Comparison of CT findings of coronavirus disease 2019 (COVID-19) pneumonia caused by different major variants.

PURPOSE: To explore the CT findings and pneumonnia progression pattern of the Alpha and Delta variants of SARS-CoV-2 by comparing them with the pre-existing wild type. METHOD: In this retrospective comparative study, a total of 392 patients with COVID-19 were included: 118 patients with wild type (70 men, 56.8 ± 20.7 years), 137 with Alpha variant (93 men, 49.4 ± 17.0 years), and 137 with Delta variant (94 men, 45.4 ± 12.4). Chest CT evaluation included opacities and repairing changes as well as lesion distribution and laterality. Chest CT severity score was also calculated. These parameters were statistically compared across the variants. RESULTS: Ground glass opacity (GGO) with consolidation and repairing changes were more frequent in the order of Delta variant, Alpha variant, and wild type throughout the disease course. Delta variant showed GGO with consolidation more conspicuously than did the other two on days 1-4 (vs. wild type, Bonferroni corrected p = 0.01; vs. Alpha variant, Bonferroni corrected p = 0.003) and days 5-8 (vs. wild type, Bonferroni corrected p < 0.001; vs. Alpha variant, Bonferroni corrected-p = 0.003). Total lung CT severity scores of Delta variant were higher than those of wild type on days 1-4 and 5-8 (Bonferroni corrected p = 0.01 and Bonferroni corrected p = 0.005, respectively) and that of Alpha variant on days 1-4 (Bonferroni corrected p = 0.002). There was no difference in the CT findings between wild type and Alpha variant. CONCLUSIONS: Pneumonia progression of Delta variant may be more rapid and severe in the early stage than in the other two.

The role of chest imaging in the diagnosis, management, and monitoring of coronavirus disease 2019 (COVID-19).

Coronavirus disease 2019 (COVID-19) pandemic has posed a major public health crisis all over the world. The role of chest imaging, especially computed tomography (CT), has evolved during the pandemic paralleling the accumulation of scientific evidence. In the early stage of the pandemic, the performance of chest imaging for COVID-19 has widely been debated especially in the context of comparison to real-time reverse transcription polymerase chain reaction. Current evidence is against the use of chest imaging for routine screening of COVID-19 contrary to the initial expectations. It still has an integral role to play, however, in its work up and staging, especially when assessing complications or disease progression. Chest CT is gold standard imaging modality for COVID-19 pneumonia; in some situations, chest X-ray or ultrasound may be an effective alternative. The most important role of radiologists in this context is to be able to identify those patients at greatest risk of imminent clinical decompensation by learning to stratify cases of COVID-19 on the basis of radiologic imaging in the most efficient and timely fashion possible. The present availability of multiple and more refined CT grading systems and classification is now making this task easier and thereby contributing to the recent improvements achieved in COVID-19 treatment and outcomes. In this article, evidence of chest imaging regarding diagnosis, management and monitoring of COVID-19 will be chronologically reviewed.

Comparison of Chest CT Grading Systems in Coronavirus Disease 2019 (COVID-19) Pneumonia.

PURPOSE: To compare the performance and interobserver agreement of the COVID-19 Reporting and Data System (CO-RADS), the COVID-19 imaging reporting and data system (COVID-RADS), the RSNA expert consensus statement, and the British Society of Thoracic Imaging (BSTI) guidance statement. MATERIALS AND METHODS: In this case-control study, total of 100 symptomatic patients suspected of having COVID-19 were included: 50 patients with COVID-19 (59±17 years, 38 men) and 50 patients without COVID-19 (65±24 years, 30 men). Eight radiologists independently scored chest CT images of the cohort according to each reporting system. The area under the receiver operating characteristic curves (AUC) and interobserver agreements were calculated and statistically compared across the systems. RESULTS: A total of 800 observations were made for each system. The level of suspicion of COVID-19 correlated with the RT-PCR positive rate except for the "negative for pneumonia" classifications in all the systems (Spearman's coefficient: ρ=1.0, P=<.001 for all the systems). Average AUCs were as follows: CO-RADS, 0.84 (95% confidence interval, 0.83-0.85): COVID-RADS, 0.80 (0.78-0.81): the RSNA statement, 0.81 (0.79-0.82): and the BSTI statement, 0.84 (0.812-0.86). Average Cohen's kappa across observers was 0.62 (95% confidence interval, 0.58-0.66), 0.63 (0.58-0.68), 0.63 (0.57-0.69), and 0.61 (0.58-0.64) for CO-RADS, COVID-RADS, the RSNA statement and the BSTI statement, respectively. CO-RADS and the BSTI statement outperformed COVID-RADS and the RSNA statement in diagnostic performance (P=.<.05 for all the comparison). CONCLUSIONS: CO-RADS, COVID-RADS, the RSNA statement and the BSTI statement provided reasonable performances and interobserver agreements in reporting CT findings of COVID-19.