key: cord-0911374-nrbwbvuh authors: Luo, Zhibing; Wang, Na; Liu, Ping; Guo, Qian; Ran, Linyu; Wang, Feilong; Tang, Yuling; Li, Qiang title: Association between chest CT features and clinical course of Coronavirus Disease 2019 date: 2020-04-22 journal: Respir Med DOI: 10.1016/j.rmed.2020.105989 sha: 2ba064bec028d3d9fad7afc8e740cb2054aa1d9a doc_id: 911374 cord_uid: nrbwbvuh Abstract Purpose This retrospective study aims to illustrate the radiographic characteristics of Coronavirus Disease 2019 and the correlation with the clinical course. Methods 195 hospitalized patients confirmed as Coronavirus Disease 2019 at First Hospital of Changsha, Hunan Province from December 31, 2019 to February 20, 2020 were enrolled. Chest computed tomography scan, clinical data and laboratory tests results were collected accordingly. Variable characteristics were recorded, radiographic evolution and outcome were analyzed along with the time course. Representative laboratory tests results were analyzed based on the image findings. Results Majority of the patients showed bilateral (73.8%), multiple lobes involvements (75.9%), peripheral distribution (83.1%), ground-glass opacification (41.0%), increased vascular margins (63.1%), long axis parallelism (55.9%), patchy ground-glass opacities beneath the pleura (51.3%) and consolidation (45.6%). According to the repeated radiology analysis, patients of improving/stable group tended to have younger age compared with worsening group (45.3 ± 15.0 VS. 59.3 ± 13.5, P = 0.001). Based on the laboratory test results, patients with positive image findings shared elder age, 46.0 (35.0–60.0)VS.31.0 (12.0–37.0) P < 0.001, and higher chance developing fever(P < 0.05); higher level of lymphocytes, C-reactive protein, erythrocyte sedimentation rate and lactate dehydrogenase; lower level of white blood cells, neutrophil and albumin(P < 0.001). Conclusions There are several specific image changes along with the disease progression may be helpful in early recognition and differential diagnosis of Coronavirus Disease 2019. Comprehensive assessments of both imaging feature and laboratory test results may offer an intact knowledge of Coronavirus Disease 2019. The most common symptoms of COVID-19 are non-specific including fever, cough, dyspnea, shortness of breath, and fatigue [7] . Some cases may rapidly progress to severe pneumonia, respiratory failure, multi-organ dysfunction and even death [8] . Gastrointestinal symptoms such as nausea, vomiting, diarrhea and asymptomatic cases have also been described [9, 10] , though relatively rare. Radiographic tests especially chest computed tomography (CT) scan showed several abnormalities strongly favor the diagnosis of COVID-19 including bilateral peripheral ground-glass opacities, consolidation and linear opacities in most cases [11] . SARS-CoV-2 virus is now identified as a member of Betacoronavirus genera of coronavirnae family [12] , which is characterized as positive-sense single-strand RNA (+ssRNA) virus [13] .The definitive diagnosis relies on positive detection of viral RNA nucleic acid amplification tests (Polymerase Chain Reaction, PCR) [14] of specimens either from upper respiratory tract (nasopharyngeal and oropharyngeal swab) or lower respiratory tract (sputum, tracheal aspirate, or bronchoalveolar lavage) [15] . Because of the high specificity but poor sensitivity of nucleic acid test, false negative cases are frequently reported. Thus, acquaintance the radiographic characteristics of COVID-19 lungs is crucial in terms of the early identification, differential diagnosis, staging as well as subsequent management strategies. In this retrospective study, we collected chest CT scan data of 195 cases and clinical characteristics in 187 case of them in First Hospital of Changsha, Hunan Province from December 31, 2019 to February 20, 2020, aiming to describe the CT scan characteristics of COVID-19 and investigate the relationship between the clinical manifestation and radiographic features. 195 hospitalized patients in First Hospital of Changsha, Hunan Province from December 31, 2019 to February 20, 2020 were enrolled and the clinical and laboratory tests data were collected accordingly. The First Hospital of Changsha, capital city of Hunan province with 8.15 million population, also known as Public Health Treatment Center of Changsha, is the only designated hospital for admission and management of COVID-19 patients from Changsha and surrounding area. All of the patients were confirmed of COVID-19 via positive detection of SARS-COV-2 RNA by PCR. CT scan was performed with supine position during a single breath-hold on a Siemens Go Top 64 scanner (Siemens Healthineers, Germany) and a GE Brivo CT325 scanner (GE Healthcare, United States) respectively. For CT acquisition, the voltage was 120kVp and tube current was 350mA, and the slice thickness of the reconstruction was 5mm. Repeated CT scan were performed in 95 patients 3-6 days after the first scan according to the clinical manifestation and rapid disease progression. This study was conducted in accordance with the amended Declaration of Helsinki. Local institutional review boards or independent ethics committees approved the protocol, and written informed consent was obtained from all patients. All the images of 195 patients were anonymously reviewed by two radiologists separately and features were evaluated as follows: 1. Laterality and location of radiographic abnormalities. 2. Numbers of the lobes affected. 3. Ground-glass opacification (GGO): defined as an area of increased attenuation in the lung with preserved bronchial and vascular markings [16] defined as the appearance of ground-glass opacity with superimposed interlobular septal thickening and intralobular septal thickening [17] . 14. Presence of mediastinal lymphadenopathy. 15. Presence of pleural effusion. 16 .Progression assessment of the lesion based on CT scan which refers to: Stable, no change; Improving, decreased area and/or density of the lesion; Worsening, increased area and/or density of the lesion. We also collected laboratory test results including body temperature, complete blood cell (CBC) count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), albumin and lactate dehydrogenase (LDH) level and analyzed comparison based on CT scan findings of total 187 patients. Statistical analysis was performed with SPSS software. Quantitative data such as age was demonstrated as mean with 95% confidence interval, other counting data were present as the percentage of the total and analyzed with Person X 2 test. Significance was defined as a P value<0.05. As shown in Table1, the mean age of our study group is 46 years old (33-59) with no difference between male and female gender. The average duration from the initial symptom onset to the first CT scan was 10.9 days (2-39 days), and there were 95 patients had repeated CT scan after average 3.4 days (3-6 days). There were 25(12.8%) confirmed cases reported no visible abnormalities at the 1 st CT scan. In contrast, there were 31.8% (62 cases) present reversed halo sign, 29.7% (58 cases) with air bronchogram, 5.6% (11 cases) with crazy paving pattern, only 3.1% (6 cases) present with pleural effusion and 1% (2 cases) with mediastinal lymphadenopathy (LAD). As shown in (Table 3) . GGO is commonly seen in many inflammatory diseases such as atypical pneumonia (viral/mycoplasmal/pneumocystis pneumonia), ARDS, pulmonary edema or pulmonary hemorrhage [19] . The pathophysiological mechanism is due to interstitial or alveolar wall thickening secondary to inflammatory reaction, partial filling of air space, or increased capillary There were several limitations of our study. First, because of the short time for data collection, there were only 95 of 195 patients had repeated CT scan and there was a lack of subsequent image follow-up. Second, the slice thickness of our CT scan was 5mm which might have relatively low sensitivity for certain radiological features such as crazy paving, interlobular septal thickening and air bronchogram. At last, there was a lack of severity analysis of our cases. Our study had shown that radiographic worsening tended to happen among elderly group but could not be able to show a correlation between the critical ill patients and radiographic evolution. In conclusion, our study had manifested several certain radiographic characteristics of COVID-19 which may be helpful for the early recognition and differential diagnosis. We also showed a correlation between radiographic feature and laboratory test results and revealed an Decreased area and density of GGO. 2c-d. Increased area and density of GGO. A Novel Coronavirus from Patients with Pneumonia in China Novel Coronavirus (2019-nCoV): situation report-22 Coronavirus disease 2019 Coronavirus disease 2019 Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia Clinical Characteristics of Coronavirus Disease 2019 in China Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China Cases From the Chinese Center for Disease Control and Prevention Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection Emerging coronaviruses: Genome structure, replication, and pathogenesis The coronavirus nucleocapsid is a multifunctional protein A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society The crazy-paving pattern: a radiological-pathological correlation. Insights Imaging Pathological findings of COVID-19 associated with acute respiratory distress syndrome High-resolution CT of parenchymal lung disease: precise correlation with WBC, white blood cell ESR, erythrocyte sedimentation rate We would like to thank all the patients and health care workers devoted themselves into this COVID-19 outbreak. Certain characteristics were identified of CT scan among COVID-19 patients Radiographic features changed along with the clinical time courseNo predictive value was found of radiographic features on COVID-19 progression Positive CT findings were correlated with clinical features ☒ The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.☐The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: