The thorax tomography correlation in COVID-19 RT-PCR positive patients

Year 2021, Volume: 3 Issue: 2, 145 - 150, 24.04.2021

Fatma Kesmez Can , Handan Alay , Sinan Yılmaz , Bahar Yılmaz Çankaya , Ayse Albayrak , Kemalettin Özden , Emine Parlak , Zülal Özkurt , Ali Gür , Sultan Tuna Akgol Gur

https://doi.org/10.38053/acmj.884102

Cited By: 2

Abstract

Aim: Although the RT-PCR test of pharyngeal swabs is the gold standard for diagnosing coronavirus disease 2019 (COVID 19), radiological imaging techniques, particularly thoracic computerized tomography (CT) were also used frequently as needed during the pandemic. The aim of this study is to investigate thorax CT findings in patients with COVID-19 confirmed by RT-PCR and to evaluate its relationship with clinical features.
Methods: This study included 311 consecutive patients who were hospitalized between April 1, 2020, and June 1, 2020, with COVID 19 diagnosis based on RT-PCR (+) results and underwent a thorax CT within 24-48 hours of admission. Symptoms, clinical status, co-morbidities of the patients were evaluated. Thorax CT findings were assessed by the Department of Radiology and the results were analyzed in relation to clinical status of the PCR (+) patients.
Results: The study group consisted of 170 male (57.7%) and 141 female (42.3%) patients with mean age 46.7 ± 33.7 years. Among the COVID 19 cases, 51 (16.4%) were asymptomatic, clinical course was mild-moderate in 197 (63.3%) and severe in 63(20.3%). During follow-up 21 (6.8%) required intensive care and 10 (3.2%) died. The most common symptoms observed were cough (33.4%), weakness (30.2%) and fever (28%). The most commonly encountered co-morbidity in COVID-19 patients was hypertension (10.3%) followed by diabetes mellitus (7.7%), coronary artery disease (5.1%). Thorax CT findings were assessed as normal in 21.9% of the patients; viral pneumonia was detected in 20.9% and 27.7% were reported as compatible with COVID 19. Bilateral involvement was seen on CT scan in 49.2% of the patients. In regard to thorax CT imaging characteristics that suggest COVID 19 disease, the most common was ground-glass opacities observed in 181 (27.2%) and the least common was vascular enlargement in 4(0.6%) of the patients.
Conclusion: COVID 19 is an air-borne disease that primarily affects the lungs. Thus, it is essential to define radiological lung involvement. The common CT findings of COVID 19 disease are similar to other viral pulmonary infections. The clinicians being familiar with common imaging features of COVID 19 would contribute to earlier detection and thus reduced mortality associated with the disease.

Keywords

Computed tomography, COVID-19, RT-PCR, Emergency, Infection

References

• Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; 382: 727-33.
• Cui J, Li F, Shi ZL. Origin and evolution of pathogenic coronaviruses. Nat Rev Microbiol 2019; 17: 181-92.
• Zu ZY, Jiang MD, Xu PP, et al. Disease 2019 (Covid-19): a perspective from China. Radiology 2020; 296: 15-25. https://doi.org/10.1148/radiol.2020200490
• Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with Covid-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 28; 395: 1054-62. https://doi.org/10.1016/S0140-6736(20)30566-3
• Singhal T. A Review of Coronavirus Disease-2019 (Covid-19). Indian J Pediatr 2020; 87: 281–6. https://doi.org/10.1007/s12098-020-03263-6
• Huang P, Liu T, Huang L, et al. Use of Chest CT in Combination with negative RT-PCR assay for the 2019 Novel Coronavirus but high clinical suspicion. Radiology 2020; 295: 22-3. https://doi.org/10.1148/radiol.2020200330
• Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J. Chest CT for typical coronavirus disease 2019 (Covid-19) pneumonia: relationship to negative RT-PCR testing. Radiology 2020; 296: 41-5. https://doi.org/10.1148/radiol.2020200343
• Kang Z, Li X, Zhou S. Recommendation of low-dose CT in the detection and management of Covid-2019. Eur Radiol 2020; 30: 4356-7. https://doi.org/10.1007/s00330-020-06809-6
• Ai T, Yang Z, Hou H, et al. Correlation of chest CT and RT-PCR testing for coronavirus disease 2019 (Covid-19) in China: a report of 1014 cases. Radiology 2020; 296: 32-40. https://doi.org/10.1148/radiol.2020200642
• Bai HX, Hsieh B, Xiong Z, et al. Performance of radiologists in differentiating Covid-19 from non-Covid-19 viral pneumonia at chest CT. Radiology 2020; 296: 46-54. https://doi.org/10.1148/radiol.2020200823
• Chung M, Bernheim A, Mei X, et al. CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV). Radiology 2020; 295: 202-7. https://doi.org/10.1148/radiol.2020200230
• Xu X, Yu C, Qu J, et al. Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2. Eur J Nucl Med Mol Imaging 2020; 47: 1275-80. https://doi.org/10.1007/s00259-020-04735-9
• Inui S, Fujikawa A, Jitsu M, et al. Chest CT Findings in cases from the cruise ship “Diamond Princess” with Coronavirus Disease 2019 (Covid-19). Radiol Cardiothorac Imaging 2020 Mar 17; 2: e200110. https://doi.org/10.1148/ryct.2020200110
• Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (Covid-19) outbreak in China: summary of a report of 72 314 cases from the Chinese center for disease control and prevention. JAMA 2020; 323: 1239-42. https://doi.org/10.1001/jama.2020.2648
• Martins-Filho PR, Tavares CSS, Santos VS. Factors associated with mortality in patients with Covid-19. A quantitative evidence synthesis of clinical and laboratory data. Eur J Intern Med 2020; 76: 97-9. https://doi.org/10.1016/j.ejim.2020.04.043
• Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ 2020; 369: m1966. https://doi.org/10.1136/bmj.m1966
• Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, et al. Clinical, laboratory and imaging features of Covid-19: A systematic review and meta-analysis. Travel Med Infect Dis 2020; 34: 101623. https://doi.org/10.1016/j.tmaid.2020.101623
• Fu L, Wang B, Yuan T, et al. Clinical characteristics of coronavirus disease 2019 (Covid-19) in China: A systematic review and meta-analysis. J Infect 2020; 80: 656-65. https://doi.org/10.1016/j.jinf.2020.03.041
• Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus Disease 2019 (Covid-19): A Systematic Review of Imaging Findings in 919 Patients. AJR Am J Roentgenol 2020; 215: 87-93. https://doi.org/10.2214/AJR.20.23034
• Ye Z, Zhang Y, Wang Y, Huang Z, Song B. Chest CT manifestations of new coronavirus disease 2019 (Covid-19): a pictorial review. Eur Radiol 2020; 30: 4381-9. https://doi.org/10.1007/s00330-020-06801-0
• Shi H, Han X, Jiang N, et al. Radiological findings from 81 patients with Covid-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis 2020; 20: 425–34. https://doi.org/10.1016/S1473-3099(20)30086-4
• Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology 2008; 246: 697-722.
• Xu X, Chen P, Wang J, et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci 2020; 63: 457-460. https://doi.org/10.1007/s11427-020-1637-5
• Wu J, Wu X, Zeng W, et al. Chest CT Findings in patients with coronavirus disease 2019 and its relationship with clinical features. Invest Radiol 2020; 55: 257-61. https://doi.org/10.1097/RLI.0000000000000670
• Ajlan AM, Ahyad RA, Jamjoom LG, Alharthy A, Madani TA. Middle East respiratory syndrome coronavirus (MERS-CoV) infection: chest CT findings. AJR Am J Roentgenol 2014; 203: 782-7.