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25 maart 2020

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

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


  • 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.