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The Performance of Chest CT in Evaluating the Clinical Severity of COVID-19 Pneumonia: Identifying Critical Cases Based on CT Characteristics.
Invest Radiol. 2020 07; 55(7):412-421.IR

Abstract

OBJECTIVES

The aim of this study was to assess the clinical severity of COVID-19 pneumonia using qualitative and/or quantitative chest computed tomography (CT) indicators and identify the CT characteristics of critical cases.

MATERIALS AND METHODS

Fifty-one patients with COVID-19 pneumonia including ordinary cases (group A, n = 12), severe cases (group B, n = 15), and critical cases (group C, n = 24) were retrospectively enrolled. The qualitative and quantitative indicators from chest CT were recorded and compared using Fisher exact test, one-way analysis of variance, Kruskal-Wallis H test, and receiver operating characteristic analysis.

RESULTS

Depending on the severity of the disease, the number of involved lung segments and lobes, the frequencies of consolidation, crazy-paving pattern, and air bronchogram increased in more severe cases. Qualitative indicators including total severity score for the whole lung and total score for crazy-paving and consolidation could distinguish groups B and C from A (69% sensitivity, 83% specificity, and 73% accuracy) but were similar between group B and group C. Combined qualitative and quantitative indicators could distinguish these 3 groups with high sensitivity (B + C vs A, 90%; C vs B, 92%), specificity (100%, 87%), and accuracy (92%, 90%). Critical cases had higher total severity score (>10) and higher total score for crazy-paving and consolidation (>4) than ordinary cases, and had higher mean lung density (>-779 HU) and full width at half maximum (>128 HU) but lower relative volume of normal lung density (≦50%) than ordinary/severe cases. In our critical cases, 8 patients with relative volume of normal lung density smaller than 40% received mechanical ventilation for supportive treatment, and 2 of them had died.

CONCLUSIONS

A rapid, accurate severity assessment of COVID-19 pneumonia based on chest CT would be feasible and could provide help for making management decisions, especially for the critical cases.

Authors+Show Affiliations

From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province.From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province.From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province.CT Research Collaboration, Siemens Healthineers Ltd, Guangzhou, Guangdong Province, China.From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32304402

Citation

Lyu, Peijie, et al. "The Performance of Chest CT in Evaluating the Clinical Severity of COVID-19 Pneumonia: Identifying Critical Cases Based On CT Characteristics." Investigative Radiology, vol. 55, no. 7, 2020, pp. 412-421.
Lyu P, Liu X, Zhang R, et al. The Performance of Chest CT in Evaluating the Clinical Severity of COVID-19 Pneumonia: Identifying Critical Cases Based on CT Characteristics. Invest Radiol. 2020;55(7):412-421.
Lyu, P., Liu, X., Zhang, R., Shi, L., & Gao, J. (2020). The Performance of Chest CT in Evaluating the Clinical Severity of COVID-19 Pneumonia: Identifying Critical Cases Based on CT Characteristics. Investigative Radiology, 55(7), 412-421. https://doi.org/10.1097/RLI.0000000000000689
Lyu P, et al. The Performance of Chest CT in Evaluating the Clinical Severity of COVID-19 Pneumonia: Identifying Critical Cases Based On CT Characteristics. Invest Radiol. 2020;55(7):412-421. PubMed PMID: 32304402.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Performance of Chest CT in Evaluating the Clinical Severity of COVID-19 Pneumonia: Identifying Critical Cases Based on CT Characteristics. AU - Lyu,Peijie, AU - Liu,Xing, AU - Zhang,Rui, AU - Shi,Lei, AU - Gao,Jianbo, PY - 2020/4/19/pubmed PY - 2020/7/7/medline PY - 2020/4/19/entrez SP - 412 EP - 421 JF - Investigative radiology JO - Invest Radiol VL - 55 IS - 7 N2 - OBJECTIVES: The aim of this study was to assess the clinical severity of COVID-19 pneumonia using qualitative and/or quantitative chest computed tomography (CT) indicators and identify the CT characteristics of critical cases. MATERIALS AND METHODS: Fifty-one patients with COVID-19 pneumonia including ordinary cases (group A, n = 12), severe cases (group B, n = 15), and critical cases (group C, n = 24) were retrospectively enrolled. The qualitative and quantitative indicators from chest CT were recorded and compared using Fisher exact test, one-way analysis of variance, Kruskal-Wallis H test, and receiver operating characteristic analysis. RESULTS: Depending on the severity of the disease, the number of involved lung segments and lobes, the frequencies of consolidation, crazy-paving pattern, and air bronchogram increased in more severe cases. Qualitative indicators including total severity score for the whole lung and total score for crazy-paving and consolidation could distinguish groups B and C from A (69% sensitivity, 83% specificity, and 73% accuracy) but were similar between group B and group C. Combined qualitative and quantitative indicators could distinguish these 3 groups with high sensitivity (B + C vs A, 90%; C vs B, 92%), specificity (100%, 87%), and accuracy (92%, 90%). Critical cases had higher total severity score (>10) and higher total score for crazy-paving and consolidation (>4) than ordinary cases, and had higher mean lung density (>-779 HU) and full width at half maximum (>128 HU) but lower relative volume of normal lung density (≦50%) than ordinary/severe cases. In our critical cases, 8 patients with relative volume of normal lung density smaller than 40% received mechanical ventilation for supportive treatment, and 2 of them had died. CONCLUSIONS: A rapid, accurate severity assessment of COVID-19 pneumonia based on chest CT would be feasible and could provide help for making management decisions, especially for the critical cases. SN - 1536-0210 UR - https://www.unboundmedicine.com/medline/citation/32304402/The_Performance_of_Chest_CT_in_Evaluating_the_Clinical_Severity_of_COVID_19_Pneumonia:_Identifying_Critical_Cases_Based_on_CT_Characteristics_ L2 - https://doi.org/10.1097/RLI.0000000000000689 DB - PRIME DP - Unbound Medicine ER -