Chest computed tomography findings of coronavirus disease 2019 (COVID-19) pneumonia

• Published in: European radiology Vol. 30; no. 10; pp. 5489 - 5498
• Main Authors: Fu, Fangfang, Lou, Jianghua, Xi, Deyan, Bai, Yan, Ma, Gongbao, Zhao, Bin, Liu, Dong, Bao, Guofeng, Lei, Zhidan, Wang, Meiyun
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2020; Springer Nature B.V
• Subjects: Adult; Aged; Betacoronavirus; Chest; Computed tomography; Consolidation; Coronaviridae; Coronavirus Infections - diagnosis; Coronaviruses; COVID-19; Diagnostic Radiology; Disease Progression; Female; Glass; Humans; Imaging; Internal Medicine; Interventional Radiology; Lobes; Lung - diagnostic imaging; Lungs; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Opacity; Pandemics; Pneumonia; Pneumonia, Viral - diagnosis; Polymerase chain reaction; Radiology; Retrospective Studies; SARS-CoV-2; Signs and symptoms; Tomography; Tomography, X-Ray Computed - methods; Ultrasound; Viral diseases; Pneumonia; Thoracic diseases; Coronavirus; Tomography, spiral computed
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-020-06920-8

Objective To retrospectively analyze the chest computed tomography (CT) features in patients with coronavirus disease 2019 (COVID-19) pneumonia. Methods From January 9, 2020, to February 26, 2020, totally 56 laboratory-confirmed patients with COVID-19 underwent chest CT. For 40 patients, follow-up CT scans were obtained. The CT images were evaluated for the number, type and distribution of the opacity, and the affected lung lobes. Furthermore, the initial CT scan and the follow-up CT scans were compared. Results Forty patients (83.6%) had two or more opacities in the lung. Eighteen (32.7%) patients had only ground-glass opacities; twenty-nine patients (52.7%) had ground-glass and consolidative opacities; and eight patients (14.5%) had only consolidation. A total of 43 patients (78.2%) showed two or more lobes involved. The opacities tended to be both in peripheral and central (30/55, 54.5%) or purely peripheral distribution (25/55, 45.5%). Fifty patients (90.9%) had the lower lobe involved. The first follow-up CT scans showed that twelve patients (30%) had improvement, 26 (65%) patients had mild-moderate progression, and two patients (5%) had severe progression with “white lungs.” The second follow-up CT showed that 22 patients (71%) showed improvement compared with the first follow-up CT, four patients (12.9%) had aggravated progression, and five patients (16.1%) showed unchanged radiographic appearance. Conclusions The common CT features of COVID-19 pneumonia are multiple lung opacities, multiple types of the opacity (ground-glass, ground-glass and consolidation, and consolidation alone), and multiple lobes especially the lower lobe involved. Follow-up CT could demonstrate the rapid progression of COVID-19 pneumonia (either in aggravation or absorption). Key Points • The predominant CT features of COVID-19 pneumonia are multiple ground-glass opacities with or without consolidation and, with both lungs, multiple lobes and especially the lower lobe affected. • CT plays a crucial role in early diagnosis and assessment of COVID-19 pneumonia progression. • CT findings of COVID-19 pneumonia may not be consistent with the clinical symptoms or the initial RT-PCR test results.