COVID-19 CT scan: Difference between revisions

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==Overview==
==Overview==
Non-contrast [[Chest]] [[CT scan]] is an effective method for the rapid diagnosis of [[COVID-19]] and monitoring the disease progression.
Non-contrast [[Chest]] [[CT scan]] is an effective method for the rapid diagnosis of [[COVID-19]] and monitoring the disease progression. [[Chest]] [[Computed tomography|CT scan]] findings in [[Patient|patients]] [[Infection|infected]] with coronavirus can include unilateral or bilateral [[pneumonia]], mottling and ground glass opacity, focal or multifocal opacities, [[Consolidation (medicine)|consolidation]], and septal thickening with subpleural and lower lobe involvement.   
[[Chest]] [[Computed tomography|CT scan]] findings in [[Patient|patients]] [[Infection|infected]] with coronavirus can include unilateral or bilateral [[pneumonia]], mottling and ground glass opacity, focal or multifocal opacities, [[Consolidation (medicine)|consolidation]], and septal thickening with subpleural and lower lobe involvement more likely.   


==CT scan==
==CT scan==
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**Severity of illness
**Severity of illness


*Bilateral ground glass opacities ± [[consolidation]] in [[posterior]] and peripheral lung regions are considered as the '''hallmark''' for [[COVID-19]]. <ref name="pmid32017661">{{cite journal| author=Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X | display-authors=etal| title=CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV). | journal=Radiology | year= 2020 | volume= 295 | issue= 1 | pages= 202-207 | pmid=32017661 | doi=10.1148/radiol.2020200230 | pmc=7194022 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32017661  }} </ref>
*Bilateral ground glass opacities ± [[consolidation]] in [[posterior]] and peripheral lung regions are considered as the hallmark for [[COVID-19]]. <ref name="pmid32017661">{{cite journal| author=Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X | display-authors=etal| title=CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV). | journal=Radiology | year= 2020 | volume= 295 | issue= 1 | pages= 202-207 | pmid=32017661 | doi=10.1148/radiol.2020200230 | pmc=7194022 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32017661  }} </ref>
*However, there are a large number of typical and atypical [[chest]] [[CT]] findings for [[COVID-19]] that are summarized in the figure below. <ref name="pmid32193638">{{cite journal| author=Ye Z, Zhang Y, Wang Y, Huang Z, Song B| title=Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. | journal=Eur Radiol | year= 2020 | volume=  | issue=  | pages=  | pmid=32193638 | doi=10.1007/s00330-020-06801-0 | pmc=7088323 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32193638  }} </ref> <ref name="pmid32489929">{{cite journal| author=Sun Z, Zhang N, Li Y, Xu X| title=A systematic review of chest imaging findings in COVID-19. | journal=Quant Imaging Med Surg | year= 2020 | volume= 10 | issue= 5 | pages= 1058-1079 | pmid=32489929 | doi=10.21037/qims-20-564 | pmc=7242306 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32489929  }} </ref>
*However, there are a large number of typical and atypical [[chest]] [[CT]] findings for [[COVID-19]] that are summarized in the figure below. <ref name="pmid32193638">{{cite journal| author=Ye Z, Zhang Y, Wang Y, Huang Z, Song B| title=Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. | journal=Eur Radiol | year= 2020 | volume=  | issue=  | pages=  | pmid=32193638 | doi=10.1007/s00330-020-06801-0 | pmc=7088323 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32193638  }} </ref> <ref name="pmid32489929">{{cite journal| author=Sun Z, Zhang N, Li Y, Xu X| title=A systematic review of chest imaging findings in COVID-19. | journal=Quant Imaging Med Surg | year= 2020 | volume= 10 | issue= 5 | pages= 1058-1079 | pmid=32489929 | doi=10.21037/qims-20-564 | pmc=7242306 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32489929  }} </ref>
[[File:CT-COVID-19.PNG|800px|center]]
[[File:CT-FINDINGS-COVID-19.PNG|700px|center]]
<br>
<br>
== Key CT Findings in [[COVID-19]] ==


* Findings on [[chest]] [[CT scan]] suggestive of [[COVID-19]] are summarized in the table below.<ref name="pmid32193638">{{cite journal| author=Ye Z, Zhang Y, Wang Y, Huang Z, Song B| title=Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. | journal=Eur Radiol | year= 2020 | volume= 30 | issue= 8 | pages= 4381-4389 | pmid=32193638 | doi=10.1007/s00330-020-06801-0 | pmc=7088323 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32193638  }} </ref><ref name="pmid32077789">{{cite journal| author=Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N | display-authors=etal| title=Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. | journal=Radiology | year= 2020 | volume= 295 | issue= 3 | pages= 200463 | pmid=32077789 | doi=10.1148/radiol.2020200463 | pmc=7233369 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32077789  }} </ref><ref name="pmid32107577">{{cite journal| author=Xu X, Yu C, Qu J, Zhang L, Jiang S, Huang D | display-authors=etal| title=Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2. | journal=Eur J Nucl Med Mol Imaging | year= 2020 | volume= 47 | issue= 5 | pages= 1275-1280 | pmid=32107577 | doi=10.1007/s00259-020-04735-9 | pmc=7080117 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32107577  }} </ref>
<br>


{| class="wikitable"
! colspan=4 style="background: #4479BA; color: #FFFFFF; " align="center"|CT manifestations of COVID-19
|-
!style="background: #4479BA; color: #FFFFFF; " align="center" |CT findings
!style="background: #4479BA; color: #FFFFFF; " align="center" |Definition
!style="background: #4479BA; color: #FFFFFF; " align="center" |CT picture
|-
|style="background: #DCDCDC; |'''[[Ground glass opacity]]'''
|
*Hazy opacity in the lungs with well defined bronchial and vascular margins 
*the most common imaging finding
*due to infection, chronic interstitial lung disease, and acute lung injury
|[[File:Covid-19-pneumonia-26.jpg|200px|thumb|center]]
|-
|style="background: #DCDCDC; |'''[[Consolidation]]'''
|
*a parenchymal density with ill-defined bronchial and vascular margins
*filling with infectious material [fluid, cells, tissue]
* due to cellular exudates in alveoli
*The presence of [[consolidation]] is a sign of disease progression
|
|-
|style="background: #DCDCDC; |''' [[Crazy paving pattern]] '''
|
* Septal thickening of inter and intra-lobar regions
* with the background of the Ground glass opacity
* Similar to paving stones
* Due to alveolar edema and acute inflammation of the lung
* Sign of progression
|[[File:Covid-19-pneumonia-122.jpg|200px|thumb|center]]
|-
|style="background: #DCDCDC; |''' [[Reticuldar]] pattern '''
|
*Linear opacities in the lungs
*Due to Interstitial thickening of inter and intralobular septa
|
|-
|style="background: #DCDCDC; |'''[[Air bronchogram]] '''
|
* Air-filled bronchi
*Low attenuated areas in the lung
|
|-
|style="background: #DCDCDC; |''' [[Bronchiectasis]] '''
|
*Irreversible dilatation of the lung airways
* Bronchus diameter more than 1.5 cm
*due to inflammation, obstruction and impaired clearance
|[[File:Cystic-bronchiectasis-causing-pneumothorax.jpg|200px|thumb|center]]
|-
|style="background: #DCDCDC; |'''[[Pleural effusion]] '''
|
* Accumulation of fluids in the pleural space
*The presence of [[pleural effusion]] in [[COVID-19]] is associated with poor [[prognosis]].
|[[File:Pericard-effusion-03.jpg|200px|thumb|center]]
|}


*[[Chest]] [[Computed tomography|CT scan]] findings in [[Patient|patients]] [[Infection|infected]] with [[coronavirus]] can include:
*[[Chest]] [[Computed tomography|CT scan]] findings in [[Patient|patients]] [[Infection|infected]] with [[COVID-19]] are usually:
** Unilateral or bilateral [[pneumonia]]<ref name="pmid15026600">{{cite journal |vauthors=Paul NS, Roberts H, Butany J, Chung T, Gold W, Mehta S, Konen E, Rao A, Provost Y, Hong HH, Zelovitsky L, Weisbrod GL |title=Radiologic pattern of disease in patients with severe acute respiratory syndrome: the Toronto experience |journal=Radiographics |volume=24 |issue=2 |pages=553–63 |date=2004 |pmid=15026600 |doi=10.1148/rg.242035193 |url=}}</ref><ref name="pmid24918624">{{cite journal |vauthors=Ajlan AM, Ahyad RA, Jamjoom LG, Alharthy A, Madani TA |title=Middle East respiratory syndrome coronavirus (MERS-CoV) infection: chest CT findings |journal=AJR Am J Roentgenol |volume=203 |issue=4 |pages=782–7 |date=October 2014 |pmid=24918624 |doi=10.2214/AJR.14.13021 |url=}}</ref><ref name="ChenZhou2020">{{cite journal|last1=Chen|first1=Nanshan|last2=Zhou|first2=Min|last3=Dong|first3=Xuan|last4=Qu|first4=Jieming|last5=Gong|first5=Fengyun|last6=Han|first6=Yang|last7=Qiu|first7=Yang|last8=Wang|first8=Jingli|last9=Liu|first9=Ying|last10=Wei|first10=Yuan|last11=Xia|first11=Jia'an|last12=Yu|first12=Ting|last13=Zhang|first13=Xinxin|last14=Zhang|first14=Li|title=Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study|journal=The Lancet|year=2020|issn=01406736|doi=10.1016/S0140-6736(20)30211-7}}</ref>
**Bilateral peripheral [[lung]] [[opacities]]<ref name="LeiLi2020">{{cite journal|last1=Lei|first1=Junqiang|last2=Li|first2=Junfeng|last3=Li|first3=Xun|last4=Qi|first4=Xiaolong|title=CT Imaging of the 2019 Novel Coronavirus (2019-nCoV)                    Pneumonia|journal=Radiology|year=2020|pages=200236|issn=0033-8419|doi=10.1148/radiol.2020200236}}</ref>
**Mottling and ground-glass opacity
**without subpleural sparing
**Focal or multifocal opacities
**[[Consolidation (medicine)|Consolidation]]
**Septal thickening
**Subpleural and lower lobe involvement more likely
*[[Chest]] [[Computed tomography|CT scan]] findings common in [[Patient|patients]] [[Infection|infected]] with [[COVID-19]] are:
**Bilateral '''peripheral''' lung opacities<ref name="LeiLi2020">{{cite journal|last1=Lei|first1=Junqiang|last2=Li|first2=Junfeng|last3=Li|first3=Xun|last4=Qi|first4=Xiaolong|title=CT Imaging of the 2019 Novel Coronavirus (2019-nCoV)                    Pneumonia|journal=Radiology|year=2020|pages=200236|issn=0033-8419|doi=10.1148/radiol.2020200236}}</ref>
**No subpleural sparing


*[[Right]] and [[left]] lower [[lung]] [[lobes]] were the most common involved [[lobes]] (65% and 63%) in [[COVID-19]]. <ref name="pmid32077789">{{cite journal| author=Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N | display-authors=etal| title=Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. | journal=Radiology | year= 2020 | volume= 295 | issue= 3 | pages= 200463 | pmid=32077789 | doi=10.1148/radiol.2020200463 | pmc=7233369 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32077789  }} </ref>
*[[Right]] and [[left]] lower [[lung]] [[lobes]] were the most common involved [[lobes]] (65% and 63%) in [[COVID-19]]. <ref name="pmid32077789">{{cite journal| author=Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N | display-authors=etal| title=Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. | journal=Radiology | year= 2020 | volume= 295 | issue= 3 | pages= 200463 | pmid=32077789 | doi=10.1148/radiol.2020200463 | pmc=7233369 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32077789  }} </ref>


*Time interval between onset of [[symptoms]] and [[chest]] [[CT]] manifestations is classified into 3 stages<ref name="pmid32077789">{{cite journal| author=Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N | display-authors=etal| title=Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. | journal=Radiology | year= 2020 | volume= 295 | issue= 3 | pages= 200463 | pmid=32077789 | doi=10.1148/radiol.2020200463 | pmc=7233369 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32077789  }} </ref>:  
*Time interval between onset of [[symptoms]] and [[chest]] [[CT]] manifestations is classified into 3 stages<ref name="pmid32077789">{{cite journal| author=Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N | display-authors=etal| title=Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. | journal=Radiology | year= 2020 | volume= 295 | issue= 3 | pages= 200463 | pmid=32077789 | doi=10.1148/radiol.2020200463 | pmc=7233369 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32077789  }} </ref>:  
** '''Early''':  between 0-2 days
** Early:  between 0-2 days
**'''Intermediate''': between 3-5 days
**Intermediate: between 3-5 days
**'''Late''': between 6-12 days
**Late: between 6-12 days
*[[Ground-glass opacities]] and [[consolidation]] are more likely to develop in the '''intermediate''' and '''late''' stages. <ref name="pmid32077789">{{cite journal| author=Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N | display-authors=etal| title=Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. | journal=Radiology | year= 2020 | volume= 295 | issue= 3 | pages= 200463 | pmid=32077789 | doi=10.1148/radiol.2020200463 | pmc=7233369 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32077789  }} </ref>
*[[Ground-glass opacities]] and [[consolidation]] are more likely to develop in the intermediate and late stages. <ref name="pmid32077789">{{cite journal| author=Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N | display-authors=etal| title=Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. | journal=Radiology | year= 2020 | volume= 295 | issue= 3 | pages= 200463 | pmid=32077789 | doi=10.1148/radiol.2020200463 | pmc=7233369 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32077789  }} </ref>
*[[Linear]] [[opacities]], [[crazy-paving pattern]], and [[reverse halo]] sign usually develop during the '''late''' stages. <ref name="pmid32077789">{{cite journal| author=Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N | display-authors=etal| title=Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. | journal=Radiology | year= 2020 | volume= 295 | issue= 3 | pages= 200463 | pmid=32077789 | doi=10.1148/radiol.2020200463 | pmc=7233369 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32077789  }} </ref>
*[[Linear]] [[opacities]], [[crazy-paving pattern]], and [[reverse halo]] sign usually develop during the late stages. <ref name="pmid32077789">{{cite journal| author=Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N | display-authors=etal| title=Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. | journal=Radiology | year= 2020 | volume= 295 | issue= 3 | pages= 200463 | pmid=32077789 | doi=10.1148/radiol.2020200463 | pmc=7233369 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32077789  }} </ref>
*The presence of [[consolidation]] is a sign of '''disease progression'''. <ref name="pmid32193638">{{cite journal| author=Ye Z, Zhang Y, Wang Y, Huang Z, Song B| title=Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. | journal=Eur Radiol | year= 2020 | volume=  | issue=  | pages=  | pmid=32193638 | doi=10.1007/s00330-020-06801-0 | pmc=7088323 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32193638  }} </ref>
 
*The presence of [[pleural effusion]] in [[COVID-19]] is associated with poor [[prognosis]].<ref name="pmid32193638">{{cite journal| author=Ye Z, Zhang Y, Wang Y, Huang Z, Song B| title=Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. | journal=Eur Radiol | year= 2020 | volume=  | issue=  | pages=  | pmid=32193638 | doi=10.1007/s00330-020-06801-0 | pmc=7088323 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32193638  }} </ref>
*The presence of [[lymphadenopathy]] and [[pericardial effusion]] are associated with severe [[COVID-19]] [[pneumonia]]. <ref name="pmid32193638">{{cite journal| author=Ye Z, Zhang Y, Wang Y, Huang Z, Song B| title=Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. | journal=Eur Radiol | year= 2020 | volume=  | issue=  | pages=  | pmid=32193638 | doi=10.1007/s00330-020-06801-0 | pmc=7088323 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32193638  }} </ref>
*The presence of [[lymphadenopathy]] and [[pericardial effusion]] are associated with severe [[COVID-19]] [[pneumonia]]. <ref name="pmid32193638">{{cite journal| author=Ye Z, Zhang Y, Wang Y, Huang Z, Song B| title=Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. | journal=Eur Radiol | year= 2020 | volume=  | issue=  | pages=  | pmid=32193638 | doi=10.1007/s00330-020-06801-0 | pmc=7088323 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32193638  }} </ref>
*[[chest]] [[CT]] manifestations are usually resolved within 14 days of [[symptoms]] onset. <ref name="PanYe2020">{{cite journal|last1=Pan|first1=Feng|last2=Ye|first2=Tianhe|last3=Sun|first3=Peng|last4=Gui|first4=Shan|last5=Liang|first5=Bo|last6=Li|first6=Lingli|last7=Zheng|first7=Dandan|last8=Wang|first8=Jiazheng|last9=Hesketh|first9=Richard L.|last10=Yang|first10=Lian|last11=Zheng|first11=Chuansheng|title=Time Course of Lung Changes at Chest CT during Recovery from                    Coronavirus Disease 2019 (COVID-19)|journal=Radiology|volume=295|issue=3|year=2020|pages=715–721|issn=0033-8419|doi=10.1148/radiol.2020200370}}</ref>
*[[chest]] [[CT]] manifestations are usually resolved within 14 days of [[symptoms]] onset. <ref name="PanYe2020">{{cite journal|last1=Pan|first1=Feng|last2=Ye|first2=Tianhe|last3=Sun|first3=Peng|last4=Gui|first4=Shan|last5=Liang|first5=Bo|last6=Li|first6=Lingli|last7=Zheng|first7=Dandan|last8=Wang|first8=Jiazheng|last9=Hesketh|first9=Richard L.|last10=Yang|first10=Lian|last11=Zheng|first11=Chuansheng|title=Time Course of Lung Changes at Chest CT during Recovery from                    Coronavirus Disease 2019 (COVID-19)|journal=Radiology|volume=295|issue=3|year=2020|pages=715–721|issn=0033-8419|doi=10.1148/radiol.2020200370}}</ref>
 
<br>
 
<br>
== Radiological Society of North America ==
== Radiological Society of North America ==
The Radiological Society of North America (RSNA) classified CT findings of COVID-19 infection into four categories which were endorsed by the Society of Thoracic Radiology and the American College of Radiology (ACR):
The Radiological Society of North America (RSNA) classified CT findings of COVID-19 infection into four categories which were endorsed by the Society of Thoracic Radiology and the American College of Radiology (ACR):
Line 77: Line 135:
|No CT features to suggest pneumonia, in particular, absent GGO and consolidation
|No CT features to suggest pneumonia, in particular, absent GGO and consolidation
|}
|}
 
<br><br>
===Images===
== CT Examples of COVID-19 ==
[[File:Coronavirus CT.jpg|300px|thumb|left|CT scan showing pulmonary focal opacity in a patient infected with COVID-19. <ref>Case courtesy of Medico Assistente Dr. Chong Keng Sang, Sam, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/73890">rID: 73890</a></ref>]]
[[File:Coronavirus CT.jpg|300px|thumb|left|CT scan showing pulmonary focal opacity in a patient infected with COVID-19. <ref>Case courtesy of Medico Assistente Dr. Chong Keng Sang, Sam, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/73890">rID: 73890</a></ref>]]
[[File:Coronavirus CT 2.jpg|300px|thumb|center|CT scan showing pulmonary multifocal opacities in a patient infected with COVID-19. <ref>Case courtesy of Medico Assistente Dr. Chong Keng Sang, Sam, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/73890">rID: 73890</a></ref>]]<br>
[[File:Coronavirus CT 2.jpg|300px|thumb|center|CT scan showing pulmonary multifocal opacities in a patient infected with COVID-19. <ref>Case courtesy of Medico Assistente Dr. Chong Keng Sang, Sam, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/73890">rID: 73890</a></ref>]]<br>

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2] Syed Hassan A. Kazmi BSc, MD [3] Aditya Ganti M.B.B.S. [4] Nasrin Nikravangolsefid, MD-MPH [5]

Overview

Non-contrast Chest CT scan is an effective method for the rapid diagnosis of COVID-19 and monitoring the disease progression. Chest CT scan findings in patients infected with coronavirus can include unilateral or bilateral pneumonia, mottling and ground glass opacity, focal or multifocal opacities, consolidation, and septal thickening with subpleural and lower lobe involvement.

CT scan

  • Non-contrast Chest CT scan is an effective method not only for the rapid diagnosis of COVID-19 but also for monitoring the disease progression. [1]
  • Given the high sensitivity of chest CT, it can be used in suspected patients with negative RT-PCR. [2]
  • Various chest CT features have been found diagnostic for COVID-19 that are associated with:
    • Duration of illness
    • Severity of illness
  • Bilateral ground glass opacities ± consolidation in posterior and peripheral lung regions are considered as the hallmark for COVID-19. [3]
  • However, there are a large number of typical and atypical chest CT findings for COVID-19 that are summarized in the figure below. [4] [5]



Key CT Findings in COVID-19


CT manifestations of COVID-19
CT findings Definition CT picture
Ground glass opacity
  • Hazy opacity in the lungs with well defined bronchial and vascular margins
  • the most common imaging finding
  • due to infection, chronic interstitial lung disease, and acute lung injury
Consolidation
  • a parenchymal density with ill-defined bronchial and vascular margins
  • filling with infectious material [fluid, cells, tissue]
  • due to cellular exudates in alveoli
  • The presence of consolidation is a sign of disease progression
Crazy paving pattern
  • Septal thickening of inter and intra-lobar regions
  • with the background of the Ground glass opacity
  • Similar to paving stones
  • Due to alveolar edema and acute inflammation of the lung
  • Sign of progression


Reticuldar pattern
  • Linear opacities in the lungs
  • Due to Interstitial thickening of inter and intralobular septa
Air bronchogram
  • Air-filled bronchi
  • Low attenuated areas in the lung
Bronchiectasis
  • Irreversible dilatation of the lung airways
  • Bronchus diameter more than 1.5 cm
  • due to inflammation, obstruction and impaired clearance
Pleural effusion



Radiological Society of North America

The Radiological Society of North America (RSNA) classified CT findings of COVID-19 infection into four categories which were endorsed by the Society of Thoracic Radiology and the American College of Radiology (ACR):

RSNA CT findings classification of Covid-19[10]
Typical appearance
  • Peripheral, bilateral, GGO +/- consolidation or visible intralobular lines (“crazy paving” pattern)
  • Multifocal GGO of rounded morphology +/- consolidation or visible intralobular lines (“crazy paving” pattern)
  • reverse halo sign or other findings of organizing pneumonia
Indeterminate appearance Absence of typical CT findings and the presence of
  • Multifocal, diffuse, perihilar, or unilateral GGO +/- consolidation lacking a specific distribution and are non-rounded or non-peripheral
  • Few very small GGO with a non-rounded and non-peripheral distribution
Atypical appearance Absence of typical or indeterminate features and the presence of
  • Isolated lobar or segmental consolidation without GGO
  • Discrete small nodules (e.g. centrilobular, tree-in-bud)
  • Lung cavitation
  • Smoother interlobular septal thickening with pleural effusion
Negative for pneumonia No CT features to suggest pneumonia, in particular, absent GGO and consolidation



CT Examples of COVID-19

CT scan showing pulmonary focal opacity in a patient infected with COVID-19. [11]
CT scan showing pulmonary multifocal opacities in a patient infected with COVID-19. [12]



CT shows bilateral, multilobar large areas of ground-glass opacities with septal thickening and a crazy-paving pattern.[13]
CT shows bilateral multilobar peripheral ground-glass opacities in both lungs predominantly in mid to lower zones.[14]



References

  1. ↑ Xu B, Xing Y, Peng J, Zheng Z, Tang W, Sun Y; et al. (2020). "Chest CT for detecting COVID-19: a systematic review and meta-analysis of diagnostic accuracy". Eur Radiol. doi:10.1007/s00330-020-06934-2. PMC 7227176 Check |pmc= value (help). PMID 32415585 Check |pmid= value (help).
  2. ↑ Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P; et al. (2020). "Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR". Radiology: 200432. doi:10.1148/radiol.2020200432. PMC 7233365 Check |pmc= value (help). PMID 32073353 Check |pmid= value (help).
  3. ↑ Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X; et al. (2020). "CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV)". Radiology. 295 (1): 202–207. doi:10.1148/radiol.2020200230. PMC 7194022 Check |pmc= value (help). PMID 32017661 Check |pmid= value (help).
  4. ↑ 4.0 4.1 4.2 Ye Z, Zhang Y, Wang Y, Huang Z, Song B (2020). "Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review". Eur Radiol. doi:10.1007/s00330-020-06801-0. PMC 7088323 Check |pmc= value (help). PMID 32193638 Check |pmid= value (help).
  5. ↑ Sun Z, Zhang N, Li Y, Xu X (2020). "A systematic review of chest imaging findings in COVID-19". Quant Imaging Med Surg. 10 (5): 1058–1079. doi:10.21037/qims-20-564. PMC 7242306 Check |pmc= value (help). PMID 32489929 Check |pmid= value (help).
  6. ↑ 6.0 6.1 6.2 6.3 6.4 Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N; et al. (2020). "Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection". Radiology. 295 (3): 200463. doi:10.1148/radiol.2020200463. PMC 7233369 Check |pmc= value (help). PMID 32077789 Check |pmid= value (help).
  7. ↑ Xu X, Yu C, Qu J, Zhang L, Jiang S, Huang D; et al. (2020). "Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2". Eur J Nucl Med Mol Imaging. 47 (5): 1275–1280. doi:10.1007/s00259-020-04735-9. PMC 7080117 Check |pmc= value (help). PMID 32107577 Check |pmid= value (help).
  8. ↑ Lei, Junqiang; Li, Junfeng; Li, Xun; Qi, Xiaolong (2020). "CT Imaging of the 2019 Novel Coronavirus (2019-nCoV) Pneumonia". Radiology: 200236. doi:10.1148/radiol.2020200236. ISSN 0033-8419.
  9. ↑ Pan, Feng; Ye, Tianhe; Sun, Peng; Gui, Shan; Liang, Bo; Li, Lingli; Zheng, Dandan; Wang, Jiazheng; Hesketh, Richard L.; Yang, Lian; Zheng, Chuansheng (2020). "Time Course of Lung Changes at Chest CT during Recovery from Coronavirus Disease 2019 (COVID-19)". Radiology. 295 (3): 715–721. doi:10.1148/radiol.2020200370. ISSN 0033-8419.
  10. ↑ Simpson, Scott; Kay, Fernando U.; Abbara, Suhny; Bhalla, Sanjeev; Chung, Jonathan H.; Chung, Michael; Henry, Travis S.; Kanne, Jeffrey P.; Kligerman, Seth; Ko, Jane P.; Litt, Harold (2020). "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". Radiology: Cardiothoracic Imaging. 2 (2): e200152. doi:10.1148/ryct.2020200152. ISSN 2638-6135.
  11. ↑ Case courtesy of Medico Assistente Dr. Chong Keng Sang, Sam, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/73890">rID: 73890</a>
  12. ↑ Case courtesy of Medico Assistente Dr. Chong Keng Sang, Sam, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/73890">rID: 73890</a>
  13. ↑ Case courtesy of Dr Antonio Rodrigues de Aguiar Neto, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/76921">rID: 76921</a>
  14. ↑ Case courtesy of Dr Bahman Rasuli, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/75768">rID: 75768</a>
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