CT features of SARS-CoV-2 pneumonia according to clinical presentation: a retrospective analysis of 120 consecutive patients from Wuhan city
Tóm tắt
To characterize the chest computed tomography (CT) findings of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) according to clinical severity. We compared the CT features of common cases and severe cases, symptomatic patients and asymptomatic patients, and febrile and afebrile patients. This was a retrospective analysis of the clinical and thoracic CT features of 120 consecutive patients with confirmed SARS-CoV-2 pneumonia admitted to a tertiary university hospital between January 10 and February 10, 2020, in Wuhan city, China. On admission, the patients generally complained of fever, cough, shortness of breath, and myalgia or fatigue, with diarrhea often present in severe cases. Severe patients were 20 years older on average and had comorbidities and an elevated lactate dehydrogenase (LDH) level. There were no differences in the CT findings between asymptomatic and symptomatic common type patients or between afebrile and febrile patients, defined according to Chinese National Health Commission guidelines. The clinical and CT features at admission may enable clinicians to promptly evaluate the prognosis of patients with SARS-CoV-2 pneumonia. Clinicians should be aware that clinically silent cases may present with CT features similar to those of symptomatic common patients.
• The clinical features and predominant patterns of abnormalities on CT for asymptomatic, typic common, and severe cases were summarized. These findings may help clinicians to identify severe patients quickly at admission.
• Clinicians should be cautious that CT findings of afebrile/asymptomatic patients are not better than the findings of other types of patients. These patients should also be quarantined.
• The use of chest CT as the main screening method in epidemic areas is recommended.
Tài liệu tham khảo
Zhu N, Zhang D, Wang W et al (2020) A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 382:727–733
World Health Organization (2020) Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). WHO, Geneva, Switzerland
World Health Organization (2020) WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020. https://www.who.int/dg/speeches/detail/whodirector-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020
Zhou P, Yang XL, Wang XG et al (2020) A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 1038:020–2012
Wong KT, Antonio GE, Hui DS et al (2003) Severe acute respiratory syndrome: radiographic appearances and pattern of progression in 138 patients. Radiology 228:401–406
Paul NS, Roberts H, Butany J et al (2004) Radiologic pattern of disease in patients with severe acute respiratory syndrome: the Toronto experience. Radiographics 24:553–563
Assiri A, Al-Tawfiq JA, Al-Rabeeah AA et al (2013) Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study. Lancet Infect Dis 13:752–761
Wang D, Hu B, Hu C et al (2020) Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 323(11):1061–1069
Chen N, Zhou M, Dong X et al (2020) Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 6736:30211–30217
Li Q, Guan X, Wu P et al (2020) Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 382:1199–1207
Guan W-j, Ni Z-y, Hu Y et al (2020) Clinical characteristics of 2019 novel coronavirus infection in China. medRxiv. https://doi.org/10.1101/2020.02.06.20020974
Duan Y-n, Qin J (2020) Pre- and posttreatment chest CT findings: 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology 295(1):21
Pan Y, Guan H (2020) Imaging changes in patients with 2019-nCov. Eur Radiol. https://doi.org/10.1007/s00330-020-06713-z
Pan Y, Guan H, Zhou S et al (2020) Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol. https://doi.org/10.1007/s00330-020-06731-x
Shi H, Han X, Zheng C (2020) Evolution of CT manifestations in a patient recovered from 2019 novel coronavirus (2019-nCoV) pneumonia in Wuhan, China. Radiology 295(1):20
Song F, Shi N, Shan F et al (2020) Emerging coronavirus 2019-nCoV pneumonia. Radiology 295(1):210–217
Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J (2020) Chest CT for typical 2019-nCoV pneumonia: relationship to negative RT-PCR testing. Radiology. https://doi.org/10.1148/radiol.2020200343
Chung M, Bernheim A, Mei X et al (2020) CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology 295(1):202–207
Lei J, Li J, Li X, Qi X (2020) CT imaging of the 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology 295(1):18
Pan F, Ye T, Sun P et al (2020) Time course of lung changes on chest CT during recovery from 2019 novel coronavirus (COVID-19) pneumonia. Radiology. https://doi.org/10.1148/radiol.2020200370
Franquet T (2011) Imaging of pulmonary viral pneumonia. Radiology 260:18–39
Koo HJ, Lim S, Choe J, Choi SH, Sung H, Do KH (2018) Radiographic and CT features of viral pneumonia. Radiographics 38:719–739
World Health Organization (2020) Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected: interim guidance. https://apps.who.int/iris/handle/10665/330893
Pneumonia diagnosis and treatment of novel coronavirus infection (trial version 5). National health commission of the People’s Republic of China http://www.nhc.gov.cn/yzygj/s7653p/202002/3b09b894ac9b4204a79db5b8912d4440/files/7260301a393845fc87fcf6dd52965ecb.pdf
National Health Commission of the People’s Republic of China. Prevention of 2019-nCoV infected pneumonia, version 2. website: http://www.nhc.gov.cn/jkj/s3577/202001/c67cfe29ecf1470e8c7fc47d3b751e88.shtml. Accessed on 8 Feb 2020
National Institute for Viral Disease Control and Prevention of China. Specific primers and probes for detection 2019 novel coronavirus. website: http://ivdc.chinacdc.cn/kyjz/202001/t20200121_211337.html Accessed on 8 Feb 2020
Ai T, Yang Z, Hou H et al (2020) Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology. https://doi.org/10.1148/radiol.2020200642