Document Type : Original Article
Authors
1 Department of Infectious Diseases, School of Medicine, Arak University of Medical Sciences, Arak, Iran
2 Department of Radiology, Faculty of Medicine, University of Medical Sciences, Arak, Iran
3 Infectious Diseases Research Center, Arak University of Medical Sciences, Arak, Iran
4 Department of Infectious Diseases, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Background: Coronavirus disease 2019 (COVID-19) can lead to lung damage.
Methods: This study examines the clinical characteristics of 190 patients with severe COVID-19 admitted to a designated hospital in Arak, Iran, from initial diagnosis with chest CT to the recovery stage in the sixth week.
Results: Serial evaluation of CT imaging features over time of COVID-19 showed that peripheral GGO with or without consolidation, especially in the posterior or lower lung zones, were the most common features (P < 0.001 - 0.002). During the first week of follow-up, patients demonstrated a higher prevalence of halo signs, peribronchvascular opacities, bronchial wall thickening, tree-in-bud appearance, and lobar in consolidations compared with pulmonary CT scans performed at the sixth week of onset. COVID-19 pneumonia showed the most severe pulmonary involvement approximately 10 days after symptom onset. After active treatment, in the second follow-up, these consolidations were complete resolution and regressed relatively faster than recovery from other types of lesions, as shown by chest CT imaging. In severe COVID-19, ground-glass opacities, consolidation, particularly in lower regions of the lungs, crazy-paving patterns, air bronchograms, and reverse halo signs are often found on the initial CT examinations (days 7 to 10). Most of these severe features gradually regressed in the absorption phase (on days 40 to 42 in early diagnosis and treatment).
Conclusion: CT imaging plays a crucial role in detecting pneumonia and has a high sensitivity in detecting COVID-19 pneumonia but cannot be used as gold-standard for COVID-19 diagnosis.
Highlights
Hossein Sarmadian (Google Scholar) (PubMed)
Shiva Shabani (Google Scholar) (PubMed)
Keywords
Main Subjects
- Liu C, Ye L, Xia R, Zheng X, Yuan C, Wang Z, et al. Chest computed tomography and clinical follow-up of discharged patients with COVID-19 in Wenzhou city, Zhejiang, China. Ann Am Thorac Soc. 2020;17(10):1231-7. doi: 10.1513/ AnnalsATS.202004-324OC.
- Pazooki B, Ahangari A, Mehrabi Nejad MM, Batavani N, Salahshour F. Evaluation of follow-up CT scans in patients with severe initial pulmonary involvement by COVID-19. Can Respir J. 2022;2022:6972998. doi: 10.1155/2022/6972998.
- Yun Y, Wang Y, Hao Y, Xu L, Cai Q. The time course of chest CT lung changes in COVID-19 patients from onset to discharge. Eur J Radiol Open. 2021;8:100305. doi: 10.1016/j. ejro.2020.100305.
- Kaufman AE, Naidu S, Ramachandran S, Kaufman DS, Fayad ZA, Mani V. Review of radiographic findings in COVID-19. World J Radiol. 2020;12(8):142-55. doi: 10.4329/wjr.v12. i8.142.
- Zhang JF, Yan K, Ye HH, Lin J, Zheng JJ, Cai T. SARS-CoV-2 turned positive in a discharged patient with COVID-19 arouses concern regarding the present standards for discharge. Int J Infect Dis. 2020;97:212-4. doi: 10.1016/j.ijid.2020.03.007.
- Chen D, Xu W, Lei Z, Huang Z, Liu J, Gao Z, et al. Recurrence of positive SARS-CoV-2 RNA in COVID-19: a case report. Int J Infect Dis. 2020;93:297-9. doi: 10.1016/j.ijid.2020.03.003.
- Asefi H, Safaie A. The role of chest CT scan in diagnosis of COVID-19. Front Emerg Med. 2020;4(2s):e64.
- Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19) imaging reporting and data system (COVID-RADS) and common lexicon: a proposal based on the imaging data of 37 studies. Eur Radiol. 2020;30(9):4930-42. doi: 10.1007/s00330-020-06863-0.
- Dai WC, Zhang HW, Yu J, Xu HJ, Chen H, Luo SP, et al. CT imaging and differential diagnosis of COVID-19. Can Assoc Radiol J. 2020;71(2):195-200. doi: 10.1177/0846537120913033.
- Han X, Fan Y, Alwalid O, Li N, Jia X, Yuan M, et al. Six-month follow-up chest CT findings after severe COVID-19 pneumonia. Radiology. 2021;299(1):E177-86. doi: 10.1148/ radiol.2021203153.
- Wang Y, Dong C, Hu Y, Li C, Ren Q, Zhang X, et al. Temporal changes of CT findings in 90 patients with COVID-19 pneumonia: a longitudinal study. Radiology. 2020;296(2):E55- 64. doi: 10.1148/radiol.2020200843.
- Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19). Radiology. 2020;295(3):715-21. doi: 10.1148/radiol.2020200370.
- Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X, et al. CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology. 2020;295(1):202-7. doi: 10.1148/ radiol.2020200230.
- Kong W, Agarwal PP. Chest imaging appearance of COVID-19 infection. Radiol Cardiothorac Imaging. 2020;2(1):e200028. doi: 10.1148/ryct.2020200028.
- Guan CS, Lv ZB, Yan S, Du YN, Chen H, Wei LG, et al. Imaging features of coronavirus disease 2019 (COVID-19): evaluation on thin-section CT. Acad Radiol. 2020;27(5):609- 13. doi: 10.1016/j.acra.2020.03.002.
)