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Frequency and Distribution of Chest Radiographic Findings in Patients Positive for COVID-19.
Radiology. 2020 08; 296(2):E72-E78.R

Abstract

Background Current coronavirus disease 2019 (COVID-19) radiologic literature is dominated by CT, and a detailed description of chest radiography appearances in relation to the disease time course is lacking. Purpose To describe the time course and severity of findings of COVID-19 at chest radiography and correlate these with real-time reverse transcription polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, nucleic acid. Materials and Methods This is a retrospective study of patients with COVID-19 confirmed by using RT-PCR and chest radiographic examinations who were admitted across four hospitals and evaluated between January and March 2020. Baseline and serial chest radiographs (n = 255) were reviewed with RT-PCR. Correlation with concurrent CT examinations (n = 28) was performed when available. Two radiologists scored each chest radiograph in consensus for consolidation, ground-glass opacity, location, and pleural fluid. A severity index was determined for each lung. The lung scores were summed to produce the final severity score. Results The study was composed of 64 patients (26 men; mean age, 56 years ± 19 [standard deviation]). Of these, 58 patients had initial positive findings with RT-PCR (91%; 95% confidence interval: 81%, 96%), 44 patients had abnormal findings at baseline chest radiography (69%; 95% confidence interval: 56%, 80%), and 38 patients had initial positive findings with RT-PCR testing and abnormal findings at baseline chest radiography (59%; 95% confidence interval: 46%, 71%). Six patients (9%) showed abnormalities at chest radiography before eventually testing positive for COVID-19 with RT-PCR. Sensitivity of initial RT-PCR (91%; 95% confidence interval: 83%, 97%) was higher than that of baseline chest radiography (69%; 95% confidence interval: 56%, 80%) (P = .009). Radiographic recovery (mean, 6 days ± 5) and virologic recovery (mean, 8 days ± 6) were not significantly different (P = .33). Consolidation was the most common finding (30 of 64; 47%) followed by ground-glass opacities (21 of 64; 33%). Abnormalities at chest radiography had a peripheral distribution (26 of 64; 41%) and lower zone distribution (32 of 64; 50%) with bilateral involvement (32 of 64; 50%). Pleural effusion was uncommon (two of 64; 3%). The severity of findings at chest radiography peaked at 10-12 days from the date of symptom onset. Conclusion Findings at chest radiography in patients with coronavirus disease 2019 frequently showed bilateral lower zone consolidation, which peaked at 10-12 days from symptom onset. © RSNA, 2020.

Authors+Show Affiliations

From the Departments of Radiology (H.Y.F.W., H.Y.S.L., C.S.Y.L., T.P.W.L.), Medicine (M.M.S.L., I.F.N.H.), and Microbiology (T.W.H.C.), Queen Mary Hospital, Hong Kong; Departments of Diagnostic Radiology (A.H.T.F., K.W.H.C., E.Y.P.L., M.D.K., M.Y.N.), Family Medicine and Primary Care (E.Y.F.W.), Pharmacology and Pharmacy (E.Y.F.W.), and Medicine (I.F.N.H.), University of Hong Kong, Room 406, Block K, Hong Kong; Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong (S.T.L.); Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong (S.T.L.); Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (T.W.Y.C., J.C.Y.L.) and Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China (M.Y.N.).From the Departments of Radiology (H.Y.F.W., H.Y.S.L., C.S.Y.L., T.P.W.L.), Medicine (M.M.S.L., I.F.N.H.), and Microbiology (T.W.H.C.), Queen Mary Hospital, Hong Kong; Departments of Diagnostic Radiology (A.H.T.F., K.W.H.C., E.Y.P.L., M.D.K., M.Y.N.), Family Medicine and Primary Care (E.Y.F.W.), Pharmacology and Pharmacy (E.Y.F.W.), and Medicine (I.F.N.H.), University of Hong Kong, Room 406, Block K, Hong Kong; Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong (S.T.L.); Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong (S.T.L.); Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (T.W.Y.C., J.C.Y.L.) and Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China (M.Y.N.).From the Departments of Radiology (H.Y.F.W., H.Y.S.L., C.S.Y.L., T.P.W.L.), Medicine (M.M.S.L., I.F.N.H.), and Microbiology (T.W.H.C.), Queen Mary Hospital, Hong Kong; Departments of Diagnostic Radiology (A.H.T.F., K.W.H.C., E.Y.P.L., M.D.K., M.Y.N.), Family Medicine and Primary Care (E.Y.F.W.), Pharmacology and Pharmacy (E.Y.F.W.), and Medicine (I.F.N.H.), University of Hong Kong, Room 406, Block K, Hong Kong; Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong (S.T.L.); Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong (S.T.L.); Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (T.W.Y.C., J.C.Y.L.) and Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China (M.Y.N.).From the Departments of Radiology (H.Y.F.W., H.Y.S.L., C.S.Y.L., T.P.W.L.), Medicine (M.M.S.L., I.F.N.H.), and Microbiology (T.W.H.C.), Queen Mary Hospital, Hong Kong; Departments of Diagnostic Radiology (A.H.T.F., K.W.H.C., E.Y.P.L., M.D.K., M.Y.N.), Family Medicine and Primary Care (E.Y.F.W.), Pharmacology and Pharmacy (E.Y.F.W.), and Medicine (I.F.N.H.), University of Hong Kong, Room 406, Block K, Hong Kong; Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong (S.T.L.); Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong (S.T.L.); Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (T.W.Y.C., J.C.Y.L.) and Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China (M.Y.N.).From the Departments of Radiology (H.Y.F.W., H.Y.S.L., C.S.Y.L., T.P.W.L.), Medicine (M.M.S.L., I.F.N.H.), and Microbiology (T.W.H.C.), Queen Mary Hospital, Hong Kong; Departments of Diagnostic Radiology (A.H.T.F., K.W.H.C., E.Y.P.L., M.D.K., M.Y.N.), Family Medicine and Primary Care (E.Y.F.W.), Pharmacology and Pharmacy (E.Y.F.W.), and Medicine (I.F.N.H.), University of Hong Kong, Room 406, Block K, Hong Kong; Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong (S.T.L.); Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong (S.T.L.); Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (T.W.Y.C., J.C.Y.L.) and Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China (M.Y.N.).From the Departments of Radiology (H.Y.F.W., H.Y.S.L., C.S.Y.L., T.P.W.L.), Medicine (M.M.S.L., I.F.N.H.), and Microbiology (T.W.H.C.), Queen Mary Hospital, Hong Kong; Departments of Diagnostic Radiology (A.H.T.F., K.W.H.C., E.Y.P.L., M.D.K., M.Y.N.), Family Medicine and Primary Care (E.Y.F.W.), Pharmacology and Pharmacy (E.Y.F.W.), and Medicine (I.F.N.H.), University of Hong Kong, Room 406, Block K, Hong Kong; Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong (S.T.L.); Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong (S.T.L.); Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (T.W.Y.C., J.C.Y.L.) and Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China (M.Y.N.).From the Departments of Radiology (H.Y.F.W., H.Y.S.L., C.S.Y.L., T.P.W.L.), Medicine (M.M.S.L., I.F.N.H.), and Microbiology (T.W.H.C.), Queen Mary Hospital, Hong Kong; Departments of Diagnostic Radiology (A.H.T.F., K.W.H.C., E.Y.P.L., M.D.K., M.Y.N.), Family Medicine and Primary Care (E.Y.F.W.), Pharmacology and Pharmacy (E.Y.F.W.), and Medicine (I.F.N.H.), University of Hong Kong, Room 406, Block K, Hong Kong; Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong (S.T.L.); Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong (S.T.L.); Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (T.W.Y.C., J.C.Y.L.) and Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China (M.Y.N.).From the Departments of Radiology (H.Y.F.W., H.Y.S.L., C.S.Y.L., T.P.W.L.), Medicine (M.M.S.L., I.F.N.H.), and Microbiology (T.W.H.C.), Queen Mary Hospital, Hong Kong; Departments of Diagnostic Radiology (A.H.T.F., K.W.H.C., E.Y.P.L., M.D.K., M.Y.N.), Family Medicine and Primary Care (E.Y.F.W.), Pharmacology and Pharmacy (E.Y.F.W.), and Medicine (I.F.N.H.), University of Hong Kong, Room 406, Block K, Hong Kong; Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong (S.T.L.); Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong (S.T.L.); Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (T.W.Y.C., J.C.Y.L.) and Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China (M.Y.N.).From the Departments of Radiology (H.Y.F.W., H.Y.S.L., C.S.Y.L., T.P.W.L.), Medicine (M.M.S.L., I.F.N.H.), and Microbiology (T.W.H.C.), Queen Mary Hospital, Hong Kong; Departments of Diagnostic Radiology (A.H.T.F., K.W.H.C., E.Y.P.L., M.D.K., M.Y.N.), Family Medicine and Primary Care (E.Y.F.W.), Pharmacology and Pharmacy (E.Y.F.W.), and Medicine (I.F.N.H.), University of Hong Kong, Room 406, Block K, Hong Kong; Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong (S.T.L.); Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong (S.T.L.); Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (T.W.Y.C., J.C.Y.L.) and Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China (M.Y.N.).From the Departments of Radiology (H.Y.F.W., H.Y.S.L., C.S.Y.L., T.P.W.L.), Medicine (M.M.S.L., I.F.N.H.), and Microbiology (T.W.H.C.), Queen Mary Hospital, Hong Kong; Departments of Diagnostic Radiology (A.H.T.F., K.W.H.C., E.Y.P.L., M.D.K., M.Y.N.), Family Medicine and Primary Care (E.Y.F.W.), Pharmacology and Pharmacy (E.Y.F.W.), and Medicine (I.F.N.H.), University of Hong Kong, Room 406, Block K, Hong Kong; Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong (S.T.L.); Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong (S.T.L.); Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (T.W.Y.C., J.C.Y.L.) and Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China (M.Y.N.).From the Departments of Radiology (H.Y.F.W., H.Y.S.L., C.S.Y.L., T.P.W.L.), Medicine (M.M.S.L., I.F.N.H.), and Microbiology (T.W.H.C.), Queen Mary Hospital, Hong Kong; Departments of Diagnostic Radiology (A.H.T.F., K.W.H.C., E.Y.P.L., M.D.K., M.Y.N.), Family Medicine and Primary Care (E.Y.F.W.), Pharmacology and Pharmacy (E.Y.F.W.), and Medicine (I.F.N.H.), University of Hong Kong, Room 406, Block K, Hong Kong; Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong (S.T.L.); Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong (S.T.L.); Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (T.W.Y.C., J.C.Y.L.) and Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China (M.Y.N.).From the Departments of Radiology (H.Y.F.W., H.Y.S.L., C.S.Y.L., T.P.W.L.), Medicine (M.M.S.L., I.F.N.H.), and Microbiology (T.W.H.C.), Queen Mary Hospital, Hong Kong; Departments of Diagnostic Radiology (A.H.T.F., K.W.H.C., E.Y.P.L., M.D.K., M.Y.N.), Family Medicine and Primary Care (E.Y.F.W.), Pharmacology and Pharmacy (E.Y.F.W.), and Medicine (I.F.N.H.), University of Hong Kong, Room 406, Block K, Hong Kong; Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong (S.T.L.); Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong (S.T.L.); Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (T.W.Y.C., J.C.Y.L.) and Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China (M.Y.N.).From the Departments of Radiology (H.Y.F.W., H.Y.S.L., C.S.Y.L., T.P.W.L.), Medicine (M.M.S.L., I.F.N.H.), and Microbiology (T.W.H.C.), Queen Mary Hospital, Hong Kong; Departments of Diagnostic Radiology (A.H.T.F., K.W.H.C., E.Y.P.L., M.D.K., M.Y.N.), Family Medicine and Primary Care (E.Y.F.W.), Pharmacology and Pharmacy (E.Y.F.W.), and Medicine (I.F.N.H.), University of Hong Kong, Room 406, Block K, Hong Kong; Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong (S.T.L.); Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong (S.T.L.); Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (T.W.Y.C., J.C.Y.L.) and Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China (M.Y.N.).From the Departments of Radiology (H.Y.F.W., H.Y.S.L., C.S.Y.L., T.P.W.L.), Medicine (M.M.S.L., I.F.N.H.), and Microbiology (T.W.H.C.), Queen Mary Hospital, Hong Kong; Departments of Diagnostic Radiology (A.H.T.F., K.W.H.C., E.Y.P.L., M.D.K., M.Y.N.), Family Medicine and Primary Care (E.Y.F.W.), Pharmacology and Pharmacy (E.Y.F.W.), and Medicine (I.F.N.H.), University of Hong Kong, Room 406, Block K, Hong Kong; Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong (S.T.L.); Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong (S.T.L.); Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (T.W.Y.C., J.C.Y.L.) and Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China (M.Y.N.).From the Departments of Radiology (H.Y.F.W., H.Y.S.L., C.S.Y.L., T.P.W.L.), Medicine (M.M.S.L., I.F.N.H.), and Microbiology (T.W.H.C.), Queen Mary Hospital, Hong Kong; Departments of Diagnostic Radiology (A.H.T.F., K.W.H.C., E.Y.P.L., M.D.K., M.Y.N.), Family Medicine and Primary Care (E.Y.F.W.), Pharmacology and Pharmacy (E.Y.F.W.), and Medicine (I.F.N.H.), University of Hong Kong, Room 406, Block K, Hong Kong; Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong (S.T.L.); Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong (S.T.L.); Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (T.W.Y.C., J.C.Y.L.) and Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China (M.Y.N.).From the Departments of Radiology (H.Y.F.W., H.Y.S.L., C.S.Y.L., T.P.W.L.), Medicine (M.M.S.L., I.F.N.H.), and Microbiology (T.W.H.C.), Queen Mary Hospital, Hong Kong; Departments of Diagnostic Radiology (A.H.T.F., K.W.H.C., E.Y.P.L., M.D.K., M.Y.N.), Family Medicine and Primary Care (E.Y.F.W.), Pharmacology and Pharmacy (E.Y.F.W.), and Medicine (I.F.N.H.), University of Hong Kong, Room 406, Block K, Hong Kong; Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong (S.T.L.); Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong (S.T.L.); Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (T.W.Y.C., J.C.Y.L.) and Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China (M.Y.N.).

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

32216717

Citation

Wong, Ho Yuen Frank, et al. "Frequency and Distribution of Chest Radiographic Findings in Patients Positive for COVID-19." Radiology, vol. 296, no. 2, 2020, pp. E72-E78.
Wong HYF, Lam HYS, Fong AH, et al. Frequency and Distribution of Chest Radiographic Findings in Patients Positive for COVID-19. Radiology. 2020;296(2):E72-E78.
Wong, H. Y. F., Lam, H. Y. S., Fong, A. H., Leung, S. T., Chin, T. W., Lo, C. S. Y., Lui, M. M., Lee, J. C. Y., Chiu, K. W., Chung, T. W., Lee, E. Y. P., Wan, E. Y. F., Hung, I. F. N., Lam, T. P. W., Kuo, M. D., & Ng, M. Y. (2020). Frequency and Distribution of Chest Radiographic Findings in Patients Positive for COVID-19. Radiology, 296(2), E72-E78. https://doi.org/10.1148/radiol.2020201160
Wong HYF, et al. Frequency and Distribution of Chest Radiographic Findings in Patients Positive for COVID-19. Radiology. 2020;296(2):E72-E78. PubMed PMID: 32216717.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Frequency and Distribution of Chest Radiographic Findings in Patients Positive for COVID-19. AU - Wong,Ho Yuen Frank, AU - Lam,Hiu Yin Sonia, AU - Fong,Ambrose Ho-Tung, AU - Leung,Siu Ting, AU - Chin,Thomas Wing-Yan, AU - Lo,Christine Shing Yen, AU - Lui,Macy Mei-Sze, AU - Lee,Jonan Chun Yin, AU - Chiu,Keith Wan-Hang, AU - Chung,Tom Wai-Hin, AU - Lee,Elaine Yuen Phin, AU - Wan,Eric Yuk Fai, AU - Hung,Ivan Fan Ngai, AU - Lam,Tina Poy Wing, AU - Kuo,Michael D, AU - Ng,Ming-Yen, Y1 - 2020/03/27/ PY - 2020/3/29/pubmed PY - 2020/8/1/medline PY - 2020/3/29/entrez SP - E72 EP - E78 JF - Radiology JO - Radiology VL - 296 IS - 2 N2 - Background Current coronavirus disease 2019 (COVID-19) radiologic literature is dominated by CT, and a detailed description of chest radiography appearances in relation to the disease time course is lacking. Purpose To describe the time course and severity of findings of COVID-19 at chest radiography and correlate these with real-time reverse transcription polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, nucleic acid. Materials and Methods This is a retrospective study of patients with COVID-19 confirmed by using RT-PCR and chest radiographic examinations who were admitted across four hospitals and evaluated between January and March 2020. Baseline and serial chest radiographs (n = 255) were reviewed with RT-PCR. Correlation with concurrent CT examinations (n = 28) was performed when available. Two radiologists scored each chest radiograph in consensus for consolidation, ground-glass opacity, location, and pleural fluid. A severity index was determined for each lung. The lung scores were summed to produce the final severity score. Results The study was composed of 64 patients (26 men; mean age, 56 years ± 19 [standard deviation]). Of these, 58 patients had initial positive findings with RT-PCR (91%; 95% confidence interval: 81%, 96%), 44 patients had abnormal findings at baseline chest radiography (69%; 95% confidence interval: 56%, 80%), and 38 patients had initial positive findings with RT-PCR testing and abnormal findings at baseline chest radiography (59%; 95% confidence interval: 46%, 71%). Six patients (9%) showed abnormalities at chest radiography before eventually testing positive for COVID-19 with RT-PCR. Sensitivity of initial RT-PCR (91%; 95% confidence interval: 83%, 97%) was higher than that of baseline chest radiography (69%; 95% confidence interval: 56%, 80%) (P = .009). Radiographic recovery (mean, 6 days ± 5) and virologic recovery (mean, 8 days ± 6) were not significantly different (P = .33). Consolidation was the most common finding (30 of 64; 47%) followed by ground-glass opacities (21 of 64; 33%). Abnormalities at chest radiography had a peripheral distribution (26 of 64; 41%) and lower zone distribution (32 of 64; 50%) with bilateral involvement (32 of 64; 50%). Pleural effusion was uncommon (two of 64; 3%). The severity of findings at chest radiography peaked at 10-12 days from the date of symptom onset. Conclusion Findings at chest radiography in patients with coronavirus disease 2019 frequently showed bilateral lower zone consolidation, which peaked at 10-12 days from symptom onset. © RSNA, 2020. SN - 1527-1315 UR - https://www.unboundmedicine.com/medline/citation/32216717/Frequency_and_Distribution_of_Chest_Radiographic_Findings_in_Patients_Positive_for_COVID_19_ L2 - https://pubs.rsna.org/doi/10.1148/radiol.2020201160?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -