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

Bron: 24-02-2020: https://www.thelancet.com/action/showPdf?pii=S1473-3099%2820%2930086-4

Aim
To describe the CT findings across different time points throughout the disease course

Key finding

• COVID-19 pneumonia manifests with chest CT-scan abnormalities, even in asymptomatic patients
• Rapid evolution from focal unilateral to diffuse bilateral ground-glass opacities that progressed to or co-existed with consolidations within 1-3 weeks
• Combining imaging features with clinical and laboratory findings could facilitate early diagnosis of COVID-19 pneumonia

Summary

• Retrospective study performed at two centres in Wuhan
• 81 patients admitted to one of the hospitals between Dec 20, 2019 and Jan 23, 2020, with confirmed COVID-19 pneumonia, were retrospectively included in this study
• Patients were grouped according to interval between symptoms onset and first CT scan:
  • group 1 → scan performed before symptoms
  • group 2 → scan performed ≤ 1 week after symptoms onset
  • group 3 → scan performed > 1 to 2 weeks after symptoms onset
  • group 4 → scan performed > 2 to 3 weeks after symptoms onset
• Characteristics full cohort:
  • mean age: 49.5 (25-81)
  • 52% male, 48% female
  • most common clinical symptoms:
    • fever 73%
    • dry cough 59%
    • headache 6%
    • generalised weakness 9%
  • mean number of involved lung segments: 10.5, with right lower lobes most commonly affected
• Typical pattern of CT imaging features per group (figure):
  • group 1: unilateral and multifocal ground-glass opacities
  • group 2: lesions quickly evolved to bilateral and diffuse ground-glass opacities, with a relative decrease in the frequency of ground-glass and transition to consolidation and mixed-pattern
  • group 3-4: ground-glass opacities continued to decrease, while consolidation became the second most common pattern
• The imaging characteristics are non-specific and bear some resemblance to those of SARS-CoV and MERS-CoV infections
• The most common pattern of of evolution throughout series of CT scans in this study was initial progression to a peak level, followed by radiographic improvement. Most patients who showed a pattern of radiographic improvement across several scans were discharged from the hospital
• Progressive radiographic deterioration, despite medical treatment, seems to be associated with poor prognosis
• Conclusion:
  • COVID-19 tends to manifest on lung CT scan as bilateral, subpleural, ground-glass opacities
  • Abnormal lung CT findings can be present even in asymptomatic patients
  • Lesions rapidly evolve into a diffuse ground-glass opacity or consolidation pattern within 1-3 weeks

Old age, male sex, underlying comorbidities and progressive radiographic deterioration on follow-up CT might be risk factors for poor prognosis in patients with COVID-19 pneumonia.