Correlation between clinical course and radiographic development on CT scan in patients with COVID-19

Yun Xie; Luyu Yang; Hui Dong; Song Cao; Wenkai Zhang; Qiong Chen; Baoliang Jin; Zhiguo Zhou; Jun Liu; Zhiyan He; Ruilan Wang

doi:10.1016/j.jointm.2021.04.004

Correlation between clinical course and radiographic development on CT scan in patients with COVID-19

J Intensive Med. 2021 May 26;1(1):52-58. doi: 10.1016/j.jointm.2021.04.004. eCollection 2021 Jul.

Authors

Yun Xie¹, Luyu Yang², Hui Dong², Song Cao², Wenkai Zhang², Qiong Chen³, Baoliang Jin⁴, Zhiguo Zhou⁴, Jun Liu⁵, Zhiyan He⁴, Ruilan Wang¹

Affiliations

¹ Department of Intensive Care Unit, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201600, China.
² Department of Intensive Care Unit, Wuhan Third Hospital, Wuhan University, Wuhan 430060, China.
³ Department of Radiology, Shanghai Xuhui Dahua Hospital, Shanghai 200442, China.
⁴ Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201600, China.
⁵ Department of nephrology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201600, China.

Abstract

Background: To analyze the correlation between clinical course and radiographic development on computed tomography (CT) in patients with confirmed coronavirus disease 2019 (COVID-19) and to provide more evidence for treatment.

Methods: This retrospective, observational, cohort study enrolled 49 patients with Reverse transcription-polymerase chain reaction (RT-PCR)-confirmed COVID-19, which included 30 patients admitted to the intensive care unit (ICU) of Wuhan Third Hospital and 19 patients either admitted to or receiving telemedicine consultation from Shanghai General Hospital, Shanghai Xuhui Dahua Hospital, and hospitals in other provinces. CT scans were performed in all enrolled patients and the radiographic features including simple ground-glass opacities (GGOs), GGO with interlobular septal thickening, consolidations with GGO, and consolidations only were monitored by repeating the CT. The progression of these radiographic features was analyzed in combination with their clinical staging and the time interval between onset of symptoms to CT.

Results: Based on illness severity, the 49 patients were classified into four stages: mild (n = 6), moderate (n = 12), severe (n = 16), and critically ill (n = 15). The CT findings were classified into three phases: early (n = 5), progression (n = 39), and recovery (n = 5). Among the 49 patients, 9 had bilateral diffuse GGO or diffuse consolidations (white lungs) and were counted as 18 lesions. Three patients had no abnormal findings on initial CT, but their repeat CT showed new lesions. In all, we identified 892 lesions including simple GGO, GGO with interlobular septal thickening, consolidations with GGO, and consolidations only.

Conclusions: Most patients had pulmonary lesions on the posterior, inferior, and peripheral lung fields on CT. The development of GGO with interlobular septal thickening, GGO with consolidations, and consolidations only happened mainly between day 8 and 14. The emergence of consolidations may suggest the progression to the severe phase of the illness, whereas simple consolidations or "white lung" may suggest a critically ill phase.

Keywords: COVID-19; Lung; Radiology.