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Radiographic findings in 240 patients with COVID-19 pneumonia: time-dependence after the onset of symptoms.
Eur Radiol. 2020 Nov; 30(11):6161-6169.ER

Abstract

OBJECTIVE

To analyze the most frequent radiographic features of COVID-19 pneumonia and assess the effectiveness of chest X-ray (CXR) in detecting pulmonary alterations.

MATERIALS AND METHODS

CXR of 240 symptomatic patients (70% male, mean age 65 ± 16 years), with SARS-CoV-2 infection confirmed by RT-PCR, was retrospectively evaluated. Patients were clustered in four groups based on the number of days between symptom onset and CXR: group A (0-2 days), 49 patients; group B (3-5), 75 patients; group C (6-9), 85 patients; and group D (> 9), 31 patients. Alteration's type (reticular/ground-glass opacity (GGO)/consolidation) and distribution (bilateral/unilateral, upper/middle/lower fields, peripheral/central) were noted. Statistical significance was tested using chi-square test.

RESULTS

Among 240 patients who underwent CXR, 180 (75%) showed alterations (group A, 63.3%; group B, 72%; group C, 81.2%; group D, 83.9%). GGO was observed in 124/180 patients (68.8%), reticular alteration in 113/180 (62.7%), and consolidation in 71/180 (39.4%). Consolidation was significantly less frequent (p < 0.01). Distribution among groups was as follows: reticular alteration (group A, 70.9%; group B, 72.2%; group C, 57.9%; group D, 46.1%), GGO (group A, 67.7%; group B, 62.9%; group C, 71%; group D, 76.9%), and consolidation (group A, 35.5%; group B, 31.4%; group C, 47.8%; group D, 38.5%). Alterations were bilateral in 73.3%. Upper, middle, and lower fields were involved in 36.7%, 79.4%, and 87.8%, respectively. Lesions were peripheral in 49.4%, central in 11.1%, or both in 39.4%. Upper fields and central zones were significantly less involved (p < 0.01).

CONCLUSIONS

The most frequent lesions in COVID-19 patients were GGO (intermediate/late phase) and reticular alteration (early phase) while consolidation gradually increased over time. The most frequent distribution was bilateral, peripheral, and with middle/lower predominance. Overall rate of negative CXR was 25%, which progressively decreased over time.

KEY POINTS

• The predominant lung changes were GGO and reticular alteration, while consolidation was less frequent. • The typical distribution pattern was bilateral, peripheral, or both peripheral and central and involved predominantly the lower and middle fields. • Chest radiography showed lung abnormalities in 75% of patients with confirmed SARS-CoV-2 infection, range varied from 63.3 to 83.9%, respectively, at 0-2 days and > 9 days from the onset of symptoms.

Authors+Show Affiliations

Department of Radiology, I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy. Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Viale Camillo Golgi, 19, 27100, Pavia, Italy.Department of Radiology, I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy. giovannisavietto@gmail.com. Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Viale Camillo Golgi, 19, 27100, Pavia, Italy. giovannisavietto@gmail.com.Department of Radiology, I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy. Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Viale Camillo Golgi, 19, 27100, Pavia, Italy.Department of Radiology, I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy. Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Viale Camillo Golgi, 19, 27100, Pavia, Italy.Medical Oncology Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.Department of Radiology, I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy.Department of Radiology, I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy.Radiology Unit, Isituti Clinici Città di Pavia, Pavia, Italy.Unit of Respiratory Diseases, Department of Internal Medicine and Therapeutics, I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy.Unit of Respiratory Diseases, Department of Internal Medicine and Therapeutics, University of Pavia and I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy.Unit Anesthesiology, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Camillo Golgi, 19, Pavia, 27100, Italy. Anesthesia and Intensive Care Unit 1, Department of Intensive Medicine, I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy.Unit Anesthesiology, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Camillo Golgi, 19, Pavia, 27100, Italy. Anesthesia and Intensive Care Unit 1, Department of Intensive Medicine, I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy.Department of Internal Medicine and Therapeutics, University of Pavia, Viale Camillo Golgi, 19, Pavia, 27100, Italy. Emergency Department, I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy.Department of Infectious and Tropical Diseases, University of Pavia and I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy.Department of Radiology, I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy. Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Viale Camillo Golgi, 19, 27100, Pavia, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32474630

Citation

Vancheri, Sergio Giuseppe, et al. "Radiographic Findings in 240 Patients With COVID-19 Pneumonia: Time-dependence After the Onset of Symptoms." European Radiology, vol. 30, no. 11, 2020, pp. 6161-6169.
Vancheri SG, Savietto G, Ballati F, et al. Radiographic findings in 240 patients with COVID-19 pneumonia: time-dependence after the onset of symptoms. Eur Radiol. 2020;30(11):6161-6169.
Vancheri, S. G., Savietto, G., Ballati, F., Maggi, A., Canino, C., Bortolotto, C., Valentini, A., Dore, R., Stella, G. M., Corsico, A. G., Iotti, G. A., Mojoli, F., Perlini, S., Bruno, R., & Preda, L. (2020). Radiographic findings in 240 patients with COVID-19 pneumonia: time-dependence after the onset of symptoms. European Radiology, 30(11), 6161-6169. https://doi.org/10.1007/s00330-020-06967-7
Vancheri SG, et al. Radiographic Findings in 240 Patients With COVID-19 Pneumonia: Time-dependence After the Onset of Symptoms. Eur Radiol. 2020;30(11):6161-6169. PubMed PMID: 32474630.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Radiographic findings in 240 patients with COVID-19 pneumonia: time-dependence after the onset of symptoms. AU - Vancheri,Sergio Giuseppe, AU - Savietto,Giovanni, AU - Ballati,Francesco, AU - Maggi,Alessia, AU - Canino,Costanza, AU - Bortolotto,Chandra, AU - Valentini,Adele, AU - Dore,Roberto, AU - Stella,Giulia Maria, AU - Corsico,Angelo Guido, AU - Iotti,Giorgio Antonio, AU - Mojoli,Francesco, AU - Perlini,Stefano, AU - Bruno,Raffaele, AU - Preda,Lorenzo, Y1 - 2020/05/30/ PY - 2020/04/01/received PY - 2020/05/14/accepted PY - 2020/04/30/revised PY - 2020/6/1/pubmed PY - 2020/10/29/medline PY - 2020/6/1/entrez KW - COVID-19 KW - Pneumonia KW - Radiography KW - Severe acute respiratory syndrome coronavirus 2 KW - Thorax SP - 6161 EP - 6169 JF - European radiology JO - Eur Radiol VL - 30 IS - 11 N2 - OBJECTIVE: To analyze the most frequent radiographic features of COVID-19 pneumonia and assess the effectiveness of chest X-ray (CXR) in detecting pulmonary alterations. MATERIALS AND METHODS: CXR of 240 symptomatic patients (70% male, mean age 65 ± 16 years), with SARS-CoV-2 infection confirmed by RT-PCR, was retrospectively evaluated. Patients were clustered in four groups based on the number of days between symptom onset and CXR: group A (0-2 days), 49 patients; group B (3-5), 75 patients; group C (6-9), 85 patients; and group D (> 9), 31 patients. Alteration's type (reticular/ground-glass opacity (GGO)/consolidation) and distribution (bilateral/unilateral, upper/middle/lower fields, peripheral/central) were noted. Statistical significance was tested using chi-square test. RESULTS: Among 240 patients who underwent CXR, 180 (75%) showed alterations (group A, 63.3%; group B, 72%; group C, 81.2%; group D, 83.9%). GGO was observed in 124/180 patients (68.8%), reticular alteration in 113/180 (62.7%), and consolidation in 71/180 (39.4%). Consolidation was significantly less frequent (p < 0.01). Distribution among groups was as follows: reticular alteration (group A, 70.9%; group B, 72.2%; group C, 57.9%; group D, 46.1%), GGO (group A, 67.7%; group B, 62.9%; group C, 71%; group D, 76.9%), and consolidation (group A, 35.5%; group B, 31.4%; group C, 47.8%; group D, 38.5%). Alterations were bilateral in 73.3%. Upper, middle, and lower fields were involved in 36.7%, 79.4%, and 87.8%, respectively. Lesions were peripheral in 49.4%, central in 11.1%, or both in 39.4%. Upper fields and central zones were significantly less involved (p < 0.01). CONCLUSIONS: The most frequent lesions in COVID-19 patients were GGO (intermediate/late phase) and reticular alteration (early phase) while consolidation gradually increased over time. The most frequent distribution was bilateral, peripheral, and with middle/lower predominance. Overall rate of negative CXR was 25%, which progressively decreased over time. KEY POINTS: • The predominant lung changes were GGO and reticular alteration, while consolidation was less frequent. • The typical distribution pattern was bilateral, peripheral, or both peripheral and central and involved predominantly the lower and middle fields. • Chest radiography showed lung abnormalities in 75% of patients with confirmed SARS-CoV-2 infection, range varied from 63.3 to 83.9%, respectively, at 0-2 days and > 9 days from the onset of symptoms. SN - 1432-1084 UR - https://www.unboundmedicine.com/medline/citation/32474630/Radiographic_findings_in_240_patients_with_COVID_19_pneumonia:_time_dependence_after_the_onset_of_symptoms_ L2 - https://dx.doi.org/10.1007/s00330-020-06967-7 DB - PRIME DP - Unbound Medicine ER -