Document Type : Research articles

Authors

1 Department of Radiology, Municipal Hospital Affiliated to Medical School of Taizhou University, Zhejiang, Taizhou, China

2 Department of Oncology, Municipal Hospital Affiliated to Medical School of Taizhou University, Zhejiang, Taizhou, China

Abstract

Background: Regarding the outbreak of highly contagious the 2019 Novel Coronavirus (2019-nCoV) in various countries and regions, data have been needed on the early chest CT images and clinical characteristics of the affected patients.
Objectives: To explore the early clinical and computed tomography (CT) characteristics of the 2019 Novel Coronavirus Disease (COVID-19) patients to improve the diagnostic level of this contagious respiratory disease.
Methods: An analysis retrospectively was implemented on the radiological features and clinical characteristics of 12 patients with COVID-19 who had undergone chest CT scanning in the designated hospital from Jan 23, 2020, to Feb 18, 2020. The clinical data on general information, epidemiological, cardinal symptoms, blood test, and CT imaging characteristics were obtained.
Results: According to the relevant diagnostic criteria, the patients were divided into two groups: mild (2 cases), and ordinary type (10 cases). The main symptoms of 2019-nCoV pneumonia were fever (9/12) and cough (8/12) with or without respiratory and other systemic symptoms. The blood test of the patients showed that most of the white blood cell count was normal (10/12), decreased lymphocyte count (6/12), and increased hypersensitive C reactive protein (hs-CRP) (5/12). In the early stage of COVID-19, the chest CT images showed patchy mixed ground-glass opacity (GGO) (8/12), mainly distributed in the periphery and posterior part of both lungs. The internal density of image lesion area was uneven, and lesions primarily manifested as "crazy-paving pattern" (8/12), with grid-like, interlobular septal thickening, thickened bronchovascular bundle and air bronchus sign and multiple fibrosis. A few cases showed pulmonary atelectasis (1/12), bilateral pleural effusion (1/12), no mediastinal or bilateral hilar lymph node enlargement.
Conclusions: The clinical characteristics of 2019-nCoV pneumonia are similar to those of common viral pneumonia. The chest CT images may be helpful for the early detection of novel coronavirus pneumonia.

Keywords

  1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5. [PubMed: 31986264]. [PubMed Central: PMC7159299].
  2. Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020;395(10223):514-23. doi: 10.1016/S0140-6736(20)30154-9. [PubMed: 31986261]. [PubMed Central: PMC7159286].
  3. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020;382(13):1199-207. doi: 10.1056/NEJMoa2001316. [PubMed: 31995857]. [PubMed Central: PMC7121484].
  4. General Office of National Health Commission. Notice on the issuance of a programme for the diagnosis and treatment of novel coronavirus (2019-nCoV) infected pneumonia (trial sixth edition). 2020. Available from: http://www.nhc.gov.cn/xcs/zhengcwj/202002/8334a8326dd94d329df351d7da8aefc2.shtml.
  5. Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radiology. 2020:200432. doi: 10.1148/radiol.2020200432. [PubMed: 32073353].
  6. Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X, et al. CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV). Radiology. 2020;295(1):202-7. doi: 10.1148/radiol.2020200230. [PubMed: 32017661].
  7. Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time Course of Lung Changes On Chest CT During Recovery From 2019 Novel Coronavirus (COVID-19) Pneumonia. Radiology. 2020:200370. doi: 10.1148/radiol.2020200370. [PubMed: 32053470].
  8. Song F, Shi N, Shan F, Zhang Z, Shen J, Lu H, et al. Emerging 2019 Novel Coronavirus (2019-nCoV) Pneumonia. Radiology. 2020;295(1):210-7. doi: 10.1148/radiol.2020200274. [PubMed: 32027573].
  9. Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Radiology. 2020:200463. doi: 10.1148/radiol.2020200463. [PubMed: 32077789].
  10. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020. doi: 10.1056/NEJMoa2002032. [PubMed: 32109013]. [PubMed Central: PMC7092819].
  11. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008;246(3):697-722. doi: 10.1148/radiol.2462070712. [PubMed: 18195376].
  12. Wu X, Dong D, Ma D. Thin-Section Computed Tomography Manifestations During Convalescence and Long-Term Follow-Up of Patients with Severe Acute Respiratory Syndrome (SARS). Med Sci Monit. 2016;22:2793-9. doi: 10.12659/msm.896985. [PubMed: 27501327]. [PubMed Central: PMC4982531].
  13. Yang Y, Yang M, Shen C, Wang F, Yuan J, Li J, et al. Evaluating the accuracy of different respiratory specimens in the laboratory diagnosis and monitoring the viral shedding of 2019-nCoV infections. medRxiv. 2020. doi: 10.1101/2020.02.11.20021493.
  14. Huang P, Liu T, Huang L, Liu H, Lei M, Xu W, et al. Use of Chest CT in Combination with Negative RT-PCR Assay for the 2019 Novel Coronavirus but High Clinical Suspicion. Radiology. 2020;295(1):22-3. doi: 10.1148/radiol.2020200330. [PubMed: 32049600].
  15. Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J. Chest CT for Typical 2019-nCoV Pneumonia: Relationship to Negative RT-PCR Testing. Radiology. 2020:200343. doi: 10.1148/radiol.2020200343. [PubMed: 32049601].
  16. Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020:200642. doi: 10.1148/radiol.2020200642. [PubMed: 32101510].
  17. Munster VJ, Koopmans M, van Doremalen N, van Riel D, de Wit E. A Novel Coronavirus Emerging in China - Key Questions for Impact Assessment. N Engl J Med. 2020;382(8):692-4. doi: 10.1056/NEJMp2000929. [PubMed: 31978293].
  18. Lee N, Hui D, Wu A, Chan P, Cameron P, Joynt GM, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003;348(20):1986-94. doi: 10.1056/NEJMoa030685. [PubMed: 12682352].
  19. Assiri A, Al-Tawfiq JA, Al-Rabeeah AA, Al-Rabiah FA, Al-Hajjar S, Al-Barrak A, et al. Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study. Lancet Infect Dis. 2013;13(9):752-61. doi: 10.1016/S1473-3099(13)70204-4. [PubMed: 23891402].
  20. Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med. 2020;382(10):929-36. doi: 10.1056/NEJMoa2001191. [PubMed: 32004427]. [PubMed Central: PMC7092802].
  21. Li X, Zeng X, Liu B, Yu Y. COVID-19 Infection Presenting with CT Halo Sign. Radiology: Cardiothoracic Imaging. 2020;2(1). e200026. doi: 10.1148/ryct.2020200026.
  22. Wu Y, Xie Y, Wang X. Longitudinal CT Findings in COVID-19 Pneumonia: Case Presenting Organizing Pneumonia Pattern. Radiology: Cardiothoracic Imaging. 2020;2(1). e200031. doi: 10.1148/ryct.2020200031.
  23. Jiang N, Zheng C, Fan Y, Han X, Chen Y, Cheng Q, et al. CT appearance of new coronavirus pneumonia in subclinical period and short-term changes. Chin J Radiol. 2020;54. doi: 10.3760/cma.j.cn112149-20200306-00333.
  24. Liu H, Zhang D, Yang Y, Long B, Yin L, Zhao M, et al. Analysis of early chest high resolution CT images of novel coronavirus pneumonia. Chin J Radiol. 2020;54. doi: 10.3760/cma.j.issn.1005-1201.2020.0007.
  25. Lu X, Gong W, Wang L, Li L, Xie B, Peng Z, et al. Clinical features and high resolutionCT imaging findings of preliminary diagnosis novel coronavirus pneumonia. Chin J Radiol. 2020;54. doi: 10.3760/cma.j.issn.1005-1201.2020.0006.
  26. Yan R, Zhang Y, Guo Y, Xia L, Zhou Q. Structure of dimeric full-length human ACE2 in complex with B0AT1. bioRxiv. 2020. doi: 10.1101/2020.02.19.956946.
  27. Tian S, Hu W, Niu L, Liu H, Xu H, Xiao S. Pulmonary Pathology of Early Phase SARS-COV-2 Pneumonia. Preprints. 2020. doi: 10.20944/preprints202002.0220.v1.
  28. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8(4):420-2. doi: 10.1016/S2213-2600(20)30076-X. [PubMed: 32085846]. [PubMed Central: PMC7164771].
  29. Ooi GC, Khong PL, Muller NL, Yiu WC, Zhou LJ, Ho JC, et al. Severe acute respiratory syndrome: temporal lung changes at thin-section CT in 30 patients. Radiology. 2004;230(3):836-44. doi: 10.1148/radiol.2303030853. [PubMed: 14990845].
  30. Yang WB, Weng QY, Xiao YR, Lin J, Zhang YP, Ji JS. CT features and clinical characteristics of 8 cluster cases of imported COVID-19. Chin J Radiol. 2020;54. doi: