ABSTRACT
Purpose: By analyzing the CT manifestations and evolution of COVID in non-epidemic areas of southeast China, analyzing the developmental abnormalities and accompanying signs in the early and late stages of the disease, providing imaging evidence for clinical diagnosis and identification, and assisting in judging disease progression and monitoring prognosis. Methods: This retrospective and multicenter study included 1,648 chest CT examinations from 693 patients with laboratory-confirmed COVID-19 infection from 16 hospitals of southeast China between January 19 and March 27, 2020. Six trained radiologists analyzed and recorded the distribution and location of the lesions in the CT images of these patients. The accompanying signs include crazy-paving sign, bronchial wall thickening, microvascular thickening, bronchogram sign, fibrous lesions, halo and reverse-halo signs, nodules, atelectasis, and pleural effusion, and at the same time, they analyze the evolution of the abovementioned manifestations over time. Result: There were 1,500 positive findings in 1,648 CT examinations of 693 patients; the average age of the patients was 46 years, including 13 children; the proportion of women was 49%. Early CT manifestations are single or multiple nodular, patchy, or flaky ground-glass-like density shadows. The frequency of occurrence of ground-glass shadows (47.27%), fibrous lesions (42.60%), and microvascular thickening (40.60%) was significantly higher than that of other signs. Ground-glass shadows increase and expand 3-7 days after the onset of symptoms. The distribution and location of lesions were not significantly related to the appearance time. Ground-glass shadow is the most common lesion, with an average absorption time of 6.2 days, followed by consolidation, with an absorption time of about 6.3 days. It takes about 8 days for pure ground-glass lesions to absorb. Consolidation change into ground glass or pure ground glass takes 10-14 days. For ground-glass opacity to evolve into pure ground-glass lesions, it takes an average of 17 days. For ground-glass lesions to evolve into consolidation, it takes 7 days, pure ground-glass lesions need 8 days to evolve into ground-glass lesions. The average time for CT signs to improve is 10-15 days, and the first to improve is the crazy-paving sign and nodules; while the progression of the disease is 6-12 days, the earliest signs of progression are air bronchogram signs, bronchial wall thickening, and bronchiectasis. There is no severe patient in this study. Conclusion: This study depicts the CT manifestation and evolution of COVID in non-epidemic origin areas, and provides valuable first-hand information for clinical diagnosis and judgment of patient's disease evolution and prediction.
ABSTRACT
The present study aimed to establish a prognostic nomogram to stratify high-risk patients with Coronavirus Disease 2019 (COVID-19) who progressed from the nonsevere condition on admission to severe during hospitalization. This multicenter retrospective study included patients with nonsevere COVID-19 on admission from Jan 10, 2020 to Feb 7, 2020. In the training cohort, independent risk factors associated with disease progression were identified by univariate and multivariate analyses. The prognostic nomogram was established and then validated externally using C-index. The study included 351 patients (293 and 58 in the training and validation cohorts, respectively), with 27 (9.2%) and 5 (8.6%) patients progressed, respectively. In the training cohort, older age (OR 1.036, 95% CI 1.000-1.073), more lobes involved on chest CT (OR 1.841, 95% CI 1.117-3.035), comorbidity present (OR 2.478, 95% CI 1.020-6.018), and lower lymphocyte count (OR 0.081, 95% CI 0.019-0.349) were identified as independent risk factors. The prognostic nomogram was established in the training cohort with satisfied external prognostic performance (C-index 0.906, 95% CI 0.806-1.000). In conclusion, older age, comorbidity present, more lobes involved on chest CT, and lower lymphocyte count are independent risk factors associated with disease progression during hospitalization for patients with nonsevere COVID-19.
ABSTRACT
BACKGROUND: Coronavirus disease 2019 (COVID-19) has widely spread worldwide and caused a pandemic. Chest CT has been found to play an important role in the diagnosis and management of COVID-19. However, quantitatively assessing temporal changes of COVID-19 pneumonia over time using CT has still not been fully elucidated. The purpose of this study was to perform a longitudinal study to quantitatively assess temporal changes of COVID-19 pneumonia. METHODS: This retrospective and multi-center study included patients with laboratory-confirmed COVID-19 infection from 16 hospitals between January 19 and March 27, 2020. Mass was used as an approach to quantitatively measure dynamic changes of pulmonary involvement in patients with COVID-19. Artificial intelligence (AI) was employed as image segmentation and analysis tool for calculating the mass of pulmonary involvement. RESULTS: A total of 581 confirmed patients with 1,309 chest CT examinations were included in this study. The median age was 46 years (IQR, 35-55; range, 4-87 years), and 311 (53.5%) patients were male. The mass of pulmonary involvement peaked on day 10 after the onset of initial symptoms. Furthermore, the mass of pulmonary involvement of older patients (>45 years) was significantly severer (P<0.001) and peaked later (day 11 vs. day 8) than that of younger patients (≤45 years). In addition, there were no significant differences in the peak time (day 10 vs. day 10) and median mass (P=0.679) of pulmonary involvement between male and female. CONCLUSIONS: Pulmonary involvement peaked on day 10 after the onset of initial symptoms in patients with COVID-19. Further, pulmonary involvement of older patients was severer and peaked later than that of younger patients. These findings suggest that AI-based quantitative mass evaluation of COVID-19 pneumonia hold great potential for monitoring the disease progression.
ABSTRACT
BACKGROUND: The 2019 novel coronavirus (COVID-19) presents a major threat to public health and has rapidly spread worldwide since the outbreak in Wuhan, Hubei Province, China in 2019. To date, there have been few reports of the varying degrees of illness caused by the COVID-19. CASE PRESENTATION: A case of 68-year-old female with COVID-19 pneumonia who had constant pain in the right upper quadrant of her abdomen during her hospitalization that was finally diagnosed as acute cholecystitis. Ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGD) was performed, and the real-time fluorescence polymerase chain reaction (RT-PCR) COVID-19 nucleic acid assay of the bile was found to be negative. PTGD, antibacterial and anti-virus combined with interferon inhalation treatment were successful. CONCLUSION: The time course of chest CT findings is typical for COVID-19 pneumonia. PTGD is useful for acute cholecystitis in COVID-19 patients. Acute cholecystitis is likely to be caused by COVID-19 .