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Observational Study
. 2021 May-Jun;63(3):218-227.
doi: 10.1016/j.rx.2021.02.004. Epub 2021 Feb 27.

Chest computed tomography findings in different phases of SARS-CoV-2 infection

[Article in English, Spanish]
I Soriano Aguadero  1 , A Ezponda Casajús  2 , F Mendoza Ferradas  2 , A Igual Rouilleault  2 , A Paternain Nuin  2 , J Pueyo Villoslada  2 , G Bastarrika  2
Affiliations
Observational Study

Chest computed tomography findings in different phases of SARS-CoV-2 infection

[Article in English, Spanish]
I Soriano Aguadero et al. Radiologia (Engl Ed). 2021 May-Jun.

Abstract
in English, Spanish

Objective: To compare the findings on chest computed tomography (CT) in patients with COVID-19 during different phases of the disease and to evaluate the reproducibility of a visual radiologic score for estimating the extent of lung involvement.

Methods: We retrospectively reviewed chest CT studies from 182 patients with RT-PCR findings positive for SARS-CoV-2. Patients were classified according to the time elapsed from the onset of symptoms, as follows: early (0-4 days), intermediate/progressive (5-9 days), or advanced (≥10 days). We analyzed the frequency of each radiologic finding, as well as the pattern, appearance, and predominant distribution of lung involvement. A visual tomographic score (range, 0-25) was used to estimate the extent of involvement in each lobe and in the total lung volume.

Results: The predominant CT finding was the ground-glass pattern (n=110; 60.4%), the most common distribution was peripheral (n = 116; 66.7%), and the most prevalent appearance was typical (n=112; 61.5%). The halo sign was seen most frequently in the early phase (25%), whereas ground-glass opacities were more common in the intermediate/progressive and advanced phases. The median severity score was 10 (IQR: 5-13), and the scores increased as the disease progressed. The interobserver agreement (kappa) was 0.92 for the appearance, 0.84 for the distribution, 0.70 for the predominant pattern, and 0.89 for the visual score.

Conclusion: The CT findings in patients with COVID-19 vary with the course of the infection. The proposed visual radiologic score is a simple, reproducible, and reliable tool for assessing lung involvement in COVID-19 pneumonia.

Objetivo: Comparar los hallazgos radiológicos mediante tomografía computarizada (TC) torácica en pacientes con COVID-19 en diferentes fases de la enfermedad y evaluar la reproducibilidad de unscore radiológico visual para estimar la extensión de la afectación pulmonar.

Métodos: Se evaluaron retrospectivamente las tomografías computarizadas de tórax de 182 pacientes con RT-PCR positiva para SARS-CoV-2. En función del tiempo de evolución de la infección, los pacientes fueron clasificados en tres grupos/estadios: fase precoz (0–4 días), intermedia/progresiva (5–9 días) y avanzada (≥10 días). Se analizó la frecuencia de cada hallazgo radiológico, así como el patrón, la apariencia y la distribución predominantes de la afectación pulmonar. La extensión de la afectación pulmonar se estimó para cada lóbulo pulmonar y para el volumen pulmonar total mediante un score tomográfico visual (rango 0−25).

Resultados: El hallazgo tomográfico predominante fue el patrón en vidrio deslustrado (n = 110, 60,4%), la distribución más frecuente, la periférica (n = 116, 66,7%) y la apariencia más prevalente, la típica (n = 112, 61,5%). El “signo del halo” se encontró más frecuentemente en la fase precoz (25%), mientras que las opacidades en vidrio deslustrado, el patrón en empedrado y las líneas subpleurales fueron más frecuentes en las fases intermedia/progresiva y avanzada. La mediana delscore de gravedad fue de 10 (RIQ: 5–13), aumentando los valores con la progresión de la enfermedad. El acuerdo interobservador (kappa, k) para la apariencia, la distribución y el patrón predominante, así como para el score visual fueron de 0,92; 0,84; 0,70, y 0,89; respectivamente.

Conclusión: Los hallazgos tomográficos en la COVID-19 varían con el curso de la infección. Elscore radiológico sugerido es una herramienta sencilla, reproducible y fiable para evaluar la afectación pulmonar en la neumonía COVID-19.

Keywords: COVID-19; COVID-19.; Computed tomography; Neumonía; Tomografía computarizada; pneumonia.

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Figures

Figure 1
Figure 1
Flowchart.
Figure 2
Figure 2
Chest computed tomography of a 44-year-old patient with COVID-19 in the early phase of the disease. A nodular opacity with a “halo” sign can be seen in the right upper lobe (arrow). A more anterior ground-glass opacity (arrowhead) is also identified.
Figure 3
Figure 3
Chest computed tomography (parenchyma window) of a 57-year-old woman with COVID-19 performed 8 days after the onset of symptoms (intermediate/progressive phase of the disease). A) Axial reconstruction. B) Sagittal reconstruction. Peripheral ground-glass opacities, predominantly in posterior segments of the lower lobes and left upper lobe (arrows), vascular engorgement (star) and subpleural lines (arrow heads).
Figure 4
Figure 4
Chest computed tomography in an 83-year-old male with COVID-19 and with symptoms for 2 weeks (advanced stage of the disease). A and B) Axial images showing consolidation (arrows) and ground-glass opacities and a reticular pattern with thickening of the interlobular septa (arrow heads) with peripheral distribution.
Figure 5
Figure 5
Predominant patterns per lobe in the early, intermediate/progressive and advanced stages of the disease.
See this image and copyright information in PMC

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