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. 2020 Sep 3;2(5):e200280.
doi: 10.1148/ryct.2020200280. eCollection 2020 Oct.

A Characteristic Chest Radiographic Pattern in the Setting of the COVID-19 Pandemic

David L Smith  1 , John-Paul Grenier  1 , Catherine Batte  1 , Bradley Spieler  1
Affiliations

A Characteristic Chest Radiographic Pattern in the Setting of the COVID-19 Pandemic

David L Smith et al. Radiol Cardiothorac Imaging. .

Abstract

Purpose: To determine the utility of chest radiography in aiding clinical diagnosis of coronavirus disease 2019 (COVID-19) utilizing reverse-transcription polymerase chain reaction (RT-PCR) as the standard of comparison.

Materials and methods: A retrospective study was performed of persons under investigation for COVID-19 presenting to this institution during the exponential growth phase of the COVID-19 outbreak in New Orleans (March 13-25, 2020). Three hundred seventy-six in-hospital chest radiographic examinations for 366 individual patients were reviewed along with concurrent RT-PCR tests. Two experienced radiologists categorized each chest radiograph as characteristic, nonspecific, or negative in appearance for COVID-19, utilizing well-documented COVID-19 imaging patterns. Chest radiograph categorization was compared against RT-PCR results to determine the utility of chest radiography in diagnosing COVID-19.

Results: Of the 366 patients, the study consisted of 178 male (49%) and 188 female (51%) patients with a mean age of 52.7 years (range, 17 to 98 years). Of the 376 chest radiographic examinations, 37 (10%) exhibited the characteristic COVID-19 appearance; 215 (57%) exhibited the nonspecific appearance; and 124 (33%) were considered negative for a pulmonary abnormality. Of the 376 RT-PCR tests evaluated, 200 (53%) were positive and 176 (47%) were negative. RT-PCR tests took an average of 2.5 days ± 0.7 to provide results. Sensitivity and specificity for correctly identifying COVID-19 with a characteristic chest radiographic pattern was 15.5% (31/200) and 96.6% (170/176), with a positive predictive value and negative predictive value of 83.8% (31/37) and 50.1% (170/339), respectively.

Conclusion: The presence of patchy and/or confluent, bandlike ground-glass opacity or consolidation in a peripheral and mid to lower lung zone distribution on a chest radiograph obtained in the setting of pandemic COVID-19 was highly suggestive of severe acute respiratory syndrome coronavirus 2 infection and should be used in conjunction with clinical judgment to make a diagnosis.© RSNA, 2020.

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Conflict of interest statement

Disclosures of Conflicts of Interest: D.L.S. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: author provides expert testimony for Hall Booth Smith on a matter unrelated to this article; author is paid by Genentech for speakers bureau giving nonbranded lectures on interstitial lung disease (unrelated to this article). Other relationships: disclosed no relevant relationships. J.P.G. disclosed no relevant relationships. C.B. disclosed no relevant relationships. B.S. disclosed no relevant relationships.

Figures

Methods flowchart. CXR = chest radiography, PCR = polymerase chain reaction.
Figure 1:
Methods flowchart. CXR = chest radiography, PCR = polymerase chain reaction.
Characteristic chest radiograph in a 63-year-old woman presenting with dyspnea and fever. Chest radiographic findings include bilateral patchy and confluent, bandlike ground-glass and consolidative opacity in a peripheral, mid to lower lung zone distribution (arrows).
Figure 2:
Characteristic chest radiograph in a 63-year-old woman presenting with dyspnea and fever. Chest radiographic findings include bilateral patchy and confluent, bandlike ground-glass and consolidative opacity in a peripheral, mid to lower lung zone distribution (arrows).
Characteristic chest radiograph in a 41-year-old woman presenting with cough and fever. Chest radiographic findings include bilateral patchy and confluent, bandlike ground-glass and consolidative opacity in a peripheral, mid to lower lung zone distribution (arrows).
Figure 3:
Characteristic chest radiograph in a 41-year-old woman presenting with cough and fever. Chest radiographic findings include bilateral patchy and confluent, bandlike ground-glass and consolidative opacity in a peripheral, mid to lower lung zone distribution (arrows).
A more subtle characteristic radiograph in a 41-year-old man presenting with dyspnea and chest pain. Patchy ground-glass opacities are limited to the peripheral portions of the mid lung zones (arrows).
Figure 4:
A more subtle characteristic radiograph in a 41-year-old man presenting with dyspnea and chest pain. Patchy ground-glass opacities are limited to the peripheral portions of the mid lung zones (arrows).
Three anteroposterior radiographs demonstrate nonspecific findings. A, Diffuse bilateral opacities including ground glass and bibasilar consolidation (arrows), in a more central distribution than in the characteristic pattern. B, Ill-defined, bibasilar opacities (arrowheads). C, Focal, unilateral airspace disease (arrows).
Figure 5a:
Three anteroposterior radiographs demonstrate nonspecific findings. A, Diffuse bilateral opacities including ground glass and bibasilar consolidation (arrows), in a more central distribution than in the characteristic pattern. B, Ill-defined, bibasilar opacities (arrowheads). C, Focal, unilateral airspace disease (arrows).
Three anteroposterior radiographs demonstrate nonspecific findings. A, Diffuse bilateral opacities including ground glass and bibasilar consolidation (arrows), in a more central distribution than in the characteristic pattern. B, Ill-defined, bibasilar opacities (arrowheads). C, Focal, unilateral airspace disease (arrows).
Figure 5b:
Three anteroposterior radiographs demonstrate nonspecific findings. A, Diffuse bilateral opacities including ground glass and bibasilar consolidation (arrows), in a more central distribution than in the characteristic pattern. B, Ill-defined, bibasilar opacities (arrowheads). C, Focal, unilateral airspace disease (arrows).
Three anteroposterior radiographs demonstrate nonspecific findings. A, Diffuse bilateral opacities including ground glass and bibasilar consolidation (arrows), in a more central distribution than in the characteristic pattern. B, Ill-defined, bibasilar opacities (arrowheads). C, Focal, unilateral airspace disease (arrows).
Figure 5c:
Three anteroposterior radiographs demonstrate nonspecific findings. A, Diffuse bilateral opacities including ground glass and bibasilar consolidation (arrows), in a more central distribution than in the characteristic pattern. B, Ill-defined, bibasilar opacities (arrowheads). C, Focal, unilateral airspace disease (arrows).
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