Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study
Heshui Shi, Xiaoyu Han, Nanchuan Jiang, Yukun Cao, Osamah Alwalid, Jin Gu, Yanqing Fan, Chuansheng Zheng, Heshui Shi, Xiaoyu Han, Nanchuan Jiang, Yukun Cao, Osamah Alwalid, Jin Gu, Yanqing Fan, Chuansheng Zheng
Abstract
Background: A cluster of patients with coronavirus disease 2019 (COVID-19) pneumonia caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were successively reported in Wuhan, China. We aimed to describe the CT findings across different timepoints throughout the disease course.
Methods: Patients with COVID-19 pneumonia (confirmed by next-generation sequencing or RT-PCR) who were admitted to one of two hospitals in Wuhan and who underwent serial chest CT scans were retrospectively enrolled. Patients were grouped on the basis of the interval between symptom onset and the first CT scan: group 1 (subclinical patients; scans done before symptom onset), group 2 (scans done ≤1 week after symptom onset), group 3 (>1 week to 2 weeks), and group 4 (>2 weeks to 3 weeks). Imaging features and their distribution were analysed and compared across the four groups.
Findings: 81 patients admitted to hospital between Dec 20, 2019, and Jan 23, 2020, were retrospectively enrolled. The cohort included 42 (52%) men and 39 (48%) women, and the mean age was 49·5 years (SD 11·0). The mean number of involved lung segments was 10·5 (SD 6·4) overall, 2·8 (3·3) in group 1, 11·1 (5·4) in group 2, 13·0 (5·7) in group 3, and 12·1 (5·9) in group 4. The predominant pattern of abnormality observed was bilateral (64 [79%] patients), peripheral (44 [54%]), ill-defined (66 [81%]), and ground-glass opacification (53 [65%]), mainly involving the right lower lobes (225 [27%] of 849 affected segments). In group 1 (n=15), the predominant pattern was unilateral (nine [60%]) and multifocal (eight [53%]) ground-glass opacities (14 [93%]). Lesions quickly evolved to bilateral (19 [90%]), diffuse (11 [52%]) ground-glass opacity predominance (17 [81%]) in group 2 (n=21). Thereafter, the prevalence of ground-glass opacities continued to decrease (17 [57%] of 30 patients in group 3, and five [33%] of 15 in group 4), and consolidation and mixed patterns became more frequent (12 [40%] in group 3, eight [53%] in group 4).
Interpretation: COVID-19 pneumonia manifests with chest CT imaging abnormalities, even in asymptomatic patients, with rapid evolution from focal unilateral to diffuse bilateral ground-glass opacities that progressed to or co-existed with consolidations within 1-3 weeks. Combining assessment of imaging features with clinical and laboratory findings could facilitate early diagnosis of COVID-19 pneumonia.
Funding: None.
Copyright © 2020 Elsevier Ltd. All rights reserved.
Figures
References
- WHO Novel coronavirus—China. Jan 12, 2020.
- WHO Coronavirus disease (COVID-19) outbreak. 2020.
- Xu X, Chen P, Wang J. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci. 2020 doi: 10.1007/s11427-020-1637-5. published online Jan 21.
- Tan W, Zhao X, Ma X. Notes from the field: a novel coronavirus genome identified in a cluster of pneumonia cases—Wuhan, China 2019–2020. China CDC Weekly. 2020;2:61–62.
- Na Z, Ding Z, Wen W. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–605.
- WHO Novel coronavirus—Thailand (ex-China) Jan 14, 2020.
- WHO Novel coronavirus—Japan (ex-China) Jan 17, 2020.
- WHO Novel coronavirus—Republic of Korea (ex-China) Jan 21, 2020.
- US Centers for Disease Control and Prevention First travel-related case of 2019 novel coronavirus detected in United States. Jan 21, 2020.
- Tsang KW, Ho PL, Ooi GC. A cluster of cases of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003;348:1977–1985.
- Assiri A, Al-Tawfq JA, Al-Rabeeah AA. Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study. Lancet Infect Dis. 2013;13:752–761.
- WHO Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance. Jan 28, 2020.
- Richman DD, Whitley RJ, Hayden FG, editors. Clinical virology. 4th edn. ASM Press; Washington: 2016.
- Ksiazek TG, Erdman D, Goldsmith CS. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med. 2003;348:1953–1966.
- Kuiken T, Fouchier RAM, Schutten M. Newly discovered coronavirus as the primary cause of severe acute respiratory syndrome. Lancet. 2003;362:263–270.
- de Groot RJ, Baker SC, Baric RS. Middle East respiratory syndrome coronavirus (MERS-CoV): announcement of the Coronavirus Study Group. J Virol. 2013;87:7790–7792.
- Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus AD, Fouchier RA. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med. 2012;367:1814–1820.
- Liu S, Sun J, Cai J. Epidemiological, clinical and viral characteristics of fatal cases of human avian influenza A (H7N9) virus in Zhejiang Province, China. J Infect. 2013;67:595–605.
- Chen X, Yang Z, Lu Y, Xu Q, Wang Q, Chen L. Clinical features and factors associated with outcomes of patients infected with a novel influenza A (H7N9) virus: a preliminary study. PLoS One. 2013;8
- Lee N, Hui D, Wu A. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003;348:1986–1994.
- Wang Q, Zhang Z, Shi Y, Jiang Y. Emerging H7N9 influenza A (novel reassortant avian-origin) pneumonia: radiologic findings. Radiology. 2013;268:882–889.
- Müller NL, Ooi GC, Khong PL, Nicolaou S. Severe acute respiratory syndrome: radiographic and CT findings. AJR Am J Roentgenol. 2003;181:3–8.
- Wong KT, Antonio GE, Hui DS. Thin-section CT of severe acute respiratory syndrome: evaluation of 73 patients exposed to or with the disease. Radiology. 2003;228:395–400.
- Zhao Z, Liang C, Zhang J, Zhang R, He H. Clinical and imaging findings in patients with severe acute respiratory syndrome. Chin Med J (Engl) 2003;116:1104–1105.
- Das KM, Lee EY, Enani MA. CT correlation with outcomes in 15 patients with acute Middle East respiratory syndrome coronavirus. AJR Am J Roentgenol. 2015;204:736–742.
- Ajlan AM, Ahyad RA, Jamjoom LG, Alharthy A, Madani TA. Middle East respiratory syndrome coronavirus (MERS-CoV) infection: chest CT findings. AJR Am J Roentgenol. 2014;203:782–787.
- Das KM, Lee EY, Al Jawder SE. Acute Middle East respiratory syndrome coronavirus: temporal lung changes observed on the chest radiographs of 55 patients. AJR Am J Roentgenol. 2015;205:W267–W274.
- Qureshi NR, Hien TT, Farrar J, Gleeson FV. The radiologic manifestations of H5N1 avian influenza. J Thorac Imaging. 2006;21:259–264.
- Ujita M, Renzoni EA, Veeraraghavan S, Wells AU, Hansell DM. Organizing pneumonia: perilobular pattern at thin-section CT. Radiology. 2004;232:757–761.
- Travis WD, Costabel U, Hansell DM. An official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med. 2013;188:733–748.
Source: PubMed