COVID-19: high-resolution computed tomography findings in the first 64 patients admitted to the Hospital of Cremona, the epicentre of the pandemic in Europe

Abstract

Purpose: In December 2019, a new coronavirus (SARS-CoV-2) was identified as being responsible for the pulmonary infection called COVID-19. On 21 February 2020, the first autochthonous case of COVID-19 was detected in Italy. Our goal is to report the most common chest computed tomography (CT) findings identified in 64 patients, in the initial phase of COVID-19.

Methods: Sixty-four chest high-resolution computed tomography (HRCT) examinations performed at the Radiology Unit of the Hospital of Cremona, from 22 to 29 February 2020, of 64 patients during first week of hospitalization for COVID-19 were retrospectively evaluated. All cases were confirmed by real-time RT-PCR for SARS-CoV-2. Image analysis was independently conducted by 2 radiologists with 10 years and 1 year of experience in chest imaging. The inter-observer agreement was obtained by applying a Cohen's κ test.

Results: The average age of patients was 67.1 years (± 12.2); men 42 (66%). HRCT was performed on the 5^th (± 1.5) day of hospitalization. More frequently, the initial CT changes of the lung show more or less extensive areas of ground-glass, as single pattern or with parenchymal consolidations. Coronavirus lung involvement appears very frequently multi-lobar, bilateral, and it concerns both subpleural and central regions. An excellent agreement (κ: 0.88-1, CI: 0.79-1.01, p < 0.05) concerning CT findings between the 2 operators was reached.

Conclusions: Our data suggest that detection of the most frequent pulmonary CT-scan changes, in the early stages of COVID-19, can be performed, with excellent agreement, among readers with different experience, and consequently attribute their exact diagnostic value, in an appropriate clinical and environmental exposure setting.

Keywords: COVID-19; HRCT; SARS-CoV-2; coronavirus; epidemic; pulmonary infection.

Figure 1

Chest high-resolution computed tomography in a 57-year-old man, unknown comorbidities. Fever and non-productive cough. Leukocytosis. Hypoxaemic and hypocapnic respiratory failure. Suspected contact with red zone subjects. NCOV-19 positive swab. A and B) In all pulmonary lobes extensive areas of increased attenuation are evident. In particular, the prevailing pattern is represented by ground glass opacities, with a tendency towards consolidation in the posterior regions. C) The alterations present a predominantly subpleural distribution and appear more evident at the lower lobes

Figure 2

Chest high-resolution computed tomography in a 43-year-old man, unknown comorbidities. Fever and non-productive cough. Leukopaenia. Hypoxaemic and hypocapnic respiratory failure. Contact with red zone subjects. NCOV-19 positive swab. Extensive ground glass opacity in the left lower lobe, with consolidation in the context (mixed lesion). Smaller lesion with similar attenuation features in the right lower lobe. Small ground glass areas in both upper lobes. The alterations have a subpleural distribution

Figure 3

Chest high-resolution computed tomography in a 45-year-old man, unknown comorbidities. Fever and non-productive cough. Leukocytosis. Hypoxaemic and hypocapnic respiratory failure. Contact with red zone subjects. NCOV-19 positive swab. A and B) In all pulmonary lobes there are evident multiple areas of ground glass attenuation. In the subpleural regions of the apical segments of both lower lobes, a perilobular distribution of ground-glass lesions is observed. C) The ground glass areas have both central and subpleural distribution