Chest CT in COVID-19: What the Radiologist Needs to Know

Thomas C Kwee, Robert M Kwee, Thomas C Kwee, Robert M Kwee

Abstract

Chest CT has a potential role in the diagnosis, detection of complications, and prognostication of coronavirus disease 2019 (COVID-19). Implementation of appropriate precautionary safety measures, chest CT protocol optimization, and a standardized reporting system based on the pulmonary findings in this disease will enhance the clinical utility of chest CT. However, chest CT examinations may lead to both false-negative and false-positive results. Furthermore, the added value of chest CT in diagnostic decision making is dependent on several dynamic variables, most notably available resources (real-time reverse transcription-polymerase chain reaction [RT-PCR] tests, personal protective equipment, CT scanners, hospital and radiology personnel availability, and isolation room capacity) and the prevalence of both COVID-19 and other diseases with overlapping manifestations at chest CT. Chest CT is valuable to detect both alternative diagnoses and complications of COVID-19 (acute respiratory distress syndrome, pulmonary embolism, and heart failure), while its role for prognostication requires further investigation. The authors describe imaging and managing care of patients with COVID-19, with topics including (a) chest CT protocol, (b) chest CT findings of COVID-19 and its complications, (c) the diagnostic accuracy of chest CT and its role in diagnostic decision making and prognostication, and (d) reporting and communicating chest CT findings. The authors also review other specific topics, including the pathophysiology and clinical manifestations of COVID-19, the World Health Organization case definition, the value of performing RT-PCR tests, and the radiology department and personnel impact related to performing chest CT in COVID-19. ©RSNA, 2020.

Figures

Figure 1a.
Figure 1a.
COVID-19 pneumonia with typical imaging features according to the Radiological Society of North America (RSNA) chest CT classification system (51). Axial nonenhanced chest CT images (lung window) in a 59-year-old man (a) and a 47-year-old man (b), each with positive RT-PCR test results for SARS-CoV-2, show bilateral areas of ground-glass opacities (arrows) in a peripheral distribution.
Figure 1b.
Figure 1b.
COVID-19 pneumonia with typical imaging features according to the Radiological Society of North America (RSNA) chest CT classification system (51). Axial nonenhanced chest CT images (lung window) in a 59-year-old man (a) and a 47-year-old man (b), each with positive RT-PCR test results for SARS-CoV-2, show bilateral areas of ground-glass opacities (arrows) in a peripheral distribution.
Figure 2.
Figure 2.
Chest CT abnormalities of relatively high prevalence in COVID-19. Axial nonenhanced chest CT image (lung window) shows bilateral ground-glass opacities and dilated segmental and subsegmental vessels, mainly on the right, in a 70-year-old man with positive RT-PCR test results for SARS-CoV-2.
Figure 3.
Figure 3.
Chest CT abnormalities of relatively intermediate prevalence in COVID-19, shown in a 63-year-old man with positive RT-PCR test results for SARS-CoV-2. Axial nonenhanced chest CT image shows a subpleural curvilinear opacity (arrow) and an area of ground-glass opacity (arrowhead) in the right upper lobe.
Figure 4.
Figure 4.
Crazy-paving pattern in a 66-year-old man with COVID-19. Axial nonenhanced chest CT image shows ground-glass opacities, with superimposed septal thickening (arrows) in the middle lobe and left lower lobe.
Figure 5a.
Figure 5a.
Halo sign in a 55-year-old man with RT-PCR-test–proven COVID-19. Axial nonenhanced chest CT images show consolidations surrounded by ground-glass opacities (arrows) in both upper lobes, findings consistent with the halo sign. There is a ground-glass opacity in the right upper lobe (arrowhead in a) and consolidation in both lower lobes (arrowheads in b).
Figure 5b.
Figure 5b.
Halo sign in a 55-year-old man with RT-PCR-test–proven COVID-19. Axial nonenhanced chest CT images show consolidations surrounded by ground-glass opacities (arrows) in both upper lobes, findings consistent with the halo sign. There is a ground-glass opacity in the right upper lobe (arrowhead in a) and consolidation in both lower lobes (arrowheads in b).
Figure 6a.
Figure 6a.
Development of cavitating lung lesions in a 47-year-old man with COVID-19. (a, b) Axial nonenhanced CT images (lung window) obtained at hospital admission show ground-glass opacities in both lungs (early progressive stage). (c, d) Axial nonenhanced CT images (lung window) obtained after 10 days show progressive organizing consolidation (peak stage). (e, f) Axial nonenhanced CT images (lung window) obtained 40 days after the baseline CT images(a, b) show cavitating lesions in both lower lobes (arrow) (late stage).
Figure 6b.
Figure 6b.
Development of cavitating lung lesions in a 47-year-old man with COVID-19. (a, b) Axial nonenhanced CT images (lung window) obtained at hospital admission show ground-glass opacities in both lungs (early progressive stage). (c, d) Axial nonenhanced CT images (lung window) obtained after 10 days show progressive organizing consolidation (peak stage). (e, f) Axial nonenhanced CT images (lung window) obtained 40 days after the baseline CT images(a, b) show cavitating lesions in both lower lobes (arrow) (late stage).
Figure 6c.
Figure 6c.
Development of cavitating lung lesions in a 47-year-old man with COVID-19. (a, b) Axial nonenhanced CT images (lung window) obtained at hospital admission show ground-glass opacities in both lungs (early progressive stage). (c, d) Axial nonenhanced CT images (lung window) obtained after 10 days show progressive organizing consolidation (peak stage). (e, f) Axial nonenhanced CT images (lung window) obtained 40 days after the baseline CT images(a, b) show cavitating lesions in both lower lobes (arrow) (late stage).
Figure 6d.
Figure 6d.
Development of cavitating lung lesions in a 47-year-old man with COVID-19. (a, b) Axial nonenhanced CT images (lung window) obtained at hospital admission show ground-glass opacities in both lungs (early progressive stage). (c, d) Axial nonenhanced CT images (lung window) obtained after 10 days show progressive organizing consolidation (peak stage). (e, f) Axial nonenhanced CT images (lung window) obtained 40 days after the baseline CT images(a, b) show cavitating lesions in both lower lobes (arrow) (late stage).
Figure 6e.
Figure 6e.
Development of cavitating lung lesions in a 47-year-old man with COVID-19. (a, b) Axial nonenhanced CT images (lung window) obtained at hospital admission show ground-glass opacities in both lungs (early progressive stage). (c, d) Axial nonenhanced CT images (lung window) obtained after 10 days show progressive organizing consolidation (peak stage). (e, f) Axial nonenhanced CT images (lung window) obtained 40 days after the baseline CT images(a, b) show cavitating lesions in both lower lobes (arrow) (late stage).
Figure 6f.
Figure 6f.
Development of cavitating lung lesions in a 47-year-old man with COVID-19. (a, b) Axial nonenhanced CT images (lung window) obtained at hospital admission show ground-glass opacities in both lungs (early progressive stage). (c, d) Axial nonenhanced CT images (lung window) obtained after 10 days show progressive organizing consolidation (peak stage). (e, f) Axial nonenhanced CT images (lung window) obtained 40 days after the baseline CT images(a, b) show cavitating lesions in both lower lobes (arrow) (late stage).
Figure 7a.
Figure 7a.
Transition from progressive stage to peak stage in a 69-year-old man with COVID-19. (a) Axial nonenhanced chest CT image (lung window) obtained at hospital admission shows bilateral areas of ground-glass opacities and crazy-paving appearance. (b)Axial contrast-enhanced chest CT image (lung window) obtained after 7 days shows progression from ground-glass opacities to multifocal organizing consolidation.
Figure 7b.
Figure 7b.
Transition from progressive stage to peak stage in a 69-year-old man with COVID-19. (a) Axial nonenhanced chest CT image (lung window) obtained at hospital admission shows bilateral areas of ground-glass opacities and crazy-paving appearance. (b)Axial contrast-enhanced chest CT image (lung window) obtained after 7 days shows progression from ground-glass opacities to multifocal organizing consolidation.
Figure 8a.
Figure 8a.
Occurrence of lung fibrosis in a 75-year-old man with COVID-19.(a) Axial nonenhanced CT image (lung window) obtained at hospital admission shows bilateral ground-glass opacities, which are mainly peripherally located. (b) Axial contrast-enhanced CT image (lung window) obtained after 8 weeks shows bilateral curvilinear parenchymal bands with distortion of lung architecture. Focal traction bronchiectasis (not shown) also manifested.
Figure 8b.
Figure 8b.
Occurrence of lung fibrosis in a 75-year-old man with COVID-19.(a) Axial nonenhanced CT image (lung window) obtained at hospital admission shows bilateral ground-glass opacities, which are mainly peripherally located. (b) Axial contrast-enhanced CT image (lung window) obtained after 8 weeks shows bilateral curvilinear parenchymal bands with distortion of lung architecture. Focal traction bronchiectasis (not shown) also manifested.
Figures 9.
Figures 9.
Findings classified as indeterminate appearance of COVID-19 pneumonia in a 26-year-old woman. Axial nonenhanced chest CT image (lung window) shows an area of ground-glass opacity (arrow) in the posterior basal segment of the left lower lobe. No other lung abnormalities were visualized. The RT-PCR test results were positive for SARS-CoV-2.
Figures 10.
Figures 10.
Findings classified as indeterminate appearance of COVID-19 pneumonia according to the RSNA chest CT classification system (51) in a 24-year-old woman. Axial nonenhanced chest CT image (lung window) shows ground-glass opacities (arrow) in the right upper lobe. In addition, there are discrete centrilobular opacities in the upper lobes. The RT-PCR test results were negative for SARS-CoV-2 but positive for influenza type A.
Figure 11.
Figure 11.
Findings classified as atypical appearance of COVID-19 pneumonia in a 94-year-old woman. Axial nonenhanced chest CT image (lung window) shows subtle centrilobular tree-in-bud opacities (arrows) in the left lower lobe. The RT-PCR test results were negative for SARS-CoV-2 but positive for influenza type A.
Figure 12a.
Figure 12a.
Mixed chest CT findings in an 86-year-old man. (a) Axial nonenhanced CT image (lung window) obtained at hospital admission shows sublobar consolidation (arrow) in the posterior segment of the right upper lobe, a finding more consistent with lobar pneumonia than COVID-19.(b) Axial CT image obtained at a more superior level shows the presence of ground-glass opacities (arrows). Altogether, the findings were classified as indeterminate for COVID-19 pneumonia, according to the RSNA chest CT classification system (51). The RT-PCR test results were positive for SARS-CoV-2.
Figure 12b.
Figure 12b.
Mixed chest CT findings in an 86-year-old man. (a) Axial nonenhanced CT image (lung window) obtained at hospital admission shows sublobar consolidation (arrow) in the posterior segment of the right upper lobe, a finding more consistent with lobar pneumonia than COVID-19.(b) Axial CT image obtained at a more superior level shows the presence of ground-glass opacities (arrows). Altogether, the findings were classified as indeterminate for COVID-19 pneumonia, according to the RSNA chest CT classification system (51). The RT-PCR test results were positive for SARS-CoV-2.
Figure 13a.
Figure 13a.
Development of ARDS in a 60-year-old man with COVID-19. (a)Axial nonenhanced CT image (lung window) obtained at hospital admission shows peripherally located ground-glass opacities (arrow), mainly in the right lung. Note the preexisting centrilobular and paraseptal emphysema.(b) Axial contrast-enhanced CT image (lung window) obtained after 3 days shows a marked progression of lung abnormalities (arrows).
Figure 13b.
Figure 13b.
Development of ARDS in a 60-year-old man with COVID-19. (a)Axial nonenhanced CT image (lung window) obtained at hospital admission shows peripherally located ground-glass opacities (arrow), mainly in the right lung. Note the preexisting centrilobular and paraseptal emphysema.(b) Axial contrast-enhanced CT image (lung window) obtained after 3 days shows a marked progression of lung abnormalities (arrows).
Figure 14a.
Figure 14a.
PE in a 73-year-old man with COVID-19. (a) Axial nonenhanced CT image (lung window) at baseline shows peripherally diffuse ground-glass opacities in both lungs. (b) Axial contrast-enhanced CT image (lung window) obtained after 10 days shows increased consolidation in both lungs. Note the bronchial dilatation within involved portions of the lungs. (c, d) Axial contrast-enhanced CT image (mediastinal window) (c) and sagittal reconstruction (d) obtained 10 days after the baseline images show a filling defect (arrow) in a segmental pulmonary artery branch in the right lower lobe, consistent with PE.
Figure 14b.
Figure 14b.
PE in a 73-year-old man with COVID-19. (a) Axial nonenhanced CT image (lung window) at baseline shows peripherally diffuse ground-glass opacities in both lungs. (b) Axial contrast-enhanced CT image (lung window) obtained after 10 days shows increased consolidation in both lungs. Note the bronchial dilatation within involved portions of the lungs. (c, d) Axial contrast-enhanced CT image (mediastinal window) (c) and sagittal reconstruction (d) obtained 10 days after the baseline images show a filling defect (arrow) in a segmental pulmonary artery branch in the right lower lobe, consistent with PE.
Figure 14c.
Figure 14c.
PE in a 73-year-old man with COVID-19. (a) Axial nonenhanced CT image (lung window) at baseline shows peripherally diffuse ground-glass opacities in both lungs. (b) Axial contrast-enhanced CT image (lung window) obtained after 10 days shows increased consolidation in both lungs. Note the bronchial dilatation within involved portions of the lungs. (c, d) Axial contrast-enhanced CT image (mediastinal window) (c) and sagittal reconstruction (d) obtained 10 days after the baseline images show a filling defect (arrow) in a segmental pulmonary artery branch in the right lower lobe, consistent with PE.
Figure 14d.
Figure 14d.
PE in a 73-year-old man with COVID-19. (a) Axial nonenhanced CT image (lung window) at baseline shows peripherally diffuse ground-glass opacities in both lungs. (b) Axial contrast-enhanced CT image (lung window) obtained after 10 days shows increased consolidation in both lungs. Note the bronchial dilatation within involved portions of the lungs. (c, d) Axial contrast-enhanced CT image (mediastinal window) (c) and sagittal reconstruction (d) obtained 10 days after the baseline images show a filling defect (arrow) in a segmental pulmonary artery branch in the right lower lobe, consistent with PE.
Figure 15a.
Figure 15a.
Superimposed pneumonia in a 69-year-old man with COVID-19.(a) Axial nonenhanced CT image (lung window) at baseline shows ground-glass opacities (arrows) posteriorly located in the left upper lobe and both lower lobes and an area of consolidation (arrowhead) in the right lower lobe. (b) Axial contrast-enhanced CT image (lung window) obtained after 22 days shows increased consolidation in both lower lobes (red arrows) and consolidation with central cavitation in the left upper lobe (yellow arrow). The culture of puslike bronchial fluid was positive forStaphylococcus aureus. Note the presence of pneumomediastinum (arrowhead), which is probably due to long-lasting positive-pressure ventilation.
Figure 15b.
Figure 15b.
Superimposed pneumonia in a 69-year-old man with COVID-19.(a) Axial nonenhanced CT image (lung window) at baseline shows ground-glass opacities (arrows) posteriorly located in the left upper lobe and both lower lobes and an area of consolidation (arrowhead) in the right lower lobe. (b) Axial contrast-enhanced CT image (lung window) obtained after 22 days shows increased consolidation in both lower lobes (red arrows) and consolidation with central cavitation in the left upper lobe (yellow arrow). The culture of puslike bronchial fluid was positive forStaphylococcus aureus. Note the presence of pneumomediastinum (arrowhead), which is probably due to long-lasting positive-pressure ventilation.

References

    1. World Health Organization . Coronavirus . . Accessed June 6, 2020 .
    1. World Health Organization . Pneumonia of unknown caus: China . . Published January 5, 2020. Accessed June 6, 2020 .
    1. World Health Organization . WHO announces COVID-19 outbreak a pandemic . . Published March 12, 2020. Accessed June 6, 2020 .
    1. Johns Hopkins University School of Medicine . Coronavirus Resource Center . . Updated June 13, 2020. Accessed June 13, 2020 .
    1. Thanh Le T , Andreadakis Z , Kumar A , et al. The COVID-19 vaccine development landscape . Nat Rev Drug Discov 2020. ; 19 ( 5 ): 305 – 306 .
    1. Huang C , Wang Y , Li X , et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China . Lancet 2020. ; 395 ( 10223 ): 497 – 506 [Published correction appears in Lancet 2020;395(10223):496.] .
    1. Yuki K , Fujiogi M , Koutsogiannaki S . COVID-19 pathophysiology: A review . Clin Immunol 2020. ; 215 : 108427 .
    1. Hoffmann M , Kleine-Weber H , Schroeder S , et al. SARS-CoV-2 Cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor . Cell 2020. ; 181 ( 2 ): 271 – 280 . e8 .
    1. Xu H , Zhong L , Deng J , et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa . Int J Oral Sci 2020. ; 12 ( 1 ): 8 .
    1. Verdecchia P , Cavallini C , Spanevello A , Angeli F . The pivotal link between ACE2 deficiency and SARS-CoV-2 infection . Eur J Intern Med 2020. ; 76 : 14 – 20 .
    1. Sungnak W , Huang N , Bécavin C , et al. SARS-CoV-2 entry factors are highly expressed in nasal epithelial cells together with innate immune genes . Nat Med 2020. ; 26 ( 5 ): 681 – 687 .
    1. Patel AB , Verma A . Nasal ACE2 levels and COVID-19 in children . JAMA doi: 10.1001/jama.2020.8946. Published online May 20, 2020. Accessed June 6, 2020 .
    1. Bunyavanich S , Do A , Vicencio A . Nasal gene expression of angiotensin-converting enzyme 2 in children and adults . JAMA 2020. ; 323 ( 23 ): 2427 – 2429 .
    1. Zhu J , Ji P , Pang J , et al. Clinical characteristics of 3062 COVID-19 patients: A meta-analysis . J Med Virol doi: 10.1002/jmv.25884. Published online April 15, 2020. Accessed June 6, 2020 .
    1. Agyeman AA , Chin KL , Landersdorfer CB , Liew D , Ofori-Asenso R . Smell and taste dysfunction in patients with COVID-19: a systematic review and meta-analysis . Mayo Clin Proc 2020. ; 95 ( 8 ): 1621 – 1631 .
    1. Gao Z , Xu Y , Sun C , et al. A systematic review of asymptomatic infections with COVID-19 . J Microbiol Immunol Infect doi: 10.1016/j.jmii.2020.05.001. Published online May 15, 2020. Accessed June 6, 2020 .
    1. Arons MM , Hatfield KM , Reddy SC , et al. Presymptomatic SARS-CoV-2 infections and transmission in a skilled nursing facility . N Engl J Med 2020. ; 382 ( 22 ): 2081 – 2090 .
    1. Al-Tawfiq JA , Leonardi R , Fasoli G , Rigamonti D . Prevalence and fatality rates of COVID-19: What are the reasons for the wide variations worldwide? Travel Med Infect Dis 2020. ; 35 : 101711 .
    1. Yang J , Zheng Y , Gou X , et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis . Int J Infect Dis 2020. ; 94 : 91 – 95 .
    1. World Health Organization . Global surveillance for COVID-19 caused by human infection with COVID-19 virus . . Published March 20, 2020. Accessed June 6, 2020 .
    1. Sethuraman N , Jeremiah SS , Ryo A . Interpreting diagnostic tests for SARS-CoV-2 . JAMA doi: 10.1001/jama.2020.8259. Published online May 6, 2020. Accessed June 6, 2020 .
    1. Kim H , Hong H , Yoon SH . Diagnostic Performance of CT and Reverse Transcriptase Polymerase Chain Reaction for Coronavirus Disease 2019: A Meta-Analysis . Radiology 2020. ; 296 ( 3 ): E145 – E155 .
    1. World Health Organization . Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases . . Published March 19, 2020. Accessed June 6, 2020 .
    1. Wölfel R , Corman VM , Guggemos W , et al. Virological assessment of hospitalized patients with COVID-2019 . Nature 2020. ; 581 ( 7809 ): 465 – 469 .
    1. Döhla M , Boesecke C , Schulte B , et al. Rapid point-of-care testing for SARS-CoV-2 in a community screening setting shows low sensitivity . Public Health 2020. ; 182 : 170 – 172 .
    1. Imai K , Tabata S , Ikeda M , et al. Clinical evaluation of an immunochromatographic IgM/IgG antibody assay and chest computed tomography for the diagnosis of COVID-19 . J Clin Virol 2020. ; 128 : 104393 .
    1. Xiang F , Wang X , He X , et al. Antibody detection and dynamic characteristics in patients with COVID-19 . Clin Infect Dis doi: 10.1093/cid/ciaa461. Published online April 19, 2020. Accessed June 6, 2020 .
    1. World Health Organization . Advice on the use of point-of-care immunodiagnostic tests for COVID-19 . . Published April 8, 2020. Accessed June 6, 2020 .
    1. Ching L , Chang SP , Nerurkar VR . COVID-19 special column: principles behind the technology for detecting SARS-CoV-2, the cause of COVID-19 . Hawaii J Health Soc Welf 2020. ; 79 ( 5 ): 136 – 142 .
    1. Klompas M . Coronavirus Disease 2019 (COVID-19): Protecting hospitals from the invisible . Ann Intern Med 2020. ; 172 ( 9 ): 619 – 620 .
    1. Guo YR , Cao QD , Hong ZS , et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak: an update on the status . Mil Med Res 2020. ; 7 ( 1 ): 11 .
    1. Li Q , Guan X , Wu P , et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia . N Engl J Med 2020. ; 382 ( 13 ): 1199 – 1207 .
    1. Setti L , Passarini F , De Gennaro G , et al. Airborne transmission route of COVID-19: why 2 meters/6 feet of inter-personal distance could not be enough . Int J Environ Res Public Health 2020. ; 17 ( 8 ): 2932 .
    1. van Doremalen N , Bushmaker T , Morris DH , et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1 . N Engl J Med 2020. ; 382 ( 16 ): 1564 – 1567 .
    1. Mossa-Basha M , Medverd J , Linnau KF , et al. Policies and guidelines for COVID-19 preparedness: experiences from the University of Washington . Radiology 2020. ; 296 ( 2 ): E26 – E31 .
    1. Mossa-Basha M , Meltzer CC , Kim DC , Tuite MJ , Kolli KP , Tan BS . Radiology department preparedness for COVID-19: Radiology scientific expert review panel . Radiology 2020. ; 296 ( 2 ): E106 – E112 .
    1. Lee JK , Jeong HW . Wearing face masks regardless of symptoms is crucial for preventing the spread of COVID-19 in hospitals . Infect Control Hosp Epidemiol doi: 10.1017/ice.2020.202. Published online May 6, 2020. Accessed June 6, 2020 .
    1. Lu R , Zhao X , Li J , et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding . Lancet 2020. ; 395 ( 10224 ): 565 – 574 .
    1. Alraddadi BM , Al-Salmi HS , Jacobs-Slifka K , et al. Risk factors for middle east respiratory syndrome coronavirus infection among healthcare personnel . Emerg Infect Dis 2016. ; 22 ( 11 ): 1915 – 1920 .
    1. Rodrigues JCL , Hare SS , Edey A , et al. An update on COVID-19 for the radiologist: A British society of Thoracic Imaging statement . Clin Radiol 2020. ; 75 ( 5 ): 323 – 325 .
    1. Kang Z , Li X , Zhou S . Recommendation of low-dose CT in the detection and management of COVID-2019 . Eur Radiol 2020. ; 30 ( 8 ): 4356 – 4357 .
    1. Agostini A , Floridi C , Borgheresi A , et al. Proposal of a low-dose, long-pitch, dual-source chest CT protocol on third-generation dual-source CT using a tin filter for spectral shaping at 100 kVp for CoronaVirus Disease 2019 (COVID-19) patients: a feasibility study . Radiol Med (Torino) 2020. ; 125 ( 4 ): 365 – 373 .
    1. Adams HJA , Kwee TC , Yakar D , Hope MD , Kwee RM . Chest CT Imaging Signature of Coronavirus Disease 2019 Infection: In Pursuit of the Scientific Evidence . Chest doi: 10.1016/j.chest.2020.06.025. Published online June 25, 2020. Accessed June 6, 2020 .
    1. Schaller T , Hirschbühl K , Burkhardt K , et al. Postmortem examination of patients with COVID-19 . JAMA 2020. ; 323 ( 24 ): 2518 – 2520 .
    1. Barton LM , Duval EJ , Stroberg E , Ghosh S , Mukhopadhyay S . COVID-19 Autopsies, Oklahoma, USA . Am J Clin Pathol 2020. ; 153 ( 6 ): 725 – 733 .
    1. Koo HJ , Lim S , Choe J , Choi SH , Sung H , Do KH . Radiographic and CT Features of Viral Pneumonia . RadioGraphics 2018. ; 38 ( 3 ): 719 – 739 .
    1. Wang Y , Dong C , Hu Y , et al. Temporal changes of CT findings in 90 patients with COVID-19 pneumonia: a longitudinal study . Radiology 2020. ; 296 ( 2 ): E55 – E64 .
    1. Ding X , Xu J , Zhou J , Long Q . Chest CT findings of COVID-19 pneumonia by duration of symptoms . Eur J Radiol 2020. ; 127 : 109009 .
    1. Bernheim A , Mei X , Huang M , et al. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection . Radiology 2020. ; 295 ( 3 ): 200463 .
    1. Inui S , Fujikawa A , Jitsu M , et al. Erratum: Chest CT findings in cases from the cruise ship “Diamond Princess” with coronavirus disease 2019 (COVID-19) . Radiol Cardiothorac Imaging 2020. ; 2 ( 2 ): e204002 .
    1. Simpson S , Kay FY , Abbara S , et al. Radiological Society of North America expert consensus statement on reporting chest CT findings related to COVID-19: Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA . Radiol Cardiothorac Imaging 2020. ; 2 ( 2 ): e200152 .
    1. McGuinness G , Zhan C , Rosenberg N , et al. High incidence of barotrauma in patients with COVID-19 infection on invasive mechanical ventilation . Radiology doi: 10.1148/radiol.2020202352. Published online July 1, 2020. Accessed June 6, 2020 .
    1. Pan F , Ye T , Sun P , et al. Time Course of Lung Changes at Chest CT during Recovery from Coronavirus Disease 2019 (COVID-19) . Radiology 2020. ; 295 ( 3 ): 715 – 721 .
    1. Pan Y , Guan H , Zhou S , et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China . Eur Radiol 2020. ; 30 ( 6 ): 3306 – 3309 .
    1. Guan CS , Lv ZB , Yan S , et al. Imaging Features of Coronavirus disease 2019 (COVID-19): Evaluation on Thin-Section CT . Acad Radiol 2020. ; 27 ( 5 ): 609 – 613 .
    1. Lei P , Fan B , Mao J , Wei J , Wang P . The progression of computed tomographic (CT) images in patients with coronavirus disease (COVID-19) pneumonia . J Infect 2020. ; 80 ( 6 ): e30 – e31 .
    1. Yu M , Xu D , Lan L , et al. Thin-section chest CT Imaging of coronavirus disease 2019 pneumonia: comparison between patients with mild and severe disease . Radiol Cardiothorac Imaging 2020. ; 2 ( 2 ): e200126 .
    1. Zompatori M , Ciccarese F , Fasano L . Overview of current lung imaging in acute respiratory distress syndrome . Eur Respir Rev 2014. ; 23 ( 134 ): 519 – 530 .
    1. Rubin GD , Ryerson CJ , Haramati LB , et al. The role of chest imaging in patient management during the COVID-19 pandemic: a multinational consensus statement from the Fleischner society . Chest 2020. ; 158 ( 1 ): 106 – 116 .
    1. O’Sullivan JW , Muntinga T , Grigg S , Ioannidis JPA . Prevalence and outcomes of incidental imaging findings: umbrella review . BMJ 2018. ; 361 : k2387 .
    1. Dutch Association of Medical Specialists . Practice guideline: Pre-operative work-up for COVID-19 infection in asymptomatic patients scheduled for surgery under general anesthesia . . Published May 1, 2020. Accessed June 6, 2020 .
    1. Bellolio MF , Heien HC , Sangaralingham LR , et al. Increased computed tomography utilization in the emergency department and its association with hospital admission . West J Emerg Med 2017. ; 18 ( 5 ): 835 – 845 .
    1. Bellolio MF , Bellew SD , Sangaralingham LR , et al. Access to primary care and computed tomography use in the emergency department . BMC Health Serv Res 2018. ; 18 ( 1 ): 154 .
    1. Jain R , Young M , Dogra S , Kennedy H , Nguyen V , Raz E . Surprise diagnosis of COVID-19 following neuroimaging evaluation for unrelated reasons during the pandemic in hot spots . AJNR Am J Neuroradiol 2020. ; 41 ( 7 ): 1177 – 1178 .
    1. Kwee RM , Krdzalic J , Fasen BACM , de Jaegere TMH ; COVID-19 CT Investigators South-East Netherlands (CISEN) Study Group. CT Scanning in Suspected Stroke or Head Trauma: Is it Worth Going the Extra Mile and Including the Chest to Screen for COVID-19 Infection? AJNR Am J Neuroradiol 2020. ; 41 ( 7 ): 1165 – 1169 .
    1. Kihira S , Schefflein J , Chung M , et al. Incidental COVID-19 related lung apical findings on stroke CTA during the COVID-19 pandemic . J Neurointerv Surg 2020. ; 12 ( 7 ): 669 – 672 .
    1. Hossain R , Lazarus MS , Roudenko A , et al. CT Scans obtained for nonpulmonary indications: associated respiratory findings of COVID-19 . Radiology 2020. ; 296 ( 3 ): E173 – E179 .
    1. Dane B , Brusca-Augello G , Kim D , Katz DS . Unexpected findings of coronavirus disease (COVID-19) at the lung bases on abdominopelvic CT . AJR Am J Roentgenol doi: 10.2214/AJR.20.23240. Published online April 22, 2020. Accessed June 6, 2020 .
    1. Siegel A , Chang PJ , Jarou ZJ , et al. Lung base findings of coronavirus disease (COVID-19) on abdominal CT in patients with predominant gastrointestinal symptoms . AJR Am J Roentgenol doi: 10.2214/AJR.20.23232. Published online April 17, 2020. Accessed June 6, 2020 .
    1. Lima DS , Ribeiro MAF Jr , Gallo G , Di Saverio S . Role of chest CT in patients with acute abdomen during the COVID-19 era . Br J Surg 2020. ; 107 ( 7 ): e196 .
    1. Nguyen TN , Abdalkader M , Jovin TG , et al. Mechanical thrombectomy in the era of the COVID-19 pandemic: emergency preparedness for neuroscience teams—a guidance statement from the Society of Vascular and Interventional Neurology . Stroke 2020. ; 51 ( 6 ): 1896 – 1901 .
    1. Nishino M , Itoh H , Hatabu H . A practical approach to high-resolution CT of diffuse lung disease . Eur J Radiol 2014. ; 83 ( 1 ): 6 – 19 .
    1. Adams HJA , Kwee TC , Yakar D , Hope MD , Kwee RM . Systematic Review and Meta-Analysis on the Value of Chest CT in the Diagnosis of Coronavirus Disease (COVID-19): Sol Scientiae, Illustra Nos . AJR Am J Roentgenol doi: 10.2214/AJR.20.23391. Published online June 1, 2020. Accessed June 6, 2020 .
    1. Raptis CA , Hammer MM , Short RG , et al. Chest CT and coronavirus disease (COVID-19): a critical review of the literature to date . AJR Am J Roentgenol doi: 10.2214/AJR.20.23202. Published online April 16, 2020. Accessed June 6, 2020 .
    1. Franquet T . Imaging of pulmonary viral pneumonia . Radiology 2011. ; 260 ( 1 ): 18 – 39 .
    1. Bai HX , Hsieh B , Xiong Z , et al. Performance of Radiologists in Differentiating COVID-19 from Non-COVID-19 Viral Pneumonia at Chest CT . Radiology 2020. ; 296 ( 2 ): E46 – E54 .
    1. Wang H , Wei R , Rao G , Zhu J , Song B . Characteristic CT findings distinguishing 2019 novel coronavirus disease (COVID-19) from influenza pneumonia . Eur Radiol 2020. ; 30 ( 9 ): 4910 – 4917 .
    1. Liu M , Zeng W , Wen Y , Zheng Y , Lv F , Xiao K . COVID-19 pneumonia: CT findings of 122 patients and differentiation from influenza pneumonia . Eur Radiol doi: 10.1007/s00330-020-06928-0. Published online May 12, 2020. Accessed June 6, 2020 .
    1. Yin Z , Kang Z , Yang D , Ding S , Luo H , Xiao E . A Comparison of clinical and chest CT findings in patients with influenza A (H1N1) virus infection and coronavirus disease (COVID-19) . AJR Am J Roentgenol doi: 10.2214/AJR.20.23214. Published online May 26, 2020. Accessed June 6, 2020 .
    1. Centers for Disease Control and Prevention . Prevention strategies for seasonal influenza in healthcare settings . . Updated October 30, 2018. Accessed June 6, 2020 .
    1. Adams HJA , Kwee TC , Kwee RM . COVID-19 and chest CT: do not put the sensitivity value in the isolation room and look beyond the numbers . Radiology doi: 10.1148/radiol.2020201709. Published online April 27, 2020. Accessed June 6, 2020 .
    1. Hammer MM , Raptis CA , Henry TS , Shah A , Bhalla S , Hope MD . Challenges in the interpretation and application of typical imaging features of COVID-19 . Lancet Respir Med 2020. ; 8 ( 6 ): 534 – 536 .
    1. Eng J , Bluemke DA . Imaging publications in the COVID-19 pandemic: applying new research results to clinical practice . Radiology doi: 10.1148/radiol.2020201724. Published online April 23, 2020. Accessed June 6, 2020 .
    1. ACR Practice Parameter for Communication of Diagnostic Imaging Findings . . Updated 2014. Accessed June 6, 2020 .
    1. De Jaegere TM , Krdzalic J , Fasen BA , Kwee RM ; COVID-19 CT Investigators South-East Netherlands (CISEN) Study Group. Radiological Society of North America chest CT classification system for reporting COVID-19 pneumonia: interobserver variability and correlation with RT-PCR . Radiol Cardiothorac Imaging 2020. ; 2 ( 3 ): e200213 .
    1. Li X , Ma X . Acute respiratory failure in COVID-19: is it “typical” ARDS? Crit Care 2020. ; 24 ( 1 ): 198 .
    1. Wu C , Chen X , Cai Y , et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China . JAMA Intern Med 2020. ; 180 ( 7 ): 1 – 11 .
    1. Hirano T , Murakami M . COVID-19: A new virus, but a familiar receptor and cytokine release syndrome . Immunity 2020. ; 52 ( 5 ): 731 – 733 .
    1. Matthay MA , Zemans RL , Zimmerman GA , et al. Acute respiratory distress syndrome . Nat Rev Dis Primers 2019. ; 5 ( 1 ): 18 .
    1. Salehi S , Abedi A , Balakrishnan S , Gholamrezanezhad A . Coronavirus disease 2019 (COVID-19): a systematic review of imaging findings in 919 patients . AJR Am J Roentgenol 2020. ; 215 ( 1 ): 87 – 93 .
    1. ARDS Definition Task Force ; Ranieri VM , Rubenfeld GD , et al. Acute respiratory distress syndrome: the Berlin Definition . JAMA 2012. ; 307 ( 23 ): 2526 – 2533 .
    1. Tay MZ , Poh CM , Rénia L , MacAry PA , Ng LFP . The trinity of COVID-19: immunity, inflammation and intervention . Nat Rev Immunol 2020. ; 20 ( 6 ): 363 – 374 .
    1. Klok FA , Kruip MJHA , van der Meer NJM , et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis . Thromb Res 2020. ; 191 : 148 – 150 .
    1. Deshpande C . Thromboembolic findings in COVID-19 autopsies: pulmonary thrombosis or embolism? Ann Intern Med doi: 10.7326/M20-3255. Published online May 15, 2020. Accessed June 6, 2020 .
    1. Oudkerk M , Büller HR , Kuijpers D , et al. Diagnosis, prevention, and treatment of thromboembolic complications in COVID-19: report of the National Institute for Public Health of the Netherlands . Radiology doi: 10.1148/radiol.2020201629. Published online April 23, 2020. Accessed June 6, 2020 .
    1. National Institutes of Health . COVID-19 Treatment Guidelines: Antithrombotic Therapy in Patients with COVID-19 . . Updated May 12, 2020. Accessed June 6, 2020 .
    1. Helms J , Tacquard C , Severac F , et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study . Intensive Care Med 2020. ; 46 ( 6 ): 1089 – 1098 .
    1. Poyiadji N , Cormier P , Patel PY , et al. Acute pulmonary embolism and COVID-19 . Radiology doi: 10.1148/radiol.2020201955. Published online May 14, 2020. Accessed June 6, 2020 .
    1. Bompard F , Monnier H , Saab I , et al. Pulmonary embolism in patients with COVID-19 pneumonia . Eur Respir J 2020. ; 56 ( 1 ): 2001365 .
    1. Grillet F , Behr J , Calame P , Aubry S , Delabrousse E . Acute Pulmonary Embolism Associated with COVID-19 Pneumonia Detected with Pulmonary CT Angiography . Radiology 2020. ; 296 ( 3 ): E186 – E188 .
    1. Kaminetzky M , Moore W , Fansiwala K , et al. Pulmonary embolism on CTPA in COVID-19 patients . Radiol Cardiothorac Imaging 2020. ; 2 ( 4 ): e200308 .
    1. Roncon L , Zuin M , Zonzin P . Age-adjusted D-dimer cut-off levels to rule out venous thromboembolism in COVID-19 patients . Thromb Res 2020. ; 190 : 102 .
    1. Lippi G , Favaloro EJ . D-dimer is associated with severity of coronavirus disease 2019: a pooled analysis . Thromb Haemost 2020. ; 120 ( 5 ): 876 – 878 .
    1. Tang N , Li D , Wang X , Sun Z . Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia . J Thromb Haemost 2020. ; 18 ( 4 ): 844 – 847 .
    1. Huttner BD , Catho G , Pano-Pardo JR , Pulcini C , Schouten J . COVID-19: don’t neglect antimicrobial stewardship principles! Clin Microbiol Infect 2020. ; 26 ( 7 ): 808 – 810 .
    1. Menter T , Haslbauer JD , Nienhold R , et al. Postmortem examination of COVID-19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction . Histopathology doi: 10.1111/his.14134. Published online May 4, 2020. Accessed June 6, 2020 .
    1. Tian S , Xiong Y , Liu H , et al. Pathological study of the 2019 novel coronavirus disease (COVID-19) through postmortem core biopsies . Mod Pathol 2020. ; 33 ( 6 ): 1007 – 1014 .
    1. Wu JH , Li X , Huang B , et al. Pathological changes of fatal coronavirus disease 2019 (COVID-19) in the lungs: report of 10 cases by postmortem needle autopsy [in Chinese] . Zhonghua Bing Li Xue Za Zhi 2020. ; 49 ( 6 ): 568 – 575 .
    1. Shi S , Qin M , Shen B , et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China . JAMA Cardiol 2020. ; 5 ( 7 ): 802 – 810 .
    1. Li K , Wu J , Wu F , et al. The clinical and chest CT features associated with severe and critical COVID-19 pneumonia . Invest Radiol 2020. ; 55 ( 6 ): 327 – 331 .
    1. Guzik TJ , Mohiddin SA , Dimarco A , et al. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options . Cardiovasc Res 2020. ; 116 ( 10 ): 1666 – 1687 .
    1. Cizgici AY , Zencirkiran Agus H , Yildiz M . COVID-19 myopericarditis: It should be kept in mind in today’s conditions . Am J Emerg Med 2020. ; 38 ( 7 ): 1547.e5 – 1547.e6 .
    1. Inciardi RM , Lupi L , Zaccone G , et al. Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19) . JAMA Cardiol 2020. ; 5 ( 7 ): 1 – 6 .
    1. Hua A , O’Gallagher K , Sado D , Byrne J . Life-threatening cardiac tamponade complicating myo-pericarditis in COVID-19 . Eur Heart J 2020. ; 41 ( 22 ): 2130 .
    1. Wang ZJ , Reddy GP , Gotway MB , Yeh BM , Hetts SW , Higgins CB . CT and MR imaging of pericardial disease . RadioGraphics 2003. ; 23 ( Spec no ): S167 – S180 .
    1. Yang R , Li X , Liu H , et al. Chest CT severity score: an imaging tool for assessing severe COVID-19 . Radiol Cardiothorac Imaging 2020. ; 2 ( 2 ): e200047 .
    1. Wynants L , Van Calster B , Collins GS , et al. Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal . BMJ 2020. ; 369 : m1328 [Published correction appears in BMJ 2020;369:m2204.] .

Source: PubMed

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