DISCOVERIES REPORTS 2021, 4: e20 10.15190/drep.2021.5 Chest Imaging and COVID-19 DOI: REVIEW Article Role of Chest Imaging in Diagnosis and Management of COVID-19 Madeeha Subhan Waleed1,*, Kinal Paresh Bhatt2, Farwah N. Fatima3, Anoopa Mathew4, Paz Ines M. Domingo5, Mehrie H. Patel6, Bishnu M. Singh7 1Ayub Medical College, 22040, Abbottabad, Pakistan 2Larkin Health System, 33143, South Miami, FL, USA 3Lahore Medical and Dental College,53400, Lahore, Pakistan 4K.S. Hegde Medical Academy, 575018, Mangaluru, Karnataka, India 5University of the East Ramon Magsaysay Memorial Medical Center, 1113, Quezon City, Philippines 6Pramukhswami Medical College, 388325, Gujarat, India 7Hetauda City Hospital, 44107, Hetauda, Nepal * Corresponding authors: Madeeha Subhan Waleed MBBS, Ayub Medical College, 22040, Abbottabad, Pakistan; Email: [email protected]; Phone:00923335634888. Submitted: Mar. 31, 2021; Revised: May 08, 2021; Accepted: May 08, 2021; Published: June 30, 2021; Citation: Waleed MS, Bhatt KP, Fatima FN, Mathew A, Domingo PIM, Patel MH, Singh BM. Role of Chest Imaging in Diagnosis and Management of COVID-19. Discoveries Reports, 2021; 4: e20. DOI: 10.15190/drep.2021.5 ABSTRACT mounting prevalence of COVID-19 in the The COVID-19 pandemic is a serious global health community demands for an accurate and sensitive threat. The standard gold test for detecting COVID - test for COVID-19. This review article sheds light 19 is a real-time reverse transcription-polymerase on the limited role of different imaging modalities in chain reaction (RT-PCR) of viral nucleic acid. There diagnosing and managing COVID-19. are different specific and nonspecific diagnostic tests available for COVID-19. The use of imaging in SUMMARY COVID-19 is considered a specific diagnostic test 1. Introduction and is stratified based on the severity of the disease. 2. Diagnostic tests of COVID-19 Chest radiographs of COVID-19 patients are usually 2.1 Specific diagnostic tests insensitive to detecting COVID-19 in the early stage. 2.2 Nonspecific diagnostic test They may have some utility, with the potential to serve as a screening tool on the frontlines in medical 3. Indications for the chest X-ray or CT scan settings with limited resources. CT (computerized 4. International approach and practice tomography) scans have greater sensitivity and are 5. Percentage of people having normal versus used in disease staging. They are a good indicator of abnormal imaging the infection in patients with negative viral testing or 6. Benefits of imaging in COVID-19 patients chest X-ray results, when clinical findings are still 7. Distinguishing between COVID-19 and other serious concerns for COVID-19. However, respiratory infections meticulous equipment decontamination is required 8. Hazards of using hospital equipment on COVID- to reduce any chance of viral contamination and 19 patients spread across patients and facility staff. It is salient 9. Conclusion to utilize the advantages of different imaging modalities in the wrestle against COVID-19. The www.discoveriesjournals.org/discoveries-reports 1 Chest Imaging and COVID-19 Keywords distress syndrome (ARDS), sepsis, and other Coronavirus, COVID-19, SARS-CoV-2, imaging, systemic complications5. People with at least one chest computerized tomography, chest X-ray. underlying condition, especially those aged 70 years or older, are more likely to have severe COVID-19 Abbreviations symptoms requiring hospital admission6. The spread Severe acute respiratory syndrome (SARS); Middle of the virus from asymptomatic individuals or those East respiratory syndrome (MERS); Enzyme within the incubation period has also been reported7. immunoassay (EIA); Enzyme-Linked Immunosorbent The identification of the disease is made through Assay (ELISA); Emergency department (ED); British both clinical and laboratory parameters. Molecular Society of Thoracic Imaging (BSTI); American Society testing using RT-PCR is done for upper respiratory of Thoracic Radiology (STR). specimens collected from oropharyngeal or nasopharyngeal samples and lower respiratory 1. Introduction samples collected through sputum, broncho-alveolar lavage, or endotracheal aspirate. Despite the limited Coronaviruses, which are RNA viruses, have been sensitivity and specificity, serology tests like rapid known to cause respiratory infections in humans. antigen and antibody tests are also used because of Previous outbreaks of severe acute respiratory the quick turn-around time. Radiological imaging syndrome (SARS) in 2002 in China and the Middle like chest X-ray, chest CT, and lung ultrasound is East respiratory syndrome (MERS) in 2012 in also used to assist with the disease's clinical Middle East countries were highly pathogenic strains diagnosis. High-resolution chest CT (HRCT) detects of coronavirus, which were associated with the early stage of the disease. The most common increased infectivity1. COVID-19 first emerged in radiological findings include multifocal ground- December 2019 when a cluster of patients in Wuhan, glass appearance along with areas of consolidation5. China, were diagnosed with pneumonia of an unknown etiology. The outbreak was determined to 2. Diagnostic tests of COVID-19 be caused by a novel coronavirus, which was later named SARS-CoV-2. COVID-19 was declared a There are different specific and nonspecific pandemic by WHO on March 11, 2020. diagnostic tests available for COVID-19. The mode of transmission of the virus is via 2.1. Specific diagnostic tests direct contact or respiratory droplets. Respiratory - RT-PCR: The gold standard diagnostic test of droplets usually spread when a person sneezes, COVID-19 demonstrates SARS-CoV-2 RNA in coughs, talks, or even sings. Indirect transmission of respiratory samples8. RT-PCR is the specific the virus through contaminated or infected surfaces diagnostic test that is used to confirm the presence of (fomites) also plays a role in the community spread SARS-CoV-2 RNA in nasopharyngeal and of the disease2. The mean incubation period for oropharyngeal secretions. In the RT-PCR system, COVID-19 is 5.2 days, with a range of 2-14 days. the RNA extracted from upper respiratory samples An infected person's potential to transmit the virus to undergoes a reverse transcription step where RNA is another person is measured by R0. It is the average converted into complementary DNA (cDNA). These number of people who will get the disease from one cDNA will undergo amplification, and finally, person with that disease. R0 is 2.2 for SARS-CoV-2 fluorescent probes will recognize and hybridize meaning each existing infection causes more than segments of amplification products9. one new infection 3. COVID-19 is mostly associated - Enzyme immunoassay (EIA) or Enzyme-Linked with fever, cough, and fatigue at the onset of the Immunosorbent Assay (ELISA): These tests are fast, disease. Headache, lymphopenia, or shortness of simple, and safe assays used in infected patients. breath are other commonly associated symptoms4. These tests detect IgM and IgG antibodies against Intestinal symptoms like diarrhea are less commonly SARS-CoV-2 nucleoprotein Rp3[10]. Different associated with SARS-COV-2 when compared to commercially available ELISA tests are Wantai SARS-CoV and MERS-CoV. Most patients have SARS-CoV-2 total antibody ELISA, Euroimmun mild to moderate illness. Severe manifestations of IgA ELISA, Euroimmun IgG ELISA. These tests are the disease include severe pneumonia (respiratory not used for diagnosing the acute phase of disease distress, tachypnea, and hypoxia), acute respiratory but for retrospective assessment of illness, www.discoveriesjournals.org/discoveries-reports 2 Chest Imaging and COVID-19 diagnosing asymptomatic patients, and close 3. Indications for the chest X-ray or CT scan contacts of confirmed cases11,12. - Immunochromatographic tests (rapid tests): These COVID-19 associated lung involvement could vary are quick tests utilizing a patient sample like whole from severe pneumonia to ARDS22, 23. The standard blood, serum, or plasma and specific buffer on an gold test for detecting COVID-19 is a real-time RT- immunochromatographic stick13. Colloidal-Gold- PCR of viral nucleic acid22. The nucleic acids are Immunochromatographic Assay (GICA) and Lateral detected in throat swabs, lower respiratory tract Flow immunoassays (LFA) are secretions, and blood. It has low efficiency due to immunochromatographic tests14,15. These tests are the low viremia and unsuitable clinical sampling. useful for diagnosing large samples, identifying False negatives from viral nucleic acid testing can suspicious cases, and also useful for screening, occur due to instrument error, sampling error, and monitoring COVID-19 in populations13. disease characteristics (asymptomatic patients). The - Protein Microarray: This technique detects proteins RT-PCR role is limited. It can lead to several false in the specimen by antibodies immobilized on a negatives, thus urging the need for radiological surface. Whenever antibodies recognize proteins, evaluation of patients, especially in the emergency there is an emission of a fluorescent signal that is department (ED) for urgent lung involvement captured and analyzed by equipment16,17. Microarray evaluation. techniques are used to map antibodies, monitor COVID-19 is very contagious, so early diagnosis immune response, develop diagnostic tests, vaccines, carries supreme importance as the diseased and identify new targets for the treatment of individual's isolation is critical in controlling the COVID-1918. global