Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Jul 17:85:e361-e368.
doi: 10.5114/pjr.2020.98009. eCollection 2020.

COVID-19 severity scoring systems in radiological imaging - a review

Piotr G Wasilewski  1   2 , Bartosz Mruk  1   2 , Samuel Mazur  1   2 , Gabriela Półtorak-Szymczak  1   2 , Katarzyna Sklinda  1   2 , Jerzy Walecki  1   2
Affiliations
Review

COVID-19 severity scoring systems in radiological imaging - a review

Piotr G Wasilewski et al. Pol J Radiol. .

Abstract

The current reference standard to make a definitive diagnosis of SARS-CoV-2 infection is the reverse transcription- polymerase chain reaction assay (rt-PCR). However, radiological imaging plays a crucial role in evaluating the course of COVID-19 and in choosing proper management of infected patients. Chest X-ray (CXR) is generally considered not to be sensitive for the detection of pulmonary abnormalities in the early stage of the disease. However, in the emergency setting CXR can be a useful diagnostic tool for monitoring the rapid progression of lung involvement in COVID-19, especially in patients admitted to intensive care units. The rapid course of SARS-CoV-2 infection and the severity and progression of lung aberrations require a method of radiological evaluation to implement and manage the appropriate treatment for infected patients. Computed tomography (CT) imaging is considered to be the most effective method for the detection of lung abnormalities, especially in the early stage of the disease. Moreover, serial chest CT imaging with different time intervals is also effective in estimating the evolution of the disease from initial diagnosis to discharge from hospital. Despite having low specificity in distinguishing abnormalities in viral infections, the high sensitivity of CT makes this method ideal for assessing the severity of the disease in patients with confirmed COVID-19. In this review, we present and discuss currently available scales that can be used to assess the severity of lung involvement in COVID-19 patients in everyday work, both for CXR and CT imaging.

Keywords: COVID-19; CT; CXR; SARS-CoV-2; X-ray; computed tomography.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflict of interest.

Figures

Figure 1
Figure 1
Chest X-ray image of a COVID-19-positive patient with lungs assessed in SARI severity scoring system at 5 points. The arrow shows diffuse alveolar changes
Figure 2
Figure 2
Chest X-ray image of a COVID-19-positive patient with lungs assessed in RALE classification at 4 points. Both lungs are assessed individually - right lung was evaluated at 1 point and left lung at 3 points. The overall RALE score was 4 points
Figure 3
Figure 3
Normal chest X-ray image with division of lungs into six levels in SXR score
Figure 4
Figure 4
Chest X-ray image of a COVID-19-positive patient with lungs assessed in chest X-ray sore at 0 points
Figure 5
Figure 5
Chest X-ray image of a COVID-19-positive patient with lungs assessed in chest X-ray sore at 8 points
Figure 6
Figure 6
Computed tomography scans of a COVID-19-positive patient in axial projection. Lungs were assessed in modified total severity scoring system (mTSS) at 6 points. The main features of lung involvement are regions of ground glass opacity; therefore, the overall mTSS score is 6A
Figure 7
Figure 7
Computed tomography scans of a COVID-19-positive patient in sagittal projection. Lungs were assessed in modified total severity scoring system (mTSS) at 6A
Figure 8
Figure 8
Computed tomography scans of a COVID-19-positive patient in coronal projection. Lungs were assessed in modified total severity scoring system (mTSS) at 6A
Figure 9
Figure 9
Computed tomography scans of a COVID-19-positive patient in axial projection. Lungs were assessed in modified total severity scoring system (mTSS) at 18 points. The main features of lung involvement are consolidations; therefore, the overall mTSS score is 18C
Figure 10
Figure 10
Computed tomography scans of a COVID-19-positive patient in sagittal projection. Lungs were assessed in modified total severity scoring system (mTSS) at 18C
Figure 11
Figure 11
Computed tomography scans of a COVID-19-positive patient in coronal projection. Lungs were assessed in modified total severity scoring system (mTSS) at 18C
See this image and copyright information in PMC

References

    1. Zhu N, Zhang D, Wang W, et al. . A novel coronavirus from patients with pneumonia in China. N Engl J Med 2020; 382: 727-733. - PMC - PubMed
    1. World Health Organization (WHO). Q&A on coronaviruses (COVID-19). Availabel at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question... (Accessed: 24.02.2020).
    1. U.S. Centers for Disease Control and Prevention (CDC). How COVID-19 Spreads. 27 January 2020. Archived from the original on 28 January 2020. Retrieved 29 January 2020.
    1. Chinese Society of Radiology. Radiological diagnosis of new coronavirus infected pneumonitis: expert recommendation from the Chinese Society of Radiology (First edition). Chin J Radiol 2020; 54: E001.
    1. Zu ZY, Jiang MD, Xu PP et al. . Coronavirus disease 2019 (COVID-19): a perspective from China. Radiology 2020; 296: E15-E25. - PMC - PubMed