COVID-19 severity scoring systems in radiological imaging - a review

Piotr G Wasilewski, Bartosz Mruk, Samuel Mazur, Gabriela Półtorak-Szymczak, Katarzyna Sklinda, Jerzy Walecki, Piotr G Wasilewski, Bartosz Mruk, Samuel Mazur, Gabriela Półtorak-Szymczak, Katarzyna Sklinda, Jerzy Walecki

Abstract

The current reference standard to make a definitive diagnosis of SARS-CoV-2 infection is the reverse transcription- polymerase chain reaction assay (rt-PCR). However, radiological imaging plays a crucial role in evaluating the course of COVID-19 and in choosing proper management of infected patients. Chest X-ray (CXR) is generally considered not to be sensitive for the detection of pulmonary abnormalities in the early stage of the disease. However, in the emergency setting CXR can be a useful diagnostic tool for monitoring the rapid progression of lung involvement in COVID-19, especially in patients admitted to intensive care units. The rapid course of SARS-CoV-2 infection and the severity and progression of lung aberrations require a method of radiological evaluation to implement and manage the appropriate treatment for infected patients. Computed tomography (CT) imaging is considered to be the most effective method for the detection of lung abnormalities, especially in the early stage of the disease. Moreover, serial chest CT imaging with different time intervals is also effective in estimating the evolution of the disease from initial diagnosis to discharge from hospital. Despite having low specificity in distinguishing abnormalities in viral infections, the high sensitivity of CT makes this method ideal for assessing the severity of the disease in patients with confirmed COVID-19. In this review, we present and discuss currently available scales that can be used to assess the severity of lung involvement in COVID-19 patients in everyday work, both for CXR and CT imaging.

Keywords: COVID-19; CT; CXR; SARS-CoV-2; X-ray; computed tomography.

Conflict of interest statement

The authors report no conflict of interest.

Copyright © Polish Medical Society of Radiology 2020.

Figures

Figure 1
Figure 1
Chest X-ray image of a COVID-19-positive patient with lungs assessed in SARI severity scoring system at 5 points. The arrow shows diffuse alveolar changes
Figure 2
Figure 2
Chest X-ray image of a COVID-19-positive patient with lungs assessed in RALE classification at 4 points. Both lungs are assessed individually - right lung was evaluated at 1 point and left lung at 3 points. The overall RALE score was 4 points
Figure 3
Figure 3
Normal chest X-ray image with division of lungs into six levels in SXR score
Figure 4
Figure 4
Chest X-ray image of a COVID-19-positive patient with lungs assessed in chest X-ray sore at 0 points
Figure 5
Figure 5
Chest X-ray image of a COVID-19-positive patient with lungs assessed in chest X-ray sore at 8 points
Figure 6
Figure 6
Computed tomography scans of a COVID-19-positive patient in axial projection. Lungs were assessed in modified total severity scoring system (mTSS) at 6 points. The main features of lung involvement are regions of ground glass opacity; therefore, the overall mTSS score is 6A
Figure 7
Figure 7
Computed tomography scans of a COVID-19-positive patient in sagittal projection. Lungs were assessed in modified total severity scoring system (mTSS) at 6A
Figure 8
Figure 8
Computed tomography scans of a COVID-19-positive patient in coronal projection. Lungs were assessed in modified total severity scoring system (mTSS) at 6A
Figure 9
Figure 9
Computed tomography scans of a COVID-19-positive patient in axial projection. Lungs were assessed in modified total severity scoring system (mTSS) at 18 points. The main features of lung involvement are consolidations; therefore, the overall mTSS score is 18C
Figure 10
Figure 10
Computed tomography scans of a COVID-19-positive patient in sagittal projection. Lungs were assessed in modified total severity scoring system (mTSS) at 18C
Figure 11
Figure 11
Computed tomography scans of a COVID-19-positive patient in coronal projection. Lungs were assessed in modified total severity scoring system (mTSS) at 18C

References

    1. Zhu N, Zhang D, Wang W, et al. . A novel coronavirus from patients with pneumonia in China. N Engl J Med 2020; 382: 727-733.
    1. World Health Organization (WHO). Q&A on coronaviruses (COVID-19). Availabel at: (Accessed: 24.02.2020).
    1. U.S. Centers for Disease Control and Prevention (CDC). How COVID-19 Spreads. 27 January 2020. Archived from the original on 28 January 2020. Retrieved 29 January 2020.
    1. Chinese Society of Radiology. Radiological diagnosis of new coronavirus infected pneumonitis: expert recommendation from the Chinese Society of Radiology (First edition). Chin J Radiol 2020; 54: E001.
    1. Zu ZY, Jiang MD, Xu PP et al. . Coronavirus disease 2019 (COVID-19): a perspective from China. Radiology 2020; 296: E15-E25.
    1. Ng MY, Lee EY, Yang J, et al. . Imaging profile of the COVID-19 infection: radiologic findings and literature review. Radiol Cardiothorac Imaging 2020, 2: e200034 DOi: 10.1148/ryct.2020200034.
    1. Borghesi A, Maroldi R. COVID-19 outbreak in Italy: experimental chest X-ray scoring system for quantifying and monitoring disease progression. Researchsquare 2020 DOI: 10.21203/-19842/v1.
    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 DOI: 10.1148/radiol.2020200463.
    1. Pan F, Ye T, Sun P, et al. . Time course of lung changes on chest CT during recovery from 2019 novel coronavirus (COVID-19) pneumonia. Radiology 2020; 295: 715-721.
    1. Taylor E, Haven K, Reed P, et al. . A chest radiograph scoring system in patients with severe acute respiratory infection: a validation study. BMC Med Imaging 2015; 15 : 61.
    1. Yoon SH, Lee KH, Kim JY, et al. . Chest radiographic and CT findings of the 2019 novel coronavirus disease (COVID-19): analysis of nine patients treated in Korea. Korean J Radiol 2020; 21: 494-500.
    1. Wong HYF, Lam HYS, Fong AHT, et al. . Frequency and distribution of chest radiographic findings in patients positive for COVID-19. Radiology 2020; 296: E72-E78. DOI: 10.1148/radiol.2020201160.
    1. Warren MA, Zhao Z, Koyama T, et al. . Severity scoring of lung oedema on the chestradiograph is associated with clinical outcomes in ARDS. Thorax 2018; 73: 840-846.
    1. Ai T, Yang Z, Hou H, et al. . Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology 2020; 296: E32-E40. DOI: 10.1148/radiol.2020200642.
    1. Miao C, Jin M, Miao L, et al. . Early chest computed tomography to diagnose COVID-19 from suspected patients: a multicenter retrospective study. Am J Emerg Med 2020 DOI: 10.1016/j.ajem.2020.04.051.
    1. Yang R, Li X, Liu H, et al. . Chest CT severity score: an imaging tool for assessing severe COVID-19. Radiology 2020 DOI: 10.1148/ryct.2020200047.
    1. Chang YC, Yu CJ, Chang SC, et al. . Pulmonary sequelae in convalescent patients after severe acute respiratory syndrome: evaluation with thin-section CT. Radiology 2005; 236: 1067-1075.
    1. Kunwei Li, Yijie Fang, et al. . CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19). Eur Radiol 2020 DOI: 10.1007/s00330-020-06817-6.
    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 DOI: 10.1097/RLI.0000000000000672.

Source: PubMed

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