Frequency and Distribution of Chest Radiographic Findings in Patients Positive for COVID-19

• Published in: Radiology Vol. 296; no. 2; pp. E72 - E78
• Main Authors: Wong, Ho Yuen Frank, Lam, Hiu Yin Sonia, Fong, Ambrose Ho-Tung, Leung, Siu Ting, Chin, Thomas Wing-Yan, Lo, Christine Shing Yen, Lui, Macy Mei-Sze, Lee, Jonan Chun Yin, Chiu, Keith Wan-Hang, Chung, Tom Wai-Hin, Lee, Elaine Yuen Phin, Wan, Eric Yuk Fai, Hung, Ivan Fan Ngai, Lam, Tina Poy Wing, Kuo, Michael D., Ng, Ming-Yen
• Format: Journal Article
• Language: English
• Published: United States 01.08.2020
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Betacoronavirus; Clinical Laboratory Techniques - methods; Coronavirus Infections - complications; Coronavirus Infections - diagnosis; Coronavirus Infections - diagnostic imaging; COVID-19; COVID-19 Testing; COVID-19 Vaccines; Female; Humans; Male; Middle Aged; Pandemics; Pneumonia, Viral - complications; Pneumonia, Viral - diagnostic imaging; Pneumonia, Viral - virology; Radiographic Image Interpretation, Computer-Assisted - methods; Reproducibility of Results; Retrospective Studies; Reverse Transcriptase Polymerase Chain Reaction - methods; SARS-CoV-2; Severity of Illness Index; Tomography, X-Ray Computed - methods; Young Adult
• DOI: 10.1148/radiol.2020201160
• ISSN: 0033-8419; 1527-1315

Background Current coronavirus disease 2019 (COVID-19) radiologic literature is dominated by CT, and a detailed description of chest radiography appearances in relation to the disease time course is lacking. Purpose To describe the time course and severity of findings of COVID-19 at chest radiography and correlate these with real-time reverse transcription polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, nucleic acid. Materials and Methods This is a retrospective study of patients with COVID-19 confirmed by using RT-PCR and chest radiographic examinations who were admitted across four hospitals and evaluated between January and March 2020. Baseline and serial chest radiographs ( = 255) were reviewed with RT-PCR. Correlation with concurrent CT examinations ( = 28) was performed when available. Two radiologists scored each chest radiograph in consensus for consolidation, ground-glass opacity, location, and pleural fluid. A severity index was determined for each lung. The lung scores were summed to produce the final severity score. Results The study was composed of 64 patients (26 men; mean age, 56 years ± 19 [standard deviation]). Of these, 58 patients had initial positive findings with RT-PCR (91%; 95% confidence interval: 81%, 96%), 44 patients had abnormal findings at baseline chest radiography (69%; 95% confidence interval: 56%, 80%), and 38 patients had initial positive findings with RT-PCR testing and abnormal findings at baseline chest radiography (59%; 95% confidence interval: 46%, 71%). Six patients (9%) showed abnormalities at chest radiography before eventually testing positive for COVID-19 with RT-PCR. Sensitivity of initial RT-PCR (91%; 95% confidence interval: 83%, 97%) was higher than that of baseline chest radiography (69%; 95% confidence interval: 56%, 80%) ( = .009). Radiographic recovery (mean, 6 days ± 5) and virologic recovery (mean, 8 days ± 6) were not significantly different ( = .33). Consolidation was the most common finding (30 of 64; 47%) followed by ground-glass opacities (21 of 64; 33%). Abnormalities at chest radiography had a peripheral distribution (26 of 64; 41%) and lower zone distribution (32 of 64; 50%) with bilateral involvement (32 of 64; 50%). Pleural effusion was uncommon (two of 64; 3%). The severity of findings at chest radiography peaked at 10-12 days from the date of symptom onset. Conclusion Findings at chest radiography in patients with coronavirus disease 2019 frequently showed bilateral lower zone consolidation, which peaked at 10-12 days from symptom onset. © RSNA, 2020.