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      Temporal Changes of CT Findings in 90 Patients with COVID-19 Pneumonia: A Longitudinal Study

      , PhD * , , MD * , , PhD, , MD, , MD, , MD, , PhD, , PhD


      Radiological Society of North America

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          CT may play a central role in the diagnosis and management of COVID-19 pneumonia.


          To perform a longitudinal study to analyze the serial CT findings over time in patients with COVID-19 pneumonia.

          Materials and Methods

          During January 16 to February 17, 2020, 90 patients (male:female, 33:57; mean age, 45 years) with COVID-19 pneumonia were prospectively enrolled and followed up until they were discharged or died, or until the end of the study. A total of 366 CT scans were acquired and reviewed by 2 groups of radiologists for the patterns and distribution of lung abnormalities, total CT scores and number of zones involved. Those features were analyzed for temporal change.


          CT scores and number of zones involved progressed rapidly, peaked during illness days 6-11 (median: 5 and 5), and followed by persistence of high levels. The predominant pattern of abnormalities after symptom onset was ground-glass opacity (35/78 [45%] to 49/79 [62%] in different periods). The percentage of mixed pattern peaked (30/78 [38%]) on illness days 12-17, and became the second most predominant pattern thereafter. Pure ground-glass opacity was the most prevalent sub-type of ground-glass opacity after symptom onset (20/50 [40%] to 20/28 [71%]). The percentage of ground-glass opacity with irregular linear opacity peaked on illness days 6-11 (14/50 [28%)]) and became the second most prevalent subtype thereafter. The distribution of lesions was predominantly bilateral and subpleural. 66/70 (94%) patients discharged had residual disease on final CT scans (median CT scores and zones involved: 4 and 4), with ground-glass opacity (42/70 [60%]) and pure ground-glass opacity (31/42 [74%]) the most common pattern and subtype.


          The extent of lung abnormalities on CT peaked during illness days 6-11. The temporal changes of the diverse CT manifestations followed a specific pattern, which might indicate the progression and recovery of the illness.

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          Most cited references 9

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          Idiopathic interstitial pneumonias: diagnostic accuracy of thin-section CT in 129 patients.

          To determine whether idiopathic interstitial pneumonias can be differentiated on the basis of the pattern and distribution of abnormalities at thin-section computed tomography (CT). Thin-section CT scans in 129 patients with histologically proved idiopathic interstitial pneumonia (35 with usual interstitial pneumonia [UIP], 24 with bronchiolitis obliterans organizing pneumonia [BOOP], 23 with desquamative interstitial pneumonia [DIP], 20 with acute interstitial pneumonia [AIP], and 27 with nonspecific interstitial pneumonia and fibrosis [NIPF]) were independently assessed by two observers without knowledge of clinical or histologic data. The observers recorded the abnormalities, diagnosis, and degree of confidence in their diagnosis. Differential diagnosis was limited to the five types of idiopathic interstitial pneumonia. The two observers made a correct diagnosis, on average, in 74 (57%) cases. On average, the correct diagnosis was made in 25 (71%) cases of UIP, 19 (79%) of BOOP, 14.5 (63%) of DIP, 13 (65%) of AIP, and 2.5 (9%) of NIPF. The two observers made a correct diagnosis with a high degree of confidence in 50 (39%) readings. There was moderate agreement between the observers for the correct diagnosis (k = 0.55) and for the correct diagnosis with a high degree of confidence (k = 0.65). Except for NIPF, the various subtypes of idiopathic interstitial pneumonias often have a characteristic appearance that allows differentiation at thin-section CT.
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            Organizing pneumonia: perilobular pattern at thin-section CT.

            To describe the appearance and frequency of a perilobular pattern at thin-section computed tomography (CT) in patients with organizing pneumonia.
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              Radiographic-clinical correlation in severe acute respiratory syndrome: study of 1373 patients in Hong Kong.

              To retrospectively analyze serial chest radiographs in all patients with severe acute respiratory syndrome (SARS) in Hong Kong for temporal changes and differences between patients who died and those who were discharged from the hospital and to compare radiographic and clinical parameters. This retrospective study had ethics review board endorsement, and the need for informed consent was waived. Selected serial chest radiographs obtained from the time of presentation until discharge or death in 1373 patients with laboratory-confirmed SARS were scored. Scoring was based on the area and location of lung opacification on radiographs obtained at each of five milestones (presentation, beginning of ribavirin therapy, beginning of corticosteroid therapy, time of most severe radiographic appearance of disease, and before discharge or death). Extents of lung opacification at these five milestones were compared between patients who died and those who survived (by using a repeated-measures analysis of variance model), and the temporal trend of the radiographic-clinical parameters was analyzed (by using Cochran-Armitage trend testing, Kendall tau correlation coefficients, and descriptive graphic analysis). The final cohort consisted of 1373 patients (1212 of whom [485 male and 727 female patients; mean age, 38.4 years] survived and 161 of whom [84 male and 77 female patients; mean age, 63.0 years] died). Among survivors, older patients had more extensive radiographic changes than younger ones. However, among patients who died, older patients had less extensive radiographic opacification at the worst stage of disease and just before death than did younger patients. Despite a higher mortality risk for male patients, both sexes in the same outcome group had similar radiographic findings. For both outcome groups, the rate of radiographic progression was similar for the first 11 days but diverged afterwards. The extent of opacification increased by approximately one zone every 4-5 days for the initial 11 days. Radiographic scores correlated with the ratio of PaO2 to the fraction of inspired oxygen, lymphocyte count, lactate dehydrogenase level, and neutrophil count at each milestone and in terms of changes between milestones (P < .01 for all correlation coefficients, except for radiographic score and neutrophil count between the first two milestones). The initial extent of radiographic opacification may be useful for prognostic prediction. Radiographic progression correlates well with that of important clinical and laboratory parameters and may be used as an objective prognostic indicator early in SARS. RSNA, 2005

                Author and article information

                Radiological Society of North America
                19 March 2020
                From the Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (Y.W., C.D., C.L., Q.R., X.Z., H.S., M.Z); Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China (Y.W., C.D., C.L., Q.R., X.Z., H.S., M.Z.); and Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (Y.H.).
                Author notes
                Address correspondence to M.Z (e-mail: zhoumin_cmu@ 123456126.com ).
                2020 by the Radiological Society of North America, Inc.

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                Funded by: HUST Innovation Project 2020
                Award ID: 2020kfyXGYJ007
                Original Research
                Thoracic Imaging


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