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Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study.
Lancet Infect Dis. 2020 04; 20(4):425-434.LI

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.

Authors+Show Affiliations

Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China.Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China.Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China.Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China.Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China.Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China.Department of Radiology, Wuhan Jinyintan Hospital, Wuhan, Hubei, China. Electronic address: 1024932023@qq.com.Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China. Electronic address: hqzcsxh@sina.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32105637

Citation

Shi, Heshui, et al. "Radiological Findings From 81 Patients With COVID-19 Pneumonia in Wuhan, China: a Descriptive Study." The Lancet. Infectious Diseases, vol. 20, no. 4, 2020, pp. 425-434.
Shi H, Han X, Jiang N, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis. 2020;20(4):425-434.
Shi, H., Han, X., Jiang, N., Cao, Y., Alwalid, O., Gu, J., Fan, Y., & Zheng, C. (2020). Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. The Lancet. Infectious Diseases, 20(4), 425-434. https://doi.org/10.1016/S1473-3099(20)30086-4
Shi H, et al. Radiological Findings From 81 Patients With COVID-19 Pneumonia in Wuhan, China: a Descriptive Study. Lancet Infect Dis. 2020;20(4):425-434. PubMed PMID: 32105637.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. AU - Shi,Heshui, AU - Han,Xiaoyu, AU - Jiang,Nanchuan, AU - Cao,Yukun, AU - Alwalid,Osamah, AU - Gu,Jin, AU - Fan,Yanqing, AU - Zheng,Chuansheng, Y1 - 2020/02/24/ PY - 2020/01/30/received PY - 2020/02/10/revised PY - 2020/02/11/accepted PY - 2020/2/28/pubmed PY - 2020/4/9/medline PY - 2020/2/28/entrez SP - 425 EP - 434 JF - The Lancet. Infectious diseases JO - Lancet Infect Dis VL - 20 IS - 4 N2 - 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. SN - 1474-4457 UR - https://www.unboundmedicine.com/medline/citation/32105637/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S1473-3099(20)30086-4 DB - PRIME DP - Unbound Medicine ER -