Chest CT Severity Score as an Auxiliary Grading Tool to COVID-19 Pneumonia Imaging Classification: A Tertiary Care Experience in Pakistan (original) (raw)
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Egyptian Journal of Radiology and Nuclear Medicine, 2022
Background: Since November 2019, the rapid outbreak of coronavirus disease 2019 (COVID-19) has become a public health emergency of international concern. COVID-19 disease is caused by a new variant of coronavirus, named as 'severe acute respiratory syndrome coronavirus 2. ' Chest CT has a potential role in the diagnosis, detection of complications and in predicting clinical recovery of patients or progression of coronavirus disease 2019. Degree and severity of lung involvement can be assessed by 25 point CT severity score. This quantification plays an important role to modify the treatment plan at times in critically ill patient of COVID-19. Hence, the purpose of present study was to describe and quantify the severity of COVID-19 infection on chest computed tomography (CT) by 25-point CT severity score and to determine the relationship of CT severity score with clinical and laboratory parameters. Results: A total of 150 patients with COVID-19 disease were assessed. Mean age of the study group was 54.46 years (62.7% males and 37.3% females). The most common comorbidity present in the study group was diabetes mellitus, which was present in 17.3% cases. Severity of disease was significantly associated with age of the patient. CT severity score was positively correlated with lymphopenia and raised CRP, D-dimer and serum ferritin levels. A significant statistical correlation was found between CT severity grade and patient survival. Conclusions: This is a large comprehensive study, collecting data from 150 cases of COVID-19 pneumonia patients, in a tertiary care hospital in India to describe the correlation of CT severity score with clinical land laboratory parameters. Chest CT severity score correlates well with laboratory parameters and can aid in predicting COVID-19 disease outcome.
Cureus
The objective of the present study is to describe high-resolution CT (HRCT) chest manifestations of coronavirus disease 2019 (COVID-19) patients presenting to a tertiary healthcare facility in Punjab, Pakistan, and to analyze the distribution of the disease in lung fields. Additionally, we assess the role of chest CT severity scoring (CT-SS) in determining the severity of pneumonia. Methods In this cross-sectional descriptive study conducted from March 30, 2020, to May 30, 2020, 87 confirmed COVID-19 patients undergoing HRCT scan in a tertiary care facility in Punjab, Pakistan were included. The HRCT chest was performed on the patients using a standard protocol. Each study was evaluated for the presence of ground-glass opacities (GGOs), consolidation, mixed pattern, distribution, crazy paving, reverse halo sign, nodules, pleural effusion, and other findings. Additionally, CT-SS was calculated by dividing each lung into 20 zones. Each zone was scored as 0, 1, and 2, representing no involvement, <50% involvement, and >50% involvement of one zone respectively (total score: 0-40 for each patient). The patients were classified into mild, moderate, and severe cases (mild: CT-SS of <20, moderate: CT-SS of 20-30, and severe: CT-SS of >30). Results GGO was the most common finding, as seen in 88.5% of the patients, followed by consolidations (52.8%) and crazy paving (33.3%). The majority of the patients showed the bilateral and peripheral distribution of the disease process. Vascular dilatation and bronchiectasis were seen in 10 patients; pleural effusions were observed in only two study patients, while no patient exhibited reverse halo sign or pulmonary nodules. The superior segment of lower lobes was the most commonly involved segment bilaterally. According to CT-SS, 78 (89.6%), six (6.9%), and three (3.45%) patients had mild, moderate, and severe disease respectively. Conclusion The typical imaging findings of COVID-19 on HRCT are GGOs with multilobe involvement and bilateral, peripheral, and basal predominance. CT-SS is helpful in categorizing pneumonia into mild, moderate, and severe types, thereby helping to identify patients with severe disease. This is particularly helpful in settings where fast triage is required.
Iranian Journal of Radiology
Background: Coronavirus disease 2019 (COVID-19) has several chest computed tomography (CT) characteristics, which are important for the early management of this disease, because viral detection via RT-PCR can be time-consuming, resulting in a delayed pneumonia diagnosis. The Radiological Society of North America (RSNA) proposed a reporting language for CT findings related to COVID-19 and defined four CT categories: typical, indeterminate, atypical, and negative. Objectives: To retrospectively evaluate the chest CT characteristics of patients with COVID-19 pneumonia. Patients and Methods: A total of 115 hospitalized laboratory-verified COVID-19 cases, underdoing chest CT scan, were included in this study from April 30 to May 15, 2020. Of 115 cases, 53 were discharged from the hospital, and 62 expired. The initial clinical features and chest CT scans were assessed for the type, pattern, distribution, and frequency of lesions. Moreover, the findings were compared between ward-hospitali...
The role of a chest computed tomography severity score in coronavirus disease 2019 pneumonia
Medicine, 2020
The chest computed tomography (CT) characteristics of coronavirus disease 2019 (COVID-19) are important for diagnostic and prognostic purposes. The aim of this study was to investigate chest CT findings in COVID-19 patients in order to determine the optimal cutoff value of a CT severity score that can be considered a potential prognostic indicator of a severe/critical outcome. The CT findings were evaluated by means of a severity score that included the extent (0-4 grading scale) and nature (0-4 grading scale) of CT abnormalities. The images were evaluated at 3 levels bilaterally. A receiver operating characteristics (ROC) curve was used to identify the optimal score (Youden's index) predicting severe/critical COVID-19. The study involved 165 COVID-19 patients (131 men [79.4%] and 34 women [20.6%] with a mean age of 61.5 ± 12.5 years), of whom 30 (18.2%) had severe/critical disease and 135 (81.8%) mild/typical disease. The most frequent CT finding was bilateral predominantly subpleural and basilar airspace changes, with more extensive ground-glass opacities than consolidation. CT findings of consolidation, a crazy-paving pattern, linear opacities, air bronchogram, and extrapulmonary lesions correlated with severe/critical COVID-19. The mean CT severity score was 63.95 in the severe/critical group, and 35.62 in the mild/typical group (P < .001). ROC curve analysis showed that a CT severity score of 38 predicted the development of severe/critical symptoms. A CT severity score can help the risk stratification of COVID-19 patients. Abbreviations: ARDS = acute respiratory distress syndrome, CI = confidence interval, COVID-19 = coronavirus disease 2019, CT = computed tomography, FiO 2 = fraction of inspired oxygen, GGO = ground-glass opacity, PaO 2 = arterial oxygen partial pressure, PEEP = positive end-respiratory pressure, SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2, WHO = World Health Organization.
Romanian Journal of Internal Medicine, 2020
Background. Coronavirus disease 2019 (COVID-19) was initially detected in Wuhan city, China. Chest CT features of COVID-19 pneumonia have been investigated mostly in China, and there is very little information available on the radiological findings occurring in other populations. In this study, we aimed to describe the characteristics of chest CT findings in confirmed cases of COVID-19 pneumonia in an Iranian population, based on a time classification. Methods. Eighty-nine patients with COVID-19 pneumonia, confirmed by a real-time RT-PCR test, who were admitted to non-ICU wards and underwent a chest CT scan were retrospectively enrolled. Descriptive evaluation of radiologic findings was performed using a classification based on the time interval between the initiation of the symptoms and chest CT-scan. Results. The median age of patients was 58.0 years, and the median time interval from the onset of symptoms to CT scan evaluation was 7 days. Most patients had bilateral (94.4%) and m...
Current Medical Imaging Formerly Current Medical Imaging Reviews, 2021
Background: Lungs are the primary organ involved in COVID-19, and the severity of pneumonia in COVID-19 patients is an important cause of morbidity and mortality. Aim: We aimed to evaluate the pneumonia severity through the visual and quantitative assessment on chest computed tomography (CT) in patients with coronavirus disease 2019 (COVID-19) and compare the CT findings with clinical and laboratory findings. Methods: We retrospectively evaluated adult COVID-19 patients who underwent chest CT along with theirclinical scores, laboratory findings, and length of hospital stay. Two independent radiologists visually evaluated the pneumonia severity on chest CT (VSQS). Quantitative CT (QCT) assessment was performed using a free DICOM viewer, and the percentage of the well-aerated lung (%WAL), high-attenuation areas (%HAA) at different threshold values, and mean lung attenuation (MLA) values were calculated. The relationship between CT scores and the clinical, laboratory data, and the leng...
Purpose: The CT Severity Score has great significance in assessing the extent of pneumonia involvement with differentiation of mild, critical and severe types and helps clinicians achieve early diagnosis and accurate treatment. Material and methods: 100 COVID-19 positive patients were analyzed for CT-SS and its correlation with clinical severity, laboratory markers and duration of hospital stay. The ROC curve was analyzed to obtain the optimum CT-SS threshold to discriminate patients in the common group from the patients of severe & critical groups and discriminate patients in the critical group from the patients of severe & common groups. Results: The study comprised 57 common category, 23 severe category and 20 critical category patients. The mean chest CT-SS score was highest in critical patients (35.95), higher in severe patients (25.52) than common patients (12.18) with mean duration of admission was 13.35, 12 and 7.65 days respectively (p-value of 0.000). The optimum CT-SS threshold for discriminating patients in the common group from the patients of severe & critical groups was 21.5 with sensitivity of 93%, specificity of 86%. The optimum CT-SS threshold for discriminating patients in the critical group from the patients of severe & common groups was 28.5 with a sensitivity & specificity of 90%. Conclusion: Initial Chest CT-SS showed significant association with duration of hospital stay and short-term prognosis of patients. Chest CT Severity Score can be used to evaluate the clinical severity of the patients on initial scans, to differentiate common, severe and critical patients and decide their management.
Evaluation of the Prognostic Value of Chest Computed Tomography Scan in COVID-19 Patients
Iranian Journal of Radiology, 2021
Background: The world is facing the coronavirus 2 pandemic since 2019 (COVID-19 infection) and all countries have challenges in management of patients based on their facilities. Chest computed tomography (CT) scan can be valuable in early detection and estimation of the pulmonary involvement in these patients. Objectives: To evaluate the prognostic value of chest CT imaging features in patients with coronavirus disease 2019 (COVID-19) pneumonia. Patients and Methods: In this cross-sectional study, 201 patients with COVID-19 were enrolled consecutively. The patients’ chest CT scans were analyzed, and the disease severity was rated using two methods: (1) total lung involvement (TLI) in which each lobe is scored from 0 to 4 based on the percentage of involvement; and (2) modified TLI in which each lobe involvement score is multiplied by the number of its segments, and the sum is recorded as the modified TLI. The patients were categorized into four groups depending on their prognosis (p...