CT imaging changes of corona virus disease 2019(COVID-19): a multi-center study in Southwest China

Abstract

Background: Since the first case of a coronavirus disease 2019 (COVID-19) infection pneumonia was detected in Wuhan, China, a series of confirmed cases of the COVID-19 were found in Southwest China. The aim of this study was to describe the imaging manifestations of hospitalized patients with confirmed COVID-19 infection in southwest China.

Methods: In this retrospective study, data were collected from 131 patients with confirmed coronavirus disease 2019 (COVID-19) from 3 Chinese hospitals. Their common clinical manifestations, as well as characteristics and evolvement features of chest CT images, were analyzed.

Results: A total of 100 (76%) patients had a history of close contact with people living in Wuhan, Hubei. The clinical manifestations of COVID-19 included cough, fever. Most of the lesions identified in chest CT images were multiple lesions of bilateral lungs, lesions were more localized in the peripheral lung, 109 (83%) patients had more than two lobes involved, 20 (15%) patients presented with patchy ground glass opacities, patchy ground glass opacities and consolidation of lesions co-existing in 61 (47%) cases. Complications such as pleural thickening, hydrothorax, pericardial effusion, and enlarged mediastinal lymph nodes were detected but only in rare cases. For the follow-up chest CT examinations (91 cases), We found 66 (73%) cases changed very quickly, with an average of 3.5 days, 25 cases (27%) presented absorbed lesions, progression was observed in 41 cases (46%), 25 (27%) cases showed no significant changes.

Conclusion: Chest CT plays an important role in diagnosing COVID-19. The imaging pattern of multifocal peripheral ground glass or mixed consolidation is highly suspicious of COVID-19, that can quickly change over a short period of time.

Keywords: Computed tomography; Coronavirus; Evolvement; Pneumonia; The chest.

Fig. 1

The lesion of multiple morphologic manifestations. The red arrows and boxes indicated the abnormalities. a Ground glass opacities; b consolidation; c consolidation with ground glass opacities; d solid nodule (red arrow)

Fig. 2

A 38-year-old male working at a hotel presented with a cough, fever, and fatigue for 10 days. a The first axial-view chest CT shows diffused, mixed shadows of ground-glass opacities and consolidations (red arrows) with blurred margins. b In the second axial-view chest CT scan conducted 2 days after the first one, the lesion density is significantly reduced and the scope of lesions is narrowed (red arrows)

Fig. 3

A 55-year-old male who had close contact with people in Wuhan presented fever for 8 day. a The initial axial chest CT shows mixed shadows of ground-glass opacities and consolidations with peripherally distributed (red arrows). b The follow-up axial-view chest CT shows no significant changes after 4 days later (red arrows)

Fig. 4

A 46-year-old female who had close contact with people in Wuhan presented fever for 1 day. a Axial-view chest CT shows ground-glass opacities in the upper right lobe with clear margins and visible interlobular septal thickening inside, forming the “crazy paving sign” (red arrow). b Follow-up axial-view chest CT scan 3 days after the first one shows that the scope of lesions increases significantly, and the lesion density also increases, along with significant thickening of the intralobular and interlobular septa (red arrow)

Fig. 5

A 64-year-old female Wuhan resident presented with fever and coughs for 3 days. a The first axial-view chest CT scan shows no lesions. b The second axial-view chest CT scan conducted 4 days after the first CT shows the presence of multiple ground-glass opacities in the lower lobe, located below the pleura with clear margins. Thickened vascular are visible inside the lesions in the lower right lobe (red arrows)