Role of pulmonary circulation assessment in CT imaging in evaluating the severity and tendency of severe and critical COVID-19 pneumonia (preprint)

Objective: To investigate the value of changes of pulmonary circulation in CT imaging in evaluating the severity and tendency of 2019 novel coronavirus disease (COVID-19) pneumonia.Methods: This retrospective study analyzed 99 severe and critical COVID-19 pneumonia patients including the 47 improved cases and 52 dead cases. Demographic data, laboratory findings, comorbidities, and CT imaging features including the diameters of pulmonary vein (PV), pulmonary artery (PA) and ascending aorta were collected and assessed.Results: The PV diameters of the deceased patients were larger than recovered patients in the severe phase. Compared with the severe phase in the improvement group, the diameters of the pulmonary veins during the improved phase were smaller, and the total CT scores were significantly decreased (p < 0.001). Instead, there was no significant difference in the ratio of main PA to aorta diameter between the recovered group and the deceased group, nor did the self control of the recovered group and the deceased group (p > 0.05). Construction of a ROC curve yielded an optimal cut-off value of the PV diameters for prediction of survival (p < 0.05).Conclusion: The changes of the PV diameters might indirectly reflect the activity of pulmonary inflammation and cardiac insufficiency. Pulmonary manifestations of severe and critical COVID-19 pneumonia might be related to myocardial injury and cardiac insufficiency, expecially accompanied by dilated PVs. Evaluation of changes in pulmonary circulation by chest CT images may be considered as a useful tool for determining the severity, fatal outcome and tendency of COVID-19.Key words: COVID-19, pneumonia, pulmonary circulation, Computed Tomography

Early fibroproliferative changes on high-resolution CT predict mortality in COVID-19 pneumonia patients with ARDS (preprint)

Objectives: To investigate the chest high-resolution CT (HRCT) findings in coronavirus disease 2019 (COVID-19) pneumonia patients with acute respiratory distress syndrome (ARDS) and to evaluate its relationship with clinical outcome.Materials and Methods In this retrospective study, seventy-nine COVID-19 patients with ARDS were recruited. Clinical data were extracted from electronic medical records and analyzed. HRCT scans, obtained within 3 days before clinical ARDS onset, were evaluated by three independent observers and graded into six findings according to the extent of fibroproliferation. Multivariable Cox proportional hazard regression analysis was used to assess the independent predictive value of the CT score and radiologically fibroproliferation. Patient survival was determined by Kaplan-Meier analysis.Results: Compared with survivors, non-survivors showed higher of lung fibroproliferation, whereas there no significant differences in the area of increased attenuation without traction bronchiolectasis or bronchiectasis. A HRCT score <230 enabled prediction of survival with 73.5% sensitivity and 93.3% specificity (AUC= 0.9; 95% CI 0.831 to 0.968). Multivariate Cox proportional hazards model showed that the HRCT score is a significant independent risk factor for mortality (HR 13.007; 95% CI 3.935 to 43.001). Kaplan-Meier analysis revealed HRCT score≥230 was associated with higher fatality rate. Organ injury occurred less frequently in patients with HRCT score<230 compared to those with HRCT score≥230.Conclusion: Early pulmonary fibroproliferative changes in HRCT predicts increased mortality and susceptibility to organ injury in COVID-19 pneumonia patients with early ARDS.

Evolution of CT Manifestations of 105 novel coronavirus pneumonia patients in Wuhan, China (preprint)

Objectives: The purpose of this study was to observe the chest HRCT manifestation evolution of the 105 patients with pneumonia caused by SARS-CoV-2.Methods: 105 confirmed patients were enrolled from January 11, 2020 to February 9, 2020. Chest HRCT were performed. The number of affected lung lobes, lesion shape, density, range, and dynamic changes of various lesions in each CT examination of each patient were recorded to comprehensively evaluate whether it is improved. Results: CT images of 105 confirmed patients were collected. The patients underwent 2-7 chest CT examinations. M/F ratio: 49/56. The age range was 23-72 y, and the mean age was 48.6±13.1 y. The patients' chest CT examinations were divided into 5 groups according to the re-examination interval, group A (25 cases): ≤3 days, group B (70 cases): 4-7 days, group C (75 cases): 8-14 days, group D (29 cases): 15-21 days, group E (4 cases):> 21 days. There was significant difference in the improvement and progress rates between group B and C. Furthermore, the changes of ground glass nodules (GGO), consolidation and cord lesions in each group were recorded.Conclusions: The chest CT manifestations of the patients changed rapidly, and the re-examination of 7-14 days was of great significance in evaluating the prognosis of patients while minimizing the radiation dose.