixia score was applied to CXR images from COVID-19 patients at a single tertiary hospital in the period May 4th–June 5th, 2020. The relationship between MBrixia score, and level of respiratory support at the time of performed CXR imaging was investigated. 37 hospitalized COVID-19 patients with 290 CXRs were identified, 22 (59.5%) were admitted to the intensive care unit and 10 (27%) died during follow-up. In a Poisson regression using all 290 MBrixia scored CXRs, a higher MBrixia score was associated with a higher level of respiratory support at the time of performed CXR. The MBrixia score could potentially be valuable as a quantitative surrogate measurement of COVID-19 pneumonia severity, and future studies should investigate the score’s validity and capabilities of predicting clinical outcomes.
Long-lasting coronavirus disease 2019 (COVID-19) symptoms beyond 12 weeks, the so-called 'long COVID' have been increasingly reported worldwide. Long COVID can be manifested in various forms, and there is an increasing demand for proper assessment and management. However, it is challenging when trying to determine the best-practice standards of care based on the current evidence because there is no internationally agreed clinical definition or clear treatment pathway. Therefore, the present guidelines have been drafted to provide advice on diagnosis and management based on the latest updated available evidence and the consensus of expert opinion. So far, no standard test and drug treatment can be strongly recommended for patients with long COVID because of a lack of evidence. The present guidelines provide advice based on 12 key questions, including appropriate interventions for long COVID that can be used in clinical practice. Continuous careful observation and studies related to long COVID are needed for the long-term impact of COVID-19 and proper management for long COVID to be determined.
Artificial intelligence (AI) methods for the automatic detection and quantification of COVID-19 lesions in chest computed tomography (CT) might play an important role in the monitoring and management of the disease. We organized an international challenge and competition for the development and comparison of AI algorithms for this task, which we supported with public data and state-of-the-art benchmark methods. Board Certified Radiologists annotated 295 public images from two sources (A and B) for algorithms training (n=199, source A), validation (n=50, source A) and testing (n=23, source A; n=23, source B). There were 1,096 registered teams of which 225 and 98 completed the validation and testing phases, respectively. The challenge showed that AI models could be rapidly designed by diverse teams with the potential to measure disease or facilitate timely and patient-specific interventions. This paper provides an overview and the major outcomes of the COVID-19 Lung CT Lesion Segmentation Challenge - 2020.
In recent days, various types of LDHs are used for biomedical functions. Due to the unique structure of LDH, it has a vast area of application. In different biomedical sectors, the application of unimolecular LDHs and various LDH-based nanohybrid materials is increasing day by day. LDH nanoparticles are significant reservoirs and carriers in different biomedical sectors such as cardiovascular drugs, anti-inflammatory drugs, cancer therapeutic agents, vitamins, antioxidants, DNAs, RNAs, antibodies and some proteins. However, the LDH-DRUG nanohybrids have absorptive capacity which can received by the mediated endocytosis process. Furthermore, in recent times LDH materials are noticed because of their uses in vaccine therapy. In bioimaging systems, LDHs are plays an important role to deliver highly sensitive contrasting agents to various targeted cells of the human body. Moreover, in biosensing applications such as several enzymatic and non-enzymatic LDH-based biosensors have been explored toward the detection of different bioactive molecules. Most of the research has been focused on the detection of glucose, dopamine and H2O2. This review encapsulates the topical advancements of LDHs and LDH-based nanoarchitectures in drug delivery, gene therapy, bioimaging and biosensing applications. Also, this review works includes all the proposed synthesis routes.
Проаналізовано 68 випадків захворювань органів грудної клітки, спричинених COVID – 19 у пацієнтів, яким надавалась консультативна, спеціалізована хірургічна торакальна допомога у базових лікувальних установах Чернівецької області за період січень-вересень 2020 р. Переважали двосторонні ураження легень - 70,6% у пацієнтів віком старші 42 роки (66,2%). Хірургічні втручання виконані у 65 (95,6%) пацієнтів. Найбільш частим ускладненням в гострий період було зареєстровано пневмоторакс на фоні активної вірусної пневмонії- 40 (58,8%) хворих, 6 (8,8%) - пацієнтів з ураженнями серця та перикарду, 7(10,3%) – геморагічні, серозно-фібринозні плеврити. Основуючись на власних даних у співставленні з приведеними в доступній літературі гістологічними та патофізіологічними дослідженнями, обґрунтована хірургічна тактика, окремі хірургічні прийоми у хворих з вірусіндукованими ускладненнями, зокрема: дренування плевральної порожнини, перикарду, відеоторакоскопічні методики. Приведено алгоритм обстежень та лікувальна тактика при формуваннях внутрішньолегеневих псевдокіст після коронавірусної хвороби. Проаналізовано 5 (7,4%) випадків у яких виникли ускладнення основних захворювань (онкологічні, неспецифічні гнійно-септичні хвороби) спричинені COVID-19.
The COVID-19 infection causes a severe form of viral pneumonia in a proportion of the infected patients. Over the last 1 year, a lot of typical and atypical radiological changes in COVID pneumonia have been documented. These radiological appearances can help in the diagnosis of COVID infection even before genetic test results are available. While some of these signs are nonspecific and found in a lot of other infections, there are a few signs that have been newly described specifically during the current pandemic. Here, we present such a rare sign in a patient from Eastern India.
Coronavirus disease 2019 (COVID-19) has reached a pandemic stage in March 2020 and currently more than 220 million patients worldwide are infected. The characteristic findings of COVID-19 pneumonia are bilateral, peripheral, rounded ground-glass opacities (GGO) which are dominantly located in the lower lobes and that may be accompanied by consolidation. The distribution of the parenchymal lesions was reported to be bilateral (88%), multi-lobar (78%) and peripheral (76%), with a tendency to involve the posterior regions of the lungs (80%). Several other chest CT findings, such as interlobular septal thickening, bronchiectasis, “crazy paving” and halo sign, have also been reported but with a lower frequency. RSNA has published consensus statements to reduce report variability among radiologists and defined 4 main categories: typical, indeterminate, atypical, and negative, to provide a relative likelihood that these findings are attributable to COVID-19 pneumonia. It is vital to understand that imaging may be normal in the early stages of COVID-19, and many conditions may present with imaging findings mimicking COVID-19 pneumonia. Chest CT may be also used as a useful tool for better identification of patients who will benefit from more aggressive therapy. In addition, CT may be used to evaluate patency of pulmonary and coronary vascular structures and myocardial damage. Although CT scan is not recommended as a diagnostic and screening tool, it can be helpful to clinician for a fast and accurate decision-making and has a crucial role in the diagnosis, risk stratifying, and follow-up of the progression of COVID-19 pneumonia.
Our daily experience in a COVID hospital has allowed us to learn about this disease in many of its changing and unusual aspects. Some of these uncommon manifestations, however, appeared more frequently than others, giving shape to a multifaceted COVID-19 disease. This pictorial review has the aim to describe the radiological aspects of atypical presentations and of some complications of COVID-19 disease in adults and children and provide a simple guide for radiologists to become familiar with the multiform aspects of this disease.
Since the beginning of 2020, coronavirus disease 2019 (COVID-19) has spread throughout China. This study explains the findings from lung computed tomography images of some patients with COVID-19 treated in this medical institution and discusses the difference between COVID-19 and other lung diseases.
Background:
Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients.
Methods:
We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death.
Results:
The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission.
Conclusions:
During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.).
Background
The pneumonia caused by the 2019 novel coronavirus (SARS-CoV-2, also called 2019-nCoV) recently break out in Wuhan, China, and was named as COVID-19. With the spread of the disease, similar cases have also been confirmed in other regions of China. We aimed to report the imaging and clinical characteristics of these patients infected with SARS-CoV-2 in Guangzhou, China.Methods
All patients with laboratory-identified SARS-CoV-2 infection by real-time polymerase chain reaction (PCR) were collected between January 23, 2020, and February 4, 2020, in a designated hospital (Guangzhou Eighth People’s Hospital). This analysis included 90 patients (39 men and 51 women; median age, 50 years (age range, 18–86 years). All the included SARS-CoV-2-infected patients underwent non-contrast enhanced chest computed tomography (CT). We analyzed the clinical characteristics of the patients, as well as the distribution characteristics, pattern, morphology, and accompanying manifestations of lung lesions. In addition, after 1–6 days (mean 3.5 days), follow-up chest CT images were evaluated to assess radiological evolution.FindingsThe majority of infected patients had a history of exposure in Wuhan or to infected patients and mostly presented with fever and cough. More than half of the patients presented bilateral, multifocal lung lesions, with peripheral distribution, and 53 (59%) patients had more than two lobes involved. Of all included patients, COVID-19 pneumonia presented with ground glass opacities in 65 (72%), consolidation in 12 (13%), crazy paving pattern in 11 (12%), interlobular thickening in 33 (37%), adjacent pleura thickening in 50 (56%), and linear opacities combined in 55 (61%). Pleural effusion, pericardial effusion, and lymphadenopathy were uncommon findings. In addition, baseline chest CT did not show any abnormalities in 21 patients (23%), but 3 patients presented bilateral ground glass opacities on the second CT after 3–4 days.ConclusionSARS-CoV-2 infection can be confirmed based on the patient’s history, clinical manifestations, imaging characteristics, and laboratory tests. Chest CT examination plays an important role in the initial diagnosis of the novel coronavirus pneumonia. Multiple patchy ground glass opacities in bilateral multiple lobular with periphery distribution are typical chest CT imaging features of the COVID-19 pneumonia.
Background
Little is known about COVID-19 outside Hubei. The aim of this paper was to describe the clinical characteristics and imaging manifestations of hospitalized patients with confirmed COVID-19 infection in Wenzhou, Zhejiang, China.
Methods
In this retrospective cohort study, 149 RT-PCR confirmed positive patients were consecutively enrolled from January 17th to February 10th, 2020 in three tertiary hospitals of Wenzhou. Outcomes were followed up until Feb 15th, 2020.
Findings
A total of 85 patients had Hubei travel/residence history, while another 49 had contact with people from Hubei and 15 had no traceable exposure history to Hubei. Fever, cough and expectoration were the most common symptoms, 14 patients had decreased oxygen saturation, 33 had leukopenia, 53 had lymphopenia, and 82 had elevated C reactive protein. On chest computed tomography, lung segments 6 and 10 were mostly involved. A total of 287 segments presented ground glass opacity, 637 presented mixed opacity and 170 presented consolidation. Lesions were more localized in the peripheral lung with a patchy form. No significant difference was found between patients with or without Hubei exposure history. Seventeen patients had normal CT on admission of these, 12 had negative findings even10 days later.
Interpretation
Most patients presented with a mild infection in our study. The imaging pattern of multifocal peripheral ground glass or mixed opacity with predominance in the lower lung is highly suspicious of COVID-19 in the first week of disease onset. Nevetheless, some patients can present with a normal chest finding despite testing positive for COVID-19. Funding: We did not receive any fundings.
Objective:
To analyze the dynamic changes of chest CT images of patients with corona virus disease-19 (COVID-19).
Methods:
Fifty-two cases of COVID-19 were admitted in the First Affiliated Hospital of Zhejiang University School of Medicine. The consecutive chest CT scans were followed up for all patients with an average of 4 scans performed per patient during the hospitalization. The shortest interval between each scan was 2 days and the longest was 7 days. The shape, number and distribution of lung shadows, as well as the characteristics of the lesions on the CT images were reviewed.
Results:
The obvious shadows infiltrating the lungs were shown on CT images in 50 cases, for other 2 cases there was no abnormal changes in the lungs during the first CT examination. Ground-glass opacities (GGO) were found in 48 cases (92.3%), and 19 cases (36.5%) had patchy consolidation and sub-consolidation, which were accompanied with air bronchi sign in 17 cases (32.7%). Forty one cases (78.8%) showed a thickened leaflet interval, 4 cases (7.6%) had a small number of fibrous stripes. During hospitalization, GGO lesions in COVID-19 patients gradually became rare, the fibrous strip shadows increased and it became the most common imaging manifestation. The lesions rapidly progressed in 39 cases (75.0%) within 6-9 days after admission. On days 10-14 of admission, the lesions distinctly resolved in 40 cases (76.9%).
Conclusions:
The chest CT images of patients with COVID-19 have certain characteristics with dynamic changes, which are of value for monitoring disease progress and clinical treatment.
Background:
A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients.
Methods:
All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not.
Findings:
By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0-58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0-13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα.
Interpretation:
The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies.
Funding:
Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
Background
The ongoing outbreak of the recently emerged novel coronavirus (2019-nCoV) poses a challenge for public health laboratories as virus isolates are unavailable while there is growing evidence that the outbreak is more widespread than initially thought, and international spread through travellers does already occur.AimWe aimed to develop and deploy robust diagnostic methodology for use in public health laboratory settings without having virus material available.Methods
Here we present a validated diagnostic workflow for 2019-nCoV, its design relying on close genetic relatedness of 2019-nCoV with SARS coronavirus, making use of synthetic nucleic acid technology.ResultsThe workflow reliably detects 2019-nCoV, and further discriminates 2019-nCoV from SARS-CoV. Through coordination between academic and public laboratories, we confirmed assay exclusivity based on 297 original clinical specimens containing a full spectrum of human respiratory viruses. Control material is made available through European Virus Archive - Global (EVAg), a European Union infrastructure project.Conclusion
The present study demonstrates the enormous response capacity achieved through coordination of academic and public laboratories in national and European research networks.
Background:
Clostridium difficile causes toxin-mediated nosocomial diarrhea and community-acquired infections; no preventive vaccine is licensed. In this phase 2 study, we explored safety, tolerability, and immunogenicity in older US adults of an investigational bivalent C. difficile vaccine that contains equal dosages of genetically and chemically detoxified toxins A and B.
Methods:
Conducted from July 2015 through March 2017, 855 healthy adults aged 65-85 years from 15 US centers were randomized 3:3:1 to receive vaccine (100 or 200 μg) or placebo at 0, 1, and 6 months (month regimen) or 1, 8, and 30 days (day regimen). Serum toxin A- and B-specific neutralizing antibodies were measured. Participant-reported local reactions (LRs) and systemic events (SEs), adverse events (AEs), serious AEs, newly diagnosed chronic medical conditions, and immediate AEs were recorded.
Results:
The 200-μg dose level elicited higher immune responses than the 100-µg dose level across regimens. Compared with the day regimen, the month regimen induced stronger and more persistent immune responses that remained elevated 12 months after dose 3. Responses peaked at month 7 (month regimen) and day 37 (day regimen). LRs (primarily injection site pain) were more frequent in vaccine recipients than controls; SE frequency was similar across groups. More related AEs were reported in the day regimen group than the month regimen group.
Conclusions:
The C. difficile vaccine was safe, well tolerated, and immunogenic in healthy US adults aged 65-85 years. Immune responses were particularly robust in the 200-μg month regimen group. These results support continued vaccine development.
Clinical trials registration:
NCT02561195.
Because of the pressure for timely, informed decisions in public health and clinical practice and the explosion of information in the scientific literature, research results must be synthesized. Meta-analyses are increasingly used to address this problem, and they often evaluate observational studies. A workshop was held in Atlanta, Ga, in April 1997, to examine the reporting of meta-analyses of observational studies and to make recommendations to aid authors, reviewers, editors, and readers.
Twenty-seven participants were selected by a steering committee, based on expertise in clinical practice, trials, statistics, epidemiology, social sciences, and biomedical editing. Deliberations of the workshop were open to other interested scientists. Funding for this activity was provided by the Centers for Disease Control and Prevention.
We conducted a systematic review of the published literature on the conduct and reporting of meta-analyses in observational studies using MEDLINE, Educational Research Information Center (ERIC), PsycLIT, and the Current Index to Statistics. We also examined reference lists of the 32 studies retrieved and contacted experts in the field. Participants were assigned to small-group discussions on the subjects of bias, searching and abstracting, heterogeneity, study categorization, and statistical methods.
From the material presented at the workshop, the authors developed a checklist summarizing recommendations for reporting meta-analyses of observational studies. The checklist and supporting evidence were circulated to all conference attendees and additional experts. All suggestions for revisions were addressed.
The proposed checklist contains specifications for reporting of meta-analyses of observational studies in epidemiology, including background, search strategy, methods, results, discussion, and conclusion. Use of the checklist should improve the usefulness of meta-analyses for authors, reviewers, editors, readers, and decision makers. An evaluation plan is suggested and research areas are explored.
An unexplained pneumonia outbreak at the end of 2019 was found to be associated with a novel coronavirus (SARS-CoV-2). The virus is the seventh known coronavirus that can infect humans. In a short period of time, this coronavirus infection has spread to many regions of the world, causing the concern of countries around the world. At present, related research on SARS-CoV-2 is still in its infancy. This article summarizes the findings of the latest research related to SARS-CoV-2 to provide reference for subsequent research and prevention. © 2020, Editorial Board of Journal of Xi'an Jiaotong University (Medical Sciences). All right reserved.
Objective:
To analyze the dynamic changes of chest CT images of patients with coronavirus disease 2019 (COVID-19).
Methods:
Fifty-two cases of COVID-19 were admitted in the First Affiliated Hospital of Zhejiang University School of Medicine. The consecutive chest CT scans were followed up for all patients with an average of 4 scans performed per patient during the hospitalization. The shortest interval between each scan was 2 days and the longest was 7 days. The shape, number and distribution of lung shadows, as well as the characteristics of the lesions on the CT images were reviewed.
Results:
The obvious shadows infiltrating the lungs were shown on CT images in 50 cases, for other 2 cases there was no abnormal changes in the lungs during the first CT examination. Ground-glass opacities (GGO) were found in 48 cases (92.3%), and 19 cases (36.5%) had patchy consolidation and sub-consolidation, which were accompanied with air bronchi sign in 17 cases (32.7%). Forty one cases (78.8%) showed a thickened leaflet interval, 4 cases (7.6%) had a small number of fibrous stripes. During hospitalization, GGO lesions in COVID-19 patients gradually became rare,the fibrous strip shadows increased and it became the most common imaging manifestation. The lesions rapidly progressed in 39 cases (75.0%) within 6-9 days after admission. On days 10-14 of admission, the lesions distinctly resolved in 40 cases (76.9%).
Conclusions:
The chest CT images of patients with COVID-19 have certain characteristics with dynamic changes, which are of value for monitoring disease progress and clinical treatment.
Objective: To improve the imaging diagnosis of novel coronavirus disease 2019 (COVID-19) by comparing the chest CT imaging characteristics between COVID-19 and bacterial pneumonia. Methods: CT data of 42 COVID-19 cases from January 16 to February 18, 2020 were retrospectively analyzed, and we also compared with the CT data of 36 cases of bacterial pneumonia collected from November 27, 2017 to February 6, 2020. Results: The incidence of bilateral lobes involvement in COVID-19 group was 73.8%, which was significantly higher than that in bacterial pneumonia group (vs 41.7%, P<0.01). The incidences of ground glass shadow (95.2%), mesh shadow (31.0%), and pavement sign (26.2%) were significantly higher than those of bacterial pneumonia (77.8%, 8.3% and 0, respectively, all P<0.05). The incidences of consolidation (35.7%), and central lobular nodule or tree-bud signs (9.5%) were lower than those of bacterial pneumonia (66.7% and 47.2%, respectively, both P<0.05). Conclusion: In COVID-19 patients, more CT signs such as ground glass shadow, mesh shadow and paved appearance were found than in bacterial pneumonia ones, whereas the consolidation shadow, central lobular nodules and tree-bud signs were less common. © 2020, Editorial Board of Medical Journal of Wuhan University. All right reserved.
Objective: To analyze the CT imaging findings of coronavirus disease 2019 (COVID-19) in Wuhan, China, in order to recognize its imaging diagnosis. Methods: The clinical data and chest CT imaging of 30 COVID-19 patients confirmed by nucleic acid assay for 2019-nCoV (SARS-CoV-2) were retrospectively analyzed. The CT findings of severe cases were compared with those of non-severe cases. Results: Most of the pneumonia lesions were located in bilateral lungs (70%). The main CT features were ground-glass shadow (100%) and consolidation (63%). There were more male patients (60%), and severe cases were more prone to pulmonary consolidation (P<0.05). Conclusion: There are characteristics CT images in COVID-19 cases, and thinner CT scan is necessary for the diagnosis. © 2020, Editorial Board of Medical Journal of Wuhan University. All right reserved.
Objective:
To evaluated the effectiveness and safety of Chinese herbal medicines (CHMs) for coronary heart disease (CHD) complicated with anxiety.
Methods:
Randomized controlled clinical trials (RCTs) with parallel-groups were included after searching through electric-databases from inception to May, 2017. Meta-analysis was undertaken with RevMan 5.3 software.
Results:
Twenty-three RCTs enrolling 1654 patients were included in this systematic review. The combination therapy (CHMs combined with anxiolytic) appeared to be superior to anxiolytic in terms of reducing the score of Zung Self-rating Anxiety scale (SAS) (mean Difference (MD), －12.25; 95% confidence interval (CI), －14.01 to －10.48, eliminating method; MD, －3.92; 95% CI, －5.48 to －2.35, tranquilizing method), improving the total effect rate (relative risk (RR), 1.26; 95% CI, 1.08 to 1.46, eliminating method) and reducing the TCM symptoms scores (MD, －2.24; 95% CI, －4.25 to －0.23, tranquilizing method) with a lower incidence of adverse events (RR, 0.46; 95% CI, 0.25 to 0.85, tonifying method). CHMs demonstrated benefits in lowering the score of Hamilton Anxiety Rating scale (MD, －6.77; 95% CI, －8.16 to －5.37, tonifying method),lowering the score of SAS (MD, －10.1; 95% CI, －13.73 to －6.30, tonifying method) and reducing the TCM symptoms scores (MD, －2.18; 95% CI, －3.12 to －1.24, tranquilizing method).
Conclusion:
We got a low evidence that CHMs,which had less side effects, showed potentially benefits to patients with CHD complicated with anxiety. While the results should be interpreted with caution. Trails with higher quality are required to verify the effectiveness and safety of CHMs for CHD complicated with anxiety.
Objective: To investigate the clinical characteristics of medical staff with novel coronavirus pneumonia(NCP). Methods: 30 patients infected with novel coronavirus referred to jianghan university hospital between January 11, 2020 and January 3, 2020 were studied. The data reviewed included those of clinical manifestations, laboratory investigation and Radiographic features. Results: The patients consisted of 10 men and 20 women, including 22 doctors and 8 nurses,aged 21~59 years(mean 35±8 years).They were divided to 26 common type and 4 severe cases, all of whom had close(within 1m) contact with patients infected of novel coronavirus pneumonia. The average contact times were 12 (7,16) and the average cumulative contact time was 2 (1.5,2.7) h.Clinical symptoms of these patients were fever in 23 patients (76.67%) , headache in 16 petients (53.33%) , fatigue or myalgia in 21patients (70%) , nausea, vomiting or diarrhea in 9 petients (30%) , cough in 25 petients (83.33%) , and dyspnea in 14 petients (46.67%) .Routine blood test revealed WBC<4.0×10(9)/L in 8 petients (26.67%) , (4-10) ×10(9)/L in 22 petients (73.33%) , and WBC>4.0×10(9)/L in 4 petients (13.33%) during the disease.Lymphocyte count<1.0×10(9)/L occurred in 12 petients (40%),abnormal liver function in 7 petients (23.33%) ,myocardial damage in 5 petients(16.67%), elevated D-dimer (>0.5mg/l) in 5 patients (16.67%). Compared with normal patients, the average exposure times, cumulative exposure time, BMI, Fever time, white blood cell count, liver enzyme, LDH, myoenzyme and D-dimer were significantly increased in severe patients, while the lymphocyte count and albumin levels in peripheral blood were significantly decreased.Chest CT mainly showed patchy shadows and interstitial changes.According to imaging examination, 11 patients (36.67%) showed Unilateral pneumonia and 19 patients (63.33%) showed bilateral pneumonia,4 patients (13.33%) showed bilateral multiple mottling and ground-glass opacity.Compared with the patients infected in the protected period, the proportion of severe infection and bilateral pneumonia were both increased in the patients infected in unprotected period. Conclusion: Medical staffs are at higher risk of infection.Infection rates are associated with contact time, the amount of suction virus. Severe patients had BMI increased, heating time prolonged, white blood cell count, lymphocyte count, D-dimer and albumin level significantly changed and were prone to be complicated with liver damage and myocardial damage.Strict protection measures is important to prevent infection for medical workers.
Background
Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described.
Methods
In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death.
Findings
191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/L (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days.
Interpretation
The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/L could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future.
Funding
Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
Objectives:
In late December, 2019, an outbreak of coronavirus disease (COVID-19) in Wuhan, China was caused by a novel coronavirus, newly named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to quantify severity of COVID-19 infection on High-Resolution CT and to determine its relationship with clinical parameters.
Materials and methods:
From Jan 11, 2020, to Feb 5, 2020, the clinical, laboratory and HRCT features of 42 patients (26-75 years, 25 males) with COVID-19 were analyzed. The initial and follow-up CT obtained a mean of 4.5 days and 11.6 days from the illness onset were retrospectively assessed for the severity and progression of pneumonia. Correlations among clinical parameters, initial CT features and progression of opacifications were evaluated with Spearman correlation and linear regression analysis.
Results:
Thirty-five (83%) patients exhibited a progressive process according to CT features during the early stage from onset. Follow-up CT findings showed progressive opacifications, consolidation, interstitial thickening, fibrous strips and air bronchograms, compared to initial CT (all p<0.05). Before regular treatments, there was a moderate correlation between the days from onset and sum score of opacifications (R=0.68, p<0.01). The C-reactive protein, erythrocyte sedimentation rate and lactate dehydrogenase showed significantly positive correlation with the severity of pneumonia assessed on initial CT (R range 0.36-0.75, p<0.05). The highest temperature and the severity of opacifications assessed on initial CT were significantly related to the progression of opacifications on follow-up CT (p=0.001-0.04).
Conclusions:
Patients with the COVID-19 infection usually presented with typical ground-grass opacities and other CT features, which showed significant correlations with some clinical and laboratory measurements. Follow-up CT images often demonstrated progressions during the early stage from illness onset.
OBJECTIVE. The purpose of this study was to investigate 62 subjects in Wuhan, China, with laboratory-confirmed coronavirus disease (COVID-19) pneumonia and describe the CT features of this epidemic disease. MATERIALS AND METHODS. A retrospective study of 62 consecutive patients with laboratory-confirmed COVID-19 pneumonia was performed. CT images and clinical data were reviewed. Two thoracic radiologists evaluated the distribution and CT signs of the lesions and also scored the extent of involvement of the CT signs. The Mann-Whitney U test was used to compare lesion distribution and CT scores. The chi-square test was used to compare the CT signs of early-phase versus advanced-phase COVID-19 pneumonia. RESULTS. A total of 62 patients (39 men and 23 women; mean [± SD] age, 52.8 ± 12.2 years; range, 30-77 years) with COVID-19 pneumonia were evaluated. Twenty-four of 30 patients who underwent routine blood tests (80.0%) had a decreased lymphocyte count. Of 27 patients who had their erythrocyte sedimentation rate and high-sensitivity C-reactive protein level assessed, 18 (66.7%) had an increased erythrocyte sedimentation rate, and all 27 (100.0%) had an elevated high-sensitivity C-reactive protein level. Multiple lesions were seen on the initial CT scan of 52 of 62 patients (83.9%). Forty-eight of 62 patients (77.4%) had predominantly peripheral distribution of lesions. The mean CT score for the upper zone (3.0 ± 3.4) was significantly lower than that for the middle (4.5 ± 3.8) and lower (4.5 ± 3.7) zones (p = 0.022 and p = 0.020, respectively), and there was no significant difference in the mean CT score of the middle and lower zones (p = 1.00). The mean CT score for the anterior area (4.4 ± 4.1) was significantly lower than that for the posterior area (7.7 ± 6.3) (p = 0.003). CT findings for the patients were as follows: 25 patients (40.3%) had ground-glass opacities (GGO), 21 (33.9%), consolidation; 39 (62.9%), GGO plus a reticular pattern; 34 (54.8%), vacuolar sign; 28 (45.2%), microvascular dilation sign; 35 (56.5%), fibrotic streaks; 21 (33.9%), a subpleural line; and 33 (53.2%), a subpleural transparent line. With regard to bronchial changes seen on CT, 45 patients (72.6%) had air bronchogram, and 11 (17.7%) had bronchus distortion. In terms of pleural changes, CT showed that 30 patients (48.4%) had pleural thickening, 35 (56.5%) had pleural retraction sign, and six (9.7%) had pleural effusion. Compared with early-phase disease (≤ 7 days after the onset of symptoms), advanced-phase disease (8-14 days after the onset of symptoms) was characterized by significantly increased frequencies of GGO plus a reticular pattern, vacuolar sign, fibrotic streaks, a subpleural line, a subpleural transparent line, air bronchogram, bronchus distortion, and pleural effusion; however, GGO significantly decreased in advanced-phase disease. CONCLUSION. CT examination of patients with COVID-19 pneumonia showed a mixed and diverse pattern with both lung parenchyma and the interstitium involved. Identification of GGO and a single lesion on the initial CT scan suggested early-phase disease. CT signs of aggravation and repair coexisted in advanced-phase disease. Lesions presented with a characteristic multifocal distribution in the middle and lower lung regions and in the posterior lung area. A decreased lymphocyte count and an increased high-sensitivity C-reactive protein level were the most common laboratory findings.
OBJECTIVE. The objective of our study was to determine the misdiagnosis rate of radiologists for coronavirus disease 2019 (COVID-19) and evaluate the performance of chest CT in the diagnosis and management of COVID-19. The CT features of COVID-19 are reported and compared with the CT features of other viruses to familiarize radiologists with possible CT patterns. MATERIALS AND METHODS. This study included the first 51 patients with a diagnosis of COVID-19 infection confirmed by nucleic acid testing (23 women and 28 men; age range, 26-83 years) and two patients with adenovirus (one woman and one man; ages, 58 and 66 years). We reviewed the clinical information, CT images, and corresponding image reports of these 53 patients. The CT images included images from 99 chest CT examinations, including initial and follow-up CT studies. We compared the image reports of the initial CT study with the laboratory test results and identified CT patterns suggestive of viral infection. RESULTS. COVID-19 was misdiagnosed as a common infection at the initial CT study in two inpatients with underlying disease and COVID-19. Viral pneumonia was correctly diagnosed at the initial CT study in the remaining 49 patients with COVID-19 and two patients with adenovirus. These patients were isolated and obtained treatment. Ground-glass opacities (GGOs) and consolidation with or without vascular enlargement, interlobular septal thickening, and air bronchogram sign are common CT features of COVID-19. The The "reversed halo" sign and pulmonary nodules with a halo sign are uncommon CT features. The CT findings of COVID-19 overlap with the CT findings of adenovirus infection. There are differences as well as similarities in the CT features of COVID-19 compared with those of the severe acute respiratory syndrome. CONCLUSION. We found that chest CT had a low rate of missed diagnosis of COVID-19 (3.9%, 2/51) and may be useful as a standard method for the rapid diagnosis of COVID-19 to optimize the management of patients. However, CT is still limited for identifying specific viruses and distinguishing between viruses.
Objective: To investigate the imaging findings of 2019 novel coronavirus pneumonia (COVID-19). Methods: From January 20 to February 5, 2020, a total of 130 patients diagnosed with COVID-19 from seven hospitals in China were collected. The imaging data were reviewed and analyzed in detail. Results: (1) Distribution: the lesion detected in the lung unilaterally in 14 cases (10.7%) and bilaterally in 116 cases (89.3%). According to the distribution in the lobes of the lung, all cases could be classified into subpleural distribution (102 cases, 78.4%), centrilobular distribution (99 cases, 76.1%) and diffused distribution (8 cases, 6.1%). (2) Number of lesions: single lesion 9 cases (6.9%); multiple lesions 113 cases (86.9%), diffuse lesions 8 cases (6.1%). (3) Imaging density: 70 cases (53.8%) of ground-glass opacity (GGO), 60 cases (46.2%) of GGO + consolidation. (4) Accompanying signs: 100 cases (76.9%) with vascular thickening, 98 cases (75.3%) with "pleural parallel sign" ; "intralobular septal thickening" in 100 cases (76.9%); "halo sign" in 13 cases (10%); "reversed-halo sign" in 6 cases (4.6%); pleural effusion in 3 cases (2.3 %), and pneumatocele in 2 cases (1.5%); no case with pulmonary cavity. Among 35 patients that underwent follow-up CT, 21 patients (60%) improved while 14 (40%) exacerbated. Conclusions: COVID-19 imaging characteristic mainly has subpleural, centrilobular and diffused distribution. The first two distributions can overlap or progress to diffused distribution. In the later period, it was mainly manifested as organizing pneumonia and fibrosis. The most valuable characteristic is the pleural parallel sign.
OBJECTIVE. The increasing number of cases of confirmed coronavirus disease (COVID-19) in China is striking. The purpose of this study was to investigate the relation between chest CT findings and the clinical conditions of COVID-19 pneumonia. MATERIALS AND METHODS. Data on 101 cases of COVID-19 pneumonia were retrospectively collected from four institutions in Hunan, China. Basic clinical characteristics and detailed imaging features were evaluated and compared between two groups on the basis of clinical status: nonemergency (mild or common disease) and emergency (severe or fatal disease). RESULTS. Patients 21-50 years old accounted for most (70.2%) of the cohort, and five (5.0%) patients had disease associated with a family outbreak. Most patients (78.2%) had fever as the onset symptom. Most patients with COVID-19 pneumonia had typical imaging features, such as ground-glass opacities (GGO) (87 [86.1%]) or mixed GGO and consolidation (65 [64.4%]), vascular enlargement in the lesion (72 [71.3%]), and traction bronchiectasis (53 [52.5%]). Lesions present on CT images were more likely to have a peripheral distribution (88 [87.1%]) and bilateral involvement (83 [82.2%]) and be lower lung predominant (55 [54.5%]) and multifocal (55 [54.5%]). Patients in the emergency group were older than those in the non-emergency group. Architectural distortion, traction bronchiectasis, and CT involvement score aided in evaluation of the severity and extent of the disease. CONCLUSION. Patients with confirmed COVID-19 pneumonia have typical imaging features that can be helpful in early screening of highly suspected cases and in evaluation of the severity and extent of disease. Most patients with COVID-19 pneumonia have GGO or mixed GGO and consolidation and vascular enlargement in the lesion. Lesions are more likely to have peripheral distribution and bilateral involvement and be lower lung predominant and multifocal. CT involvement score can help in evaluation of the severity and extent of the disease.
Objective:
To investigate the clinical and CT features associated with severe and critical Corona Virus Disease 2019 (COVID-19) pneumonia.
Materials and methods:
Eighty-three patients with COVID-19 pneumonia including 25 severe/critical cases and 58 ordinary cases were enrolled. The chest CT images and clinical data of them were reviewed and compared. The risk factors associated with disease severity were analyzed.
Results:
Compared with the ordinary patients, the severe/critical patients had older ages, higher incidence of comorbidities, cough, expectoration, chest pain and dyspnea. The incidences of consolidation, linear opacities, crazy-paving pattern and bronchial wall thickening in severe/critical patients were significantly higher than those of the ordinary patients. Besides, severe/critical patients showed higher incidences of lymph node enlargement, pericardial effusion and pleural effusion than the ordinary patients. The CT scores of severe/critical patients were significantly higher than those of the ordinary patients (P < 0.001). Receiver operating characteristic (ROC) curve showed that the sensitivity and specificity of CT Score were 80.0% and 82.8% respectively for the discrimination of the two types. The clinical factors of age > 50 years old, comorbidities, dyspnea, chest pain, cough, expectoration, decreased lymphocytes and increased inflammation indicators were risk factors for severe/critical COVID-19 pneumonia. CT findings of consolidation, linear opacities, crazy-paving pattern, bronchial wall thickening, high CT scores and extrapulmonary lesions were features of severe/critical COVID-19 pneumonia.
Conclusions:
There are significant differences in clinical symptoms, laboratory examinations and CT manifestations between the ordinary patients and the severe/critical patients. Many factors are related to the severity of the disease, which can help clinicians to judge the severity of the patient and evaluate the prognosis.
Background:
We aimed to report the clinical characteristics of imported coronavirus disease-19 (COVID-19) in Jiangsu Province.
Methods:
We retrospectively investigated the clinical, imaging, and laboratory characteristics of confirmed cases of COVID-19 with WHO interim guidance in three Grade ⅢA hospitals of Jiangsu from Jan 22 to Feb 14, 2020. Real time RT-PCR was used to detect the new coronavirus in respiratory samples.
Results:
Of the 80 patients infected with COVID-19, 41 patients were female, with a median age of 46.1 years. Except for 3 severe patients, the rest of the 77 patients exhibited mild or moderate symptoms. 9 patients were unconfirmed until a third-time nucleic acid test. 38 cases had a history of chronic diseases. The main clinical manifestations of the patients were fever and cough, which accounted for 63 cases (78.75%) and 51 cases (-63.75%) respectively. Only 3 patients (3.75%) showed liver dysfunction. Imaging examination showed that 55 patients (-68.75%) showed abnormal, 25 cases (31.25%) had no abnormal density shadow in the parenchyma of both lungs. Up to now, 21 cases were discharged from the hospital, and no patient died. The average length of stay for discharged patients was 8 days.
Conclusions:
Compared with the cases in Wuhan, the cases in Jiangsu exhibited mild or moderate symptoms and no obvious gender susceptivity. The proportion of patients having liver dysfunction and abnormal CT imaging was relatively lower than that of Wuhan. Notably, infected patients may be falsely excluded based on two consecutively negative respiratory pathogenic nucleic acid test results.
Background:
A cluster of patients with coronavirus disease 2019 (COVID-19) pneumonia caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were successively reported in Wuhan, China. We aimed to describe the CT findings across different timepoints throughout the disease course.
Methods:
Patients with COVID-19 pneumonia (confirmed by next-generation sequencing or RT-PCR) who were admitted to one of two hospitals in Wuhan and who underwent serial chest CT scans were retrospectively enrolled. Patients were grouped on the basis of the interval between symptom onset and the first CT scan: group 1 (subclinical patients; scans done before symptom onset), group 2 (scans done ≤1 week after symptom onset), group 3 (>1 week to 2 weeks), and group 4 (>2 weeks to 3 weeks). Imaging features and their distribution were analysed and compared across the four groups.
Findings:
81 patients admitted to hospital between Dec 20, 2019, and Jan 23, 2020, were retrospectively enrolled. The cohort included 42 (52%) men and 39 (48%) women, and the mean age was 49·5 years (SD 11·0). The mean number of involved lung segments was 10·5 (SD 6·4) overall, 2·8 (3·3) in group 1, 11·1 (5·4) in group 2, 13·0 (5·7) in group 3, and 12·1 (5·9) in group 4. The predominant pattern of abnormality observed was bilateral (64 [79%] patients), peripheral (44 [54%]), ill-defined (66 [81%]), and ground-glass opacification (53 [65%]), mainly involving the right lower lobes (225 [27%] of 849 affected segments). In group 1 (n=15), the predominant pattern was unilateral (nine [60%]) and multifocal (eight [53%]) ground-glass opacities (14 [93%]). Lesions quickly evolved to bilateral (19 [90%]), diffuse (11 [52%]) ground-glass opacity predominance (17 [81%]) in group 2 (n=21). Thereafter, the prevalence of ground-glass opacities continued to decrease (17 [57%] of 30 patients in group 3, and five [33%] of 15 in group 4), and consolidation and mixed patterns became more frequent (12 [40%] in group 3, eight [53%] in group 4).
Interpretation:
COVID-19 pneumonia manifests with chest CT imaging abnormalities, even in asymptomatic patients, with rapid evolution from focal unilateral to diffuse bilateral ground-glass opacities that progressed to or co-existed with consolidations within 1-3 weeks. Combining assessment of imaging features with clinical and laboratory findings could facilitate early diagnosis of COVID-19 pneumonia.
Funding:
None.
Purpose:
To investigate the clinical and imaging characteristics of computed tomography (CT) in novel coronavirus pneumonia (NCP) caused by SARS-CoV-2.
Materials and methods:
A retrospective analysis was performed on the imaging findings of patients confirmed with COVID-19 pneumonia who had chest CT scanning and treatment after disease onset. The clinical and imaging data were analyzed.
Results:
Fifty patients were enrolled, including mild type in nine, common in 28, severe in 10 and critically severe in the rest three. Mild patients (29 years) were significantly (P<0.03) younger than either common (44.5 years) or severe (54.7) and critically severe (65.7 years) patients, and common patients were also significantly (P<0.03) younger than severe and critically severe patients. Mild patients had low to moderate fever (<39.1°C), 49 (98%) patients had normal or slightly reduced leukocyte count, 14 (28%) had decreased counts of lymphocytes, and 26 (52%) patients had increased C-reactive protein. Nine mild patients were negative in CT imaging. For all the other types of NCP, the lesion was in the right upper lobe in 30 cases, right middle lobe in 22, right lower lobe in 39, left upper lobe in 33 and left lower lobe in 36. The lesion was primarily located in the peripheral area under the pleura with possible extension towards the pulmonary hilum. Symmetrical lesions were seen in 26 cases and asymmetrical in 15. The density of lesion was mostly uneven with ground glass opacity as the primary presentation accompanied by partial consolidation and fibrosis.
Conclusion:
CT imaging presentations of NCP are mostly patchy ground glass opacities in the peripheral areas under the pleura with partial consolidation which will be absorbed with formation of fibrotic stripes if improved. CT scanning provides important bases for early diagnosis and treatment of NCP.
Objectives:
To investigate the chest computed tomography (CT) findings in patients with confirmed corona virus disease 2019 (COVID-19) and to evaluate its relationship with clinical features.
Materials and methods:
Study sample consisted of 80 patients diagnosed as COVID-19 from January to February 2020. The chest CT images and clinical data were reviewed and the relationship between them was analyzed.
Results:
Totally 80 patients diagnosed with COVID-19 were included. With regards to the clinical manifestations, 58/80 (73%) of patients had cough, 61/80 (76%) of patients had high temperature levels. The most frequent CT abnormalities observed were ground glass opacity (GGO) (73/80 cases, 91%), consolidation (50/80 cases, 63%) and interlobular septal thickening (47/80, 59%). Most of the lesions were multiple, with an average of 12±6 lung segments involved. The most common involved lung segments were the dorsal segment of the right lower lobe (69/80, 86%), the posterior basal segment of the right lower lobe (68/80, 85%), the lateral basal segment of the right lower lobe (64/80, 80%), the dorsal segment of the left lower lobe (61/80, 76%) and the posterior basal segment of the left lower lobe (65/80, 81%). The average pulmonary inflammation index (PII) value was (34%±20%) for all the patients. Correlation analysis showed that the PII value was significantly correlated with the values of lymphocyte count, monocyte count, C-reactive protein, procalcitonin, days from illness onset and body temperature (p<0.05).
Conclusion:
The common chest CT findings of COVID-19 are multiple GGO, consolidation and interlobular septal thickening in both lungs, which are mostly distributed under the pleura. There are significant correlations between the degree of pulmonary inflammation and the main clinical symptoms and laboratory results. CT plays an important role in the diagnosis and evaluation of this emerging global health emergency.
The purpose of this case report is to describe the imaging and associated clinical features of an asymptomatic novel coronavirus pneumonia (COVID-19) patient outside Wuhan, China. The principle findings are that in this patient with laboratory-confirmed COVID-19, CT findings preceded symptoms and included bilateral pleural effusions, previously not reported in association with COVID-19. The role of this case report is promotion of potential recognition amongst radiologists of this new disease, which has been declared a global health emergency by the World Health Organization (WHO).
In this retrospective study, chest CTs of 121 symptomatic patients infected with coronavirus disease-19 (COVID-19) from four centers in China from January 18, 2020 to February 2, 2020 were reviewed for common CT findings in relationship to the time between symptom onset and the initial CT scan (i.e. early, 0-2 days (36 patients), intermediate 3-5 days (33 patients), late 6-12 days (25 patients)). The hallmarks of COVID-19 infection on imaging were bilateral and peripheral ground-glass and consolidative pulmonary opacities. Notably, 20/36 (56%) of early patients had a normal CT. With a longer time after the onset of symptoms, CT findings were more frequent, including consolidation, bilateral and peripheral disease, greater total lung involvement, linear opacities, "crazy-paving" pattern and the "reverse halo" sign. Bilateral lung involvement was observed in 10/36 early patients (28%), 25/33 intermediate patients (76%), and 22/25 late patients (88%).
Objective: To investigate the clinical characteristics of medical staff with novel coronavirus pneumonia(NCP). Methods: 30 patients infected with novel coronavirus referred to jianghan university hospital between January 11, 2020 and January 3, 2020 were studied. The data reviewed included those of clinical manifestations, laboratory investigation and Radiographic features. Results: The patients consisted of 10 men and 20 women, including 22 doctors and 8 nurses,aged 21~59 years(mean 35±8 years).They were divided to 26 common type and 4 severe cases, all of whom had close(within 1m) contact with patients infected of novel coronavirus pneumonia. The average contact times were 12 (7,16) and the average cumulative contact time was 2 (1.5,2.7) h.Clinical symptoms of these patients were fever in 23 patients (76.67%) , headache in 16 petients (53.33%) , fatigue or myalgia in 21patients (70%) , nausea, vomiting or diarrhea in 9 petients (30%) , cough in 25 petients (83.33%) , and dyspnea in 14 petients (46.67%) .Routine blood test revealed WBC <4.0×10(9)/L in 8 petients (26.67%) , (4-10) ×10(9)/L in 22 petients (73.33%) , and WBC>4.0×10(9)/L in 4 petients (13.33%) during the disease.Lymphocyte count <1.0×10(9)/L occurred in 12 petients (40%),abnormal liver function in 7 petients (23.33%) ,myocardial damage in 5 petients(16.67%), elevated D-dimer (>0.5mg/l) in 5 patients (16.67%). Compared with normal patients, the average exposure times, cumulative exposure time, BMI, Fever time, white blood cell count, liver enzyme, LDH, myoenzyme and D-dimer were significantly increased in severe patients, while the lymphocyte count and albumin levels in peripheral blood were significantly decreased.Chest CT mainly showed patchy shadows and interstitial changes.According to imaging examination, 11 patients (36.67%) showed Unilateral pneumonia and 19 patients (63.33%) showed bilateral pneumonia,4 patients (13.33%) showed bilateral multiple mottling and ground-glass opacity.Compared with the patients infected in the protected period, the proportion of severe infection and bilateral pneumonia were both increased in the patients infected in unprotected period. Conclusion: Medical staffs are at higher risk of infection.Infection rates are associated with contact time, the amount of suction virus. Severe patients had BMI increased, heating time prolonged , white blood cell count, lymphocyte count, D-dimer and albumin level significantly changed and were prone to be complicated with liver damage and myocardial damage.Strict protection measures is important to prevent infection for medical workers.
Objectives
The purpose of this study was to observe the imaging characteristics of the novel coronavirus pneumonia.Methods
Sixty-three confirmed patients were enrolled from December 30, 2019 to January 31, 2020. High-resolution CT (HRCT) of the chest was performed. The number of affected lobes, ground glass nodules (GGO), patchy/punctate ground glass opacities, patchy consolidation, fibrous stripes and irregular solid nodules in each patient's chest CT image were recorded. Additionally, we performed imaging follow-up of these patients.ResultsCT images of 63 confirmed patients were collected. M/F ratio: 33/30. The mean age was 44.9 ± 15.2 years. The mean number of affected lobes was 3.3 ± 1.8. Nineteen (30.2%) patients had one affected lobe, five (7.9%) patients had two affected lobes, four (6.3%) patients had three affected lobes, seven (11.1%) patients had four affected lobes while 28 (44.4%) patients had 5 affected lobes. Fifty-four (85.7%) patients had patchy/punctate ground glass opacities, 14 (22.2%) patients had GGO, 12 (19.0%) patients had patchy consolidation, 11 (17.5%) patients had fibrous stripes and 8 (12.7%) patients had irregular solid nodules. Fifty-four (85.7%) patients progressed, including single GGO increased, enlarged and consolidated; fibrous stripe enlarged, while solid nodules increased and enlarged.Conclusions
Imaging changes in novel viral pneumonia are rapid. The manifestations of the novel coronavirus pneumonia are diverse. Imaging changes of typical viral pneumonia and some specific imaging features were observed. Therefore, we need to strengthen the recognition of image changes to help clinicians to diagnose quickly and accurately.Key Points• High-resolution CT (HRCT) of the chest is critical for early detection, evaluation of disease severity and follow-up of patients with the novel coronavirus pneumonia.• The manifestations of the novel coronavirus pneumonia are diverse and change rapidly.• Radiologists should be aware of the various features of the disease and temporal changes.