The role of imaging in 2019 novel coronavirus pneumonia (COVID-19)

Abstract

Almost the entire world, not only China, is currently experiencing the outbreak of a novel coronavirus that causes respiratory disease, severe pneumonia, and even death. The outbreak began in Wuhan, China, in December of 2019 and is currently still ongoing. This novel coronavirus is highly contagious and has resulted in a continuously increasing number of infections and deaths that have already surpassed the SARS-CoV outbreak that occurred in China between 2002 and 2003. It is now officially a pandemic, announced by WHO on the 11th of March. Currently, the 2019 novel coronavirus (SARS-CoV-2) can be identified by virus isolation or viral nucleic acid detection; however, false negatives associated with the nucleic acid detection provide a clinical challenge and thus make the imaging examination crucial. Imaging exams have been a main clinical diagnostic criteria for the 2019 novel coronavirus disease (COVID-19) in China. Imaging features of multiple patchy areas of ground glass opacity and consolidation predominately in the periphery of the lungs are characteristic manifestations on chest CT and extremely helpful in the early detection and diagnosis of this disease, which aids prompt diagnosis and the eventual control of this emerging global health emergency. Key Points • In December 2019, China, an outbreak of pneumonia caused by a novel, highly contagious coronavirus raised grave concerns and posed a huge threat to global public health. • Among the infected patients, characteristic findings on CT imaging include multiple, patchy, ground-glass opacity, crazy-paving pattern, and consolidation shadows, mainly distributed in the peripheral and subpleural areas of both lungs, which are very helpful for the frontline clinicians. • Imaging examination has become the indispensable means not only in the early detection and diagnosis but also in monitoring the clinical course, evaluating the disease severity, and may be presented as an important warning signal preceding the negative RT-PCR test results.

Keywords: Coronavirus; Diagnostic imaging; Mass chest X-ray; Multidetector computed tomography; Pneumonia.

Fig. 1

Countries, territories, and areas with reported confirmed cases of COVID-19, as of March 13, 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports

Fig. 2

Chest radiograph (a) in a 61-year-old man shows bilateral patchy, somewhat nodular opacities in the mid to lower lungs [16]. Unenhanced computed tomography (CT) images (b) in a 33-year-old woman., Images show multiple ground glass opacities in the periphery of the bilateral lungs. The bilateral, peripheral patterns of opacities without subpleural sparing are common and characteristic CT findings of the 2019 novel coronavirus pneumonia [22]. Chest CT image of a 71-year-old male (c) shows consolidation in the peripheral right upper lobe and a patchy area of ground glass opacity with some associated consolidation intra- and interlobular septal thickening within the left upper lobe [25]

Fig. 3

Typical CT findings of COVID-19. Chest CT (a) in a 75-year-old male show multiple patchy areas of pure ground glass opacity (GGO) and GGO with reticular and/or interlobular septal thickening [25]. Chest CT image of a 38-year-old male (b) shows multiple patches, grid-like lobule, and thickening of interlobular septa, typical “paving stone-like” signs [19]. An axial CT image obtained in 65-year-old female (c) shows bilateral ground glass and consolidative opacities with a striking peripheral distribution [23]. CT image of a 65-year-old male (d) shows large consolidation in the right middle lobe, patchy consolidation in the posterior and basal segment of right lower lobe, with air bronchogram inside [19]

Fig. 4

CT manifestations of different stages of COVID-19