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Diagnostic Value and Key Features of Computed Tomography in Coronavirus Disease 2019

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Diagnostic Value and Key Features of Computed Tomography in Coronavirus Disease 2019 Emerging Microbes & Infections ISSN: (Print) 2222-1751 (Online) Journal homepage: https://www.tandfonline.com/loi/temi20 Diagnostic value and key features of computed tomography in Coronavirus Disease 2019 Bingjie Li, Xin Li, Yaxuan Wang, Yikai Han, Yidi Wang, Chen Wang, Guorui Zhang, Jianjun Jin, Hongxia Jia, Feifei Fan, Wang Ma, Hong Liu & Yue Zhou To cite this article: Bingjie Li, Xin Li, Yaxuan Wang, Yikai Han, Yidi Wang, Chen Wang, Guorui Zhang, Jianjun Jin, Hongxia Jia, Feifei Fan, Wang Ma, Hong Liu & Yue Zhou (2020) Diagnostic value and key features of computed tomography in Coronavirus Disease 2019, Emerging Microbes & Infections, 9:1, 787-793, DOI: 10.1080/22221751.2020.1750307 To link to this article: https://doi.org/10.1080/22221751.2020.1750307 © 2020 The Author(s). Published by Informa Accepted author version posted online: 02 UK Limited, trading as Taylor & Francis Apr 2020. Group, on behalf of Shanghai Shangyixun Published online: 23 Apr 2020. Cultural Communication Co., Ltd Submit your article to this journal Article views: 5909 View related articles View Crossmark data Citing articles: 1 View citing articles Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=temi20 Emerging Microbes & Infections 2020, VOL. 9 https://doi.org/10.1080/22221751.2020.1750307 REVIEW Diagnostic value and key features of computed tomography in Coronavirus Disease 2019 Bingjie Lia*, Xin Lia*, Yaxuan Wanga, Yikai Hana, Yidi Wanga, Chen Wanga, Guorui Zhangb, Jianjun Jinb, Hongxia Jiab, Feifei Fanb, Wang Maa, Hong Liub and Yue Zhouc aDepartment of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China; bDepartment of Respiratory Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China; cDepartment of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China ABSTRACT On 31 December 2019, a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, Hubei province, China, and caused the outbreak of the Coronavirus Disease 2019 (COVID-19). To date, computed tomography (CT) findings have been recommended as major evidence for the clinical diagnosis of COVID-19 in Hubei, China. This review focuses on the imaging characteristics and changes throughout the disease course in patients with COVID-19 in order to provide some help for clinicians. Typical CT findings included bilateral ground-glass opacity, pulmonary consolidation, and prominent distribution in the posterior and peripheral parts of the lungs. This review also provides a comparison between COVID-19 and other diseases that have similar CT findings. Since most patients with COVID-19 infection share typical imaging features, radiological examinations have an irreplaceable role in screening, diagnosis and monitoring treatment effects in clinical practice. ARTICLE HISTORY Received 25 February 2020; Revised 20 March 2020; Accepted 26 March 2020 KEYWORDS Coronavirus Disease 2019; computed tomography; diagnosis; SARS-CoV-2; ground-glass opacity Introduction [5–9]. Unlike SARS and MERS, asymptomatic COVID-19 patients have been reported to be conta- On 31 December Wuhan, Hubei province 2019, a gious [10]. Therefore, the transmission capability of series of unidentified pneumonia disease cases were SARS-CoV-2 may be greater than that of SARS. reported in, central China, with epidemiological links Although the fatality rate of COVID-19 is lower than to the Huanan Seafood Wholesale Market [1]. Soon SARS and MERS, COVID-19 has killed more people after, the Chinese Centre for Disease Control and Pre- than SARS and MERS combined [11]. vention isolated a novel coronavirus from human epi- Sequence analysis shows that SARS-CoV-2 has the thelial cells as the causative agent of this outbreak, typical genome structure of the coronavirus and which was named severe acute respiratory syndrome belongs to the beta coronavirus genus, which is the coronavirus 2 (SARS-CoV-2) [2]. On 30 January seventh member of the family of coronaviruses that 2020, the World Health Organization (WHO) declared infect humans [12–14]. COVID-19 is the third wide- the transmission of SARS-CoV-2 as the sixth Public spread pandemic virus-related after SARS in 2002 Health Emergency of International Concern [3]. On and MERS in 2012. SARS-CoV-2 has an 80% similarity 12 February 2020, WHO named the disease caused to SARS and 50% similarity to MERS at the genome by SARS-CoV-2 as Coronavirus Disease 2019 level [12]. SARS-COV-2 can be easily transmitted (COVID-19). On 11 March 2020, WHO formally from person to person through close contact, droplets announced that COVID-19 was a pandemic [4]. As and aerosols [5,6,15,16]. According to recent reports, of 18 March 2020, there are now more than 194,000 the most common symptom of SARS-COV-2 infection confirmed cases in 164 countries, with 7864 cases of is fever, cough, myalgia and fatigue, and the less com- mortality. The number of confirmed cases and deaths mon symptoms were sputum production, haemoptysis, exceeds those of Severe Acute Respiratory Syndrome and diarrhoea[17,18]. The median incubation period is (SARS) and the Middle East Respiratory Syndrome 5.1 days [19]. Therefore, early diagnosis and isolation (MERS). At present, the basic reproductive number are important to control the spread of the epidemic. of SARS-CoV-2 has been estimated to lie between 2.2 At present, real-time reverse-transcription–polymer- and 3.9 by different teams in China and other countries ase-chain-reaction (RT–PCR) assay for COVID-19 CONTACT Yue Zhou [email protected] The First Affiliated Hospital Zhengzhou University, Jianshe Street, Zhengzhou, Henan, China *These authors contributed equally to this work. © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group, on behalf of Shanghai Shangyixun Cultural Communication Co., Ltd This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 788 B. Li et al. has been developed and is being used in clinics. In the So far, only seven case series [18,23–28] and some current emergency, the high false negative rate and the case reports [29–37] have investigated the chest CT shortage of RT–PCR implies that many COVID-19 imaging features of COVID-19 pneumonia. According patients may not be identified on time. However, to these reports, patients with COVID-19 can show most patients with COVID-19 has been diagnosed typical imaging features at the early stages of the dis- with pneumonia and characteristic computed tom- ease. Chest CT plays an important role in the screening ography (CT) imaging patterns; thus radiological and preliminary diagnosis of COVID-19 pneumonia. examinations are essential for the early diagnosis and Among the first 41 COVID-19 patients that were lab- evaluation of the disease. In this review, we focus on oratory-confirmed in Wuhan before January 2, a lim- the imaging characteristics and changes in patients ited analysis of chest imaging showed all patients had with COVID-19 to provide some help for frontline abnormalities in chest CT, and 40 (98%) of them had clinicians. bilateral lung involvement. In this study, it was found that patients with severe cases who were on admission were more likely to have bilateral multiple lobular and Typical imaging features of COVID-19 subsegmental areas of consolidation, while admitted Currently, chest radiography remains the first-line patients with mild cases were more likely to have bilat- imaging test for identifying pneumonia because it eral GGO and subsegmental areas of consolidation offers simplicity, low cost, and considerable infor- [18]. Similar characteristics were found in another mation, and can be considered the reference standard 51-person study cohort: most pulmonary lesions [20]. However, COVID-19 is similar to SARS and involved bilateral lungs with multiple lung lobes, and MERS with regard to clinical manifestations and ima- were mainly distributed in the posterior and peripheral ging features. Considering the experiences with SARS part of the lungs. Moreover, 39(77%) patients had pure and MERS treatments, CT is more sensitive and GGO on CT, 38(75%) had GGO with reticular and/or specific than X-rays and can identify the abnormalities interlobular septal thickening on CT, 30 (59%) had in the lungs earlier [21,22]. In addition, 5 patients GGO with consolidation on CT scans, while 28(55%) underwent chest radiography along with chest CT had pure consolidation on CT scans. Notably, consoli- examinations in a recent study. Of these, 2 patients dation is considered a sign of disease progression. had normal chest radiography findings, despite also Younger patients tended to have more GGO, while having CT examinations performed on the same day older patients tended to show more pulmonary conso- that showed ground-glass opacity (GGO). Moreover, lidation. This is also consistent with the phenomenon the chest radiography findings of the other 3 patients where the prognosis of young patients is better than did not show the peripheral predominance that was that of elderly patients [24]. Chung et al. found that visible on their respective CT scans [23]. The reason the crazy-paving pattern often appeared in patients for the negative chest radiography findings in patients
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