Imaging Profile of the COVID-19 Infection: Radiologic Findings and Literature Review

Abstract

Purpose: To present the findings of 21 coronavirus disease 2019 (COVID-19) cases from two Chinese centers with CT and chest radiographic findings, as well as follow-up imaging in five cases.

Materials and methods: This was a retrospective study in Shenzhen and Hong Kong. Patients with COVID-19 infection were included. A systematic review of the published literature on radiologic features of COVID-19 infection was conducted.

Results: The predominant imaging pattern was of ground-glass opacification with occasional consolidation in the peripheries. Pleural effusions and lymphadenopathy were absent in all cases. Patients demonstrated evolution of the ground-glass opacities into consolidation and subsequent resolution of the airspace changes. Ground-glass and consolidative opacities visible on CT are sometimes undetectable on chest radiography, suggesting that CT is a more sensitive imaging modality for investigation. The systematic review identified four other studies confirming the findings of bilateral and peripheral ground glass with or without consolidation as the predominant finding at CT chest examinations.

Conclusion: Pulmonary manifestation of COVID-19 infection is predominantly characterized by ground-glass opacification with occasional consolidation on CT. Radiographic findings in patients presenting in Shenzhen and Hong Kong are in keeping with four previous publications from other sites.© RSNA, 2020See editorial by Kay and Abbara in this issue.

Figure 1:

A 65-year-old female patient who had traveled to Wuhan, China, subsequently developing fever and cough 5 days after arrival. She returned to Shenzhen, China, and underwent this chest CT examination 7 days after symptom onset. A, Coronal and, B, axial CT images show a mixture of ground glass and consolidation in the periphery of the lungs (red arrows), with the absence of pleural effusions, which was the typical appearance of patients with confirmed COVID-19 infection.

Figure 2:

A comparison of, A, chest radiograph and, B, thorax CT coronal image. The ground-glass opacities in the right lower lobe periphery on the CT (red arrows) are not visible on the chest radiograph, which was taken within 1 hour of the CT.

Figure 3:

A 10-year-old asymptomatic male child with confirmed COVID-19 infection, who had traveled to Wuhan, China, with his family. A, Image shows the initial CT scan at time of presentation, with consolidation in the left lower lobe apical segment. B, Image shows mild improvement in the lung consolidation 4 days later.

Figure 4:

Chest CT follow-up in a patient who had no previous travel to Wuhan, China, but had contact with a patient with confirmed COVID-19 infection. Axial slices from day 0 of presentation to the hospital shows ground-glass opacities in the left lower lobe (arrow, A), but not in the right upper lobe (C). Subsequently, 3 days later, the follow-up CT showed an increase in the ground-glass changes with some peripheral consolidation (reversed halo, arrow, B) and new ground-glass opacities in the right upper lobe periphery (arrow, D).

Figure 5:

Chest radiographs in an older male patient from Wuhan, China, who traveled to Hong Kong, China. These are three chest radiographs selected out of the daily chest radiographs acquired in this patient. The consolidation in the right lower zone on day 0 persisted into day 4 with new consolidative changes in the right midzone periphery and perihilar region. This midzone change improved on the day 7 radiograph.

Figure 6:

Axial CT images show, A, case of COVID-19 and, B, a case of severe acute respiratory syndrome from 2003. Both cases demonstrate similar predominantly ground-glass opacities affecting both lungs.