key: cord-0716337-76vgtd63
authors: Jiang, Maoqing; Chen, Ping; Li, Tianfu; Tang, Yifan; Chen, Xueqin; Chen, Xiaomin; Ruan, Xinzhong
title: Chest CT imaging features and clinical outcome of coronavirus disease 2019 (COVID-19): A single-center case study in Ningbo, China
date: 2020-05-30
journal: Clin Imaging
DOI: 10.1016/j.clinimag.2020.05.028
sha: b77d22a1e6da1b49d3978071bc1fd2b39f46b78e
doc_id: 716337
cord_uid: 76vgtd63

OBJECTIVE: The purpose of this study was to investigate the chest CT imaging features and clinical outcome of coronavirus disease 2019 (COVID-19) in Ningbo, China. METHODS: In this retrospective study, twenty-eight confirmed and seven highly suspected cases of COVID-19 were enrolled in Ningbo first hospital from January 26, 2020 to March 5, 2020. Cases were confirmed by real-time polymerase chain reaction (RT-PCR). The initial and follow-up chest CT imaging features, epidemiological history, and outcome were analyzed. RESULTS: The average age of the patients was 57.3 ± 15.3 years (range: 27–96 years), including 25 females and 10 males. On CT images, 89.3% (25/28) confirmed and 100% (7/7) suspected patients had ground-glass opacities (GGOs), and GGOs with mixed consolidations were observed in 35.7% (10/28) confirmed and 42.9% (3/7) suspected cases, most of these lesions were distributed under the peripheral of both lungs. 17 confirmed and 4 suspected cases had a history of participating in Ningbo Tian-tong Temple rituals and all had GGOs in their lungs during the initial CT scan. As of March 25, 2020, the lung lesions of our cases were significantly resolved and all patients have been discharged from the hospital. CONCLUSION: The most common chest CT features are multiple bilateral and peripheral GGOs with mixed consolidations or not in the lungs of patients with COVID-19. Chest CT plays an important role in the diagnosis and monitoring treatment response of this disease. There was no reported death in our cases.

Since December 2019, a cluster of patients with respiratory illness of unknown origin has emerged in Wuhan, Hubei province, China [1] . The confirmed cases were caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), infection, officially named coronavirus disease 2019 . It is a disease of person-to-person transmission [2] . Up to March 4, 2020, China reported a total of 80270 confirmed cases, 520 suspected cases, 49856 cured cases and 2981 deaths [3] . At present, the disease has been spreading rapidly to more than 100 countries and 6 continents, leading to a serious global public health issue [4, 5] . [8] . Chest CT plays a critical role in the diagnosis of the disease and the typical imaging findings were multi-focal ground-glass opacifications at the bilateral peripheral margin, mainly involving the lower right lobe [9] . RT-PCR test remains the reference standard method for diagnosis of COVID-19 even though with a lower sensitivity (59%) compared to chest CT imaging (88%) [10] . However, the epidemiological characteristics, clinical and imaging manifestations, and outcome were not the same in different areas [7, 11] .

J o u r n a l P r e -p r o o f This study was approved by the Institutional Review Board of Ningbo First Hospital, Ningbo, Zhejiang province, China. Informed consent was waived for the nature of this retrospective study that involved no potential interest and/or risks between the patients and researchers. All of the data was evaluated with de-identified.

A total of 28 confirmed and 7 suspected patients with COVID-19 who underwent chest CT scans in our hospital were enrolled in this study from January 26, 2020 to

March 5, 2020. The following items were investigated in all patients: epidemiological history (travel and/or resident in Wuhan or close contact history to fevered persons who were confirmed or suspected with COVID-19 pneumonia within 14 days before the onset of illness), clinical manifestations (any symptoms of fever, cough, shortness of breath, muscle ache, fatigue, diarrhea, vomit, and etc.), chest CT imaging features (such as ground-glass opacity, consolidation, and etc.), laboratory examinations (blood routine test, and etc.) and RT-PCR test for COVID-19 nucleic acid in throat swabs or lower respiratory tract. The confirmed and highly suspected cases with COVID-19 pneumonia were treated in the isolation ward. All patients were excluded form type A (H1N1, H3N2, H7N9) and B influenza viruses infection by laboratory tests.

According to the protocols from the national health commission of the people's republic of China, the discharged criteria were: afebrile for more than 3 days, respiratory symptoms improved significantly, lung lesions on chest radiograph or CT were significantly resolved, and at least two consecutive negative of COVID-19 nucleic acid tests with an interval of 24 hours or more [13] .

All patients were imaged with 5 mm slice thickness CT on a 16-row multidetector CT scanner (Siemens Somatom Sensation, Siemens, Erlangen, Germany) using the routine chest protocol. The patients were scanned by our technicians in a supine position, arm raised, during breath-holding at full inspiration. All CT images were evaluated using a lung window, with a window level of -600 HU and window width of 1400 HU. The slice thickness for reconstruction was 1.5 mm. 

The variables were expressed as the mean ± standard deviation. The statistical comparison in different groups was analyzed by Chi-squared test. The results of the difference between the comparative tests were considered statistically significant at a 2-tailed value of p < 0.05. SPSS version 13.0 software (SPSS Inc., Chicago, IL) was used for all statistical analysis.

The clinical characteristics were summarized in Table 1 Epidemiological history revealed that 60.0% (21/35) of the cases had a close contact with a confirmed patient at a ritual in Ningbo Tian-tong Temple. Seven cases had a history of exposure to infected patients from Wuhan and 5 with infected patients outside Wuhan, and the remaining 2 had no obvious exposure history to patients with COVID-19. As of March 25, 2020, all cases were discharged from the hospital, including the 96-year-old female patient. During follow-up, there was no reported death.

A total of 110 chest CT scans were performed in 35 patients, 2-5 times per patient, with an average interval of 5.6±2.8 days (range: 1-20 days). The initial chest CT scans were performed at 6.1±3.7 days (range: 1-16 days) after the onset illness. The chest CT imaging features of 28 confirmed cases, 7 suspected cases, and cases related to Ningbo Tian-tong Temple or not were shown in Table 3 .

Of the 28 confirmed cases, the most common CT features were bilateral and peripheral GGOs, which were observed in 25 cases (Fig. 1) , followed by GGOs with mixed consolidations (10/28). One patient just had a micronodular foci at the subpleural basal segment of the lower lobe of the right lung. Two patients were negative on initial CT scans. Of the 7 suspected cases, peripheral GGOs were observed in all of them (Table 3) , and these features were similar to the confirmed cases (Fig. 2) . Of the 21 cases related to Ningbo Tian-tong Temple rituals, 17 were confirmed to have COVID-19 pneumonia and the remaining 4 were suspected, all of them had GGOs in the lungs during the initial CT scans, which were similar to the confirmed cases from other areas (Fig. 3) .

In our 35 cases, there were no signs of pericardial effusion, pleural effusion and enlarged lymph nodes on initial CT scans. Three old patients exhibited a progress on the second CT scan, but the lesions were resolved significantly during follow-up CT scans (Fig. 4) . First of all, the number of the patients enrolled in this study was relatively small owing to a single-center case review. Second, the time from onset illness to the initial chest CT scan was inconsistent, and the time interval of each follow-up CT scans was different, so the temporal changes of CT imaging features to different patients could not be accurately evaluated.

In conclusion, our results showed that the most common CT features are multiple J o u r n a l P r e -p r o o f Peri-bronchial distribution 2 (7.1%) 1 (14.3%) 3 (14.3%) 0 (0%) Diffuse distribution 2 (7.1%) 0 (0%) 2 (9.5%) 0 (0%) 

Tang YW Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle

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Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series

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Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study

Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases

Novel coronavirus disease (Covid-19): the first two patients in the UK with person to person transmission

Chest CT Findings in Patients with Corona Virus Disease 2019 and its Relationship with Clinical Features. Invest Radiol. 2020. 13. National Health Commission of the People's Republic of China. Diagnosis and treatment protocols of pneumonia caused by a novel coronavirus

Fleischner Society: glossary of terms for thoracic imaging

Spectrum of clinical and radiographic findings in patients with diagnosis of H1N1 and correlation with clinical severity

Clinical Characteristics of Coronavirus Disease 2019 in China