Chest Computed Tomography (CT) as a Predictor of Clinical Course in Coronavirus Disease

Abstract

BACKGROUND Chest imaging may be taken into consideration in detecting viral lung infections, especially if there are no tests available or there is a need for a prompt diagnosis. Imaging modalities enable evaluation of the character and extent of pulmonary lesions and monitoring of the disease course. The aim of this study was to verify the prognostic value of chest CT in COVID-19 patients. MATERIAL AND METHODS We conducted a retrospective review of clinical data and CT scans of 156 patients with SARS-CoV-2 infection confirmed by real-time reverse-transcription polymerase-chain-reaction (rRT-PCR) assay hospitalized in the Central Clinical Hospital of the Ministry of the Interior in Warsaw and in the Medical Centre in Łańcut, Poland. The total severity score (TSS) was used to quantify the extent of lung opacification in CT scans. RESULTS The dominant pattern in discharged patients was ground-glass opacities, whereas in the non-survivors, the dominant pulmonary changes were consolidations. The non-survivors were more likely to have pleural effusion, pleural thickening, lymphadenopathy, air bronchogram, and bronchiolectasis. There were no statistically significant differences among the 3 analyzed groups (non-survivors, discharged patients, and patients who underwent prolonged hospitalization) in the presence of fibrotic lesions, segmental or subsegmental pulmonary vessel enlargement, subpleural lines, air bubble sign, and halo sign. CONCLUSIONS Lung CT is a diagnostic tool with prognostic utility in COVID-19 patients. The correlation of the available clinical data with semi-quantitative radiological features enables evaluation of disease severity. The occurrence of specific radiomics shows a positive correlation with prognosis.

Figure 1

Non-contrast chest CT image of a 20-year-old man with mild COVID-19 pneumonia in the axial plane. CT scan shows ground-glass opacities in multiple lung segments.

Figure 2

A 66-year-old male COVID-19 patient presenting cough and myalgia for 7 days. CT scan shows a reticular pattern superimposed on the background of GGO, resembling the sign of crazy paving stones.

Figure 3

A 82-year-old male COVID-19 patient presenting fever with cough for 11 days. CT scan shows bilateral pulmonary consolidations.

Figure 4

A 49-year-old female COVID-19 patient presenting fever for 8 days. CT scan in the axial plane shows vascular enlargement in the left lung lobe.

Figure 5

Non-contrast chest CT image of a 27-year-old man with mild COVID-19 pneumonia in the coronal plane. CT scan shows traction bronchiectasis in the right upper and middle lobe.

Figure 6

The Kruskal-Wallis test showing statistically significant differences (s <0.00001) in the TSS score between the analyzed groups of patients. Group A – ‘discharged patients’, Group B – ‘patients who underwent prolonged hospitalization’, Group C – ‘non-survivors’.

Figure 7

Correlation between the number of affected lung lobes and patient’s outcome. Group A – ‘discharged patients’, Group B – ‘patients who underwent prolonged hospitalization’, Group C – ‘non-survivors’.

Figure 8

Correlation between MEWS on admission and patient’s outcome. Group A – ‘discharged patients’, Group B – ‘patients who underwent prolonged hospitalization’, Group C – ‘non-survivors’.