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1.
Eur J Radiol ; 130: 109202, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-684452

ABSTRACT

BACKGROUND: So far, only a few studies evaluated the correlation between CT features and clinical outcome in patients with COVID-19 pneumonia. PURPOSE: To evaluate CT ability in differentiating critically ill patients requiring invasive ventilation from patients with less severe disease. METHODS: We retrospectively collected data from patients admitted to our institution for COVID-19 pneumonia between March 5th-24th. Patients were considered critically ill or non-critically ill, depending on the need for mechanical ventilation. CT images from both groups were analyzed for the assessment of qualitative features and disease extension, using a quantitative semiautomatic method. We evaluated the differences between the two groups for clinical, laboratory and CT data. Analyses were conducted on a per-protocol basis. RESULTS: 189 patients were analyzed. PaO2/FIO2 ratio and oxygen saturation (SaO2) were decreased in critically ill patients. At CT, mixed pattern (ground glass opacities (GGO) and consolidation) and GGO alone were more frequent respectively in critically ill and in non-critically ill patients (p < 0.05). Lung volume involvement was significantly higher in critically ill patients (38.5 % vs. 5.8 %, p < 0.05). A cut-off of 23.0 % of lung involvement showed 96 % sensitivity and 96 % specificity in distinguishing critically ill patients from patients with less severe disease. The fraction of involved lung was related to lactate dehydrogenase (LDH) levels, PaO2/FIO2 ratio and SaO2 (p < 0.05). CONCLUSION: Lung disease extension, assessed using quantitative CT, has a significant relationship with clinical severity and may predict the need for invasive ventilation in patients with COVID-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnostic imaging , Image Interpretation, Computer-Assisted/methods , Pneumonia, Viral/diagnostic imaging , Tomography, X-Ray Computed/methods , Aged , Critical Illness , Evaluation Studies as Topic , Female , Humans , Lung/diagnostic imaging , Male , Middle Aged , Pandemics , Research Design , Retrospective Studies , Risk Factors , Sensitivity and Specificity
2.
Medicine (Baltimore) ; 99(30): e21396, 2020 Jul 24.
Article in English | MEDLINE | ID: covidwho-684031

ABSTRACT

A large number of healthcare workers have been infected with coronavirus disease-2019 (COVID-19). We aimed to investigate their clinical and chest computed tomography (CT) characteristics.The clinical, laboratory test and CT features of 43 medical and hospital staff with confirmed COVID-19 (MP group, 26-70 years old) were retrospectively analyzed, and compared to 43 non-medical related patients (non-MP group, 26-71 years old). Follow-up CT characteristics were analyzed to assess the disease progression in the period of hospitalization.At admission, the main complaints of the MP group, including fever (81.4%), fatigue (48.8%) and cough (41.9%), were similar to the non-MP group. The C-reactive protein, erythrocyte sedimentation rate, and lactate dehydrogenase levels were higher in the non-MP group than the MP group (17.5 ±â€Š22.4 mg/L, 20.2 ±â€Š23.4 mm/H and 219 ±â€Š66U/L, respectively, P < .05). Ground-grass opacities, consolidation, interstitial thickening were common CT features of both groups. The severity of opacities on initial CT were less in the MP group (5.3 ±â€Š3.9 scores) than in the non-MP group (9.1 ±â€Š4.8 scores, P < .05). Before regular treatments, the sum score of the opacities showed weak to moderate correlations with duration, C-reactive protein, erythrocyte sedimentation rate and lactate dehydrogenase levels (R ranged from 0.341-0.651, P < .05). In the study time window, the duration from illness onset to when the most obvious pulmonary opacities were observed, according to CT findings, were similar in the MP group (13.3 ±â€Š6.6 days) and the non-MP group (13.8 ±â€Š5.1 days, P = .69). Mild to moderate anxiety and depression were observed in both groups.Despite greater knowledge of how to protect themselves than the general population, healthcare workers are also susceptible to COVID-19 infection. Occupational exposure is a very important factor. Healthcare workers have a higher vigilance about the infection in the early stage of the disease.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnostic imaging , Occupational Diseases/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Tomography, X-Ray Computed/methods , Adult , Aged , Coronavirus Infections/transmission , Coronavirus Infections/virology , Female , Health Personnel/statistics & numerical data , Humans , Infectious Disease Transmission, Patient-to-Professional , Lung/diagnostic imaging , Lung/pathology , Male , Middle Aged , Occupational Diseases/virology , Occupational Exposure/adverse effects , Pandemics , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Retrospective Studies
3.
Clin Neuroradiol ; 30(3): 447-452, 2020 Sep.
Article in German | MEDLINE | ID: covidwho-754693

ABSTRACT

BACKGROUND AND PURPOSE: To analyze standard operating procedures (SOP) of acute stroke imaging and interventions during COVID-19 pandemic with special emphasis on chest CT within a multimodal stroke protocol. METHODS: A questionnaire was distributed via email to members of the Professional Organization of German Neuroradiologists (Berufsverband Deutscher Neuroradiologen e.V.). RESULTS: Answers were received from 25 units: eleven of them acquire chest CT, three in any patient and eight, when COVID-19 is suspected due to body temperature increase, patient's history or when the latter cannot be sufficiently obtained. Preliminary data indicate a high sensitivity and moderate negative predictive value. CONCLUSION: Different SOP reflect an uncertainty whether chest CT should be acquired as part of a multimodal stroke protocol. Accuracy of low dose chest CT cannot be determined yet. The strengths and limitations of chest CT are discussed.


Subject(s)
Coronavirus Infections/complications , Lung/diagnostic imaging , Pneumonia, Viral/complications , Practice Patterns, Physicians' , Stroke/diagnostic imaging , Stroke/virology , Clinical Protocols , Germany , Humans , Pandemics , Patient Selection , Surveys and Questionnaires , Tomography, X-Ray Computed
4.
J Coll Physicians Surg Pak ; 30(8): 785-789, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-745630

ABSTRACT

OBJECTIVE: To investigate airway abnormalities on chest CT in adult patients with COVID-19 pneumonia. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Radiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China, from January to April, 2020. METHODOLOGY: CT scan images were analysed retrospectively. The main CT findings, including pulmonary opacities, airway wall visibility, wall thickening, luminal changes, and the formation of mucus plugs were evaluated. Airway segments were classified into three types based on the spatial relationship between conducting airways and pulmonary opacities. RESULTS: A total of 275 lesions were detected in 52 patients. Of these, 170 (61.82%) lesions were associated with 243 airway segments, including segments enclosed within lesions (type I, 152, 62.55%), crossing the lesions (type II, 51, 20.99%), and abutting the lesions (type III, 40, 16.46%). The bronchial walls of 154 (63.37%) segments were ill-defined; whereas, the walls of 89 (36.63%) segments were well-defined; in the latter group, 62 (69.66%) showed mild thickening. The bronchial lumen of 183 (75.31%) segments presented mild bronchiectasis and 60 (24.69%) segments appeared normal. Mucus plug was detected in one segment (0.41%). There were no cases of bronchial stenosis, and all bronchial segments located in normal lung regions appeared normal. The appearance of 196 (80.66%) affected bronchi was completely restored before hospital discharge. CONCLUSION: Typical airway changes in adult COVID-19 pneumonia include bronchial wall thickening without significant stenosis of the airway lumen and the absence of bronchial mucus plugs. Moreover, bronchi located in unaffected lung regions have a normal appearance. These characteristics have potential value in differential diagnosis. Key Words: Coronavirus disease, Airway, Computed tomography, Chest.


Subject(s)
Coronavirus Infections/diagnostic imaging , Lung/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Tomography, X-Ray Computed/methods , Adult , Betacoronavirus , Clinical Laboratory Techniques , Coronavirus , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Radiography, Thoracic , Retrospective Studies , Thorax
5.
Monaldi Arch Chest Dis ; 90(3)2020 Sep 04.
Article in English | MEDLINE | ID: covidwho-745210

ABSTRACT

'Tree-in-bud' (TIB) appearance in computed tomography (CT) chest is most commonly a manifestation of infection. We here describe an unusual cause of TIB during the COVID-19 pandemic. A young male patient who had a history of fever, cough, and respiratory distress presented in the emergency department. As these symptoms matched with coronavirus infection, the COVID-19 test was done, which was found negative. He was then moved to the intensive care unit where he developed severe acute respiratory distress syndrome and was put on mechanical ventilation. Further workup did not reveal any source of infection, as all his cultures were negative, but his CT chest showed a tree-in-bud appearance. After obtaining a detailed history from his friends, the patient was found a chronic abuser of inhaled cocaine and treated with intravenous steroids. Subsequently, he was weaned from the ventilator and discharged from the intensive care unit after becoming asymptomatic.


Subject(s)
Cocaine Smoking/adverse effects , Cocaine-Related Disorders/diagnosis , Coronavirus Infections/diagnosis , Lung Injury/diagnostic imaging , Lung/diagnostic imaging , Pneumonia, Viral/diagnosis , Respiratory Distress Syndrome, Adult/diagnostic imaging , Adult , Betacoronavirus , Cocaine-Related Disorders/complications , Diagnosis, Differential , Glucocorticoids/therapeutic use , Humans , Lung Injury/etiology , Lung Injury/therapy , Male , Methylprednisolone/therapeutic use , Pandemics , Respiration, Artificial , Respiratory Distress Syndrome, Adult/etiology , Respiratory Distress Syndrome, Adult/therapy , Tomography, X-Ray Computed
6.
BMC Pregnancy Childbirth ; 20(1): 511, 2020 Sep 04.
Article in English | MEDLINE | ID: covidwho-744979

ABSTRACT

BACKGROUND: It has been proposed that pregnant women and their fetuses may be particularly at risk for poor outcomes due to the coronavirus (COVID-19) pandemic. From the few case series that are available in the literature, women with high risk pregnancies have been associated with higher morbidity. It has been suggested that pregnancy induced immune responses and cardio-vascular changes can exaggerate the course of the COVID-19 infection. CASE PRESENTATION: A 26-year old Somalian woman (G2P1) presented with a nine-day history of shortness of breath, dry cough, myalgia, nausea, abdominal pain and fever. A nasopharyngeal swab returned positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Her condition rapidly worsened leading to severe liver and coagulation impairment. An emergency Caesarean section was performed at gestational week 32 + 6 after which the patient made a rapid recovery. Severe COVID-19 promptly improved by the termination of the pregnancy or atypical HELLP (Hemolysis, Elevated Liver Enzymes and Low Platelet Count) exacerbated by concomitant COVID-19 infection could not be ruled out. There was no evidence of vertical transmission. CONCLUSIONS: This case adds to the growing body of evidence which raises concerns about the possible negative maternal outcomes of COVID-19 infection during pregnancy and advocates for pregnant women to be recognized as a vulnerable group during the current pandemic.


Subject(s)
Blood Coagulation Disorders/blood , Cesarean Section , Coronavirus Infections/blood , Liver Diseases/blood , Obesity, Maternal , Pneumonia, Viral/blood , Pregnancy Complications, Infectious/blood , Adult , Antithrombin III/metabolism , Apgar Score , Betacoronavirus , Blood Coagulation Disorders/etiology , Coronavirus Infections/complications , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/physiopathology , Diagnosis, Differential , Female , Fibrin Fibrinogen Degradation Products/metabolism , HELLP Syndrome/diagnosis , Humans , Infant, Newborn , Infant, Premature , L-Lactate Dehydrogenase/blood , Liver Diseases/etiology , Lung/diagnostic imaging , Male , Pandemics , Partial Thromboplastin Time , Platelet Count , Pneumonia, Viral/complications , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/physiopathology , Pregnancy , Pregnancy Complications, Infectious/physiopathology , Sweden , Tomography, X-Ray Computed
7.
Medicine (Baltimore) ; 99(35): e21804, 2020 Aug 28.
Article in English | MEDLINE | ID: covidwho-740204

ABSTRACT

INTRODUCTION: Pneumonia is one of the most important characteristics of coronavirus disease 2019 (COVID-19) and imaging findings of COVID-19 pneumonia are diverse and change over disease course. However, the detailed clinical course of organizing pneumonia (OP) caused by COVID-19 has not been clarified. PATIENT CONCERNS: A 60-year-old man and a 61-year-old woman diagnosed with mild COVID-19 were admitted to our hospital. Their respiratory symptoms were deteriorating even after initiating treatment with antiviral drugs. DIAGNOSIS: Chest X-rays and computed tomography scan showed a rapid progression of linear consolidation with reversed halo sign, distributed in subpleural and peri-bronchial regions. They also presented with pulmonary fibrosis findings, including traction bronchiectasis and marked lung volume reduction. They were diagnosed with rapidly progressing OP. INTERVENTIONS: They were treated with systemic corticosteroids. OUTCOMES: The patients' imaging findings and respiratory conditions improved rapidly without any adverse effects. CONCLUSION: Physicians should carefully monitor patients with COVID-19, as they can develop rapidly progressive and fibrotic OP, which respond to corticosteroids.


Subject(s)
Coronavirus Infections , Lung , Pandemics , Pneumonia, Viral , Prednisolone/administration & dosage , Pulmonary Fibrosis , Antiviral Agents/therapeutic use , Coronavirus Infections/complications , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Disease Progression , Dose-Response Relationship, Drug , Female , Glucocorticoids/administration & dosage , Humans , Lung/diagnostic imaging , Lung/pathology , Male , Middle Aged , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/etiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Pulmonary Fibrosis/diagnostic imaging , Pulmonary Fibrosis/etiology , Tomography, X-Ray Computed/methods , Treatment Outcome
8.
J Korean Med Sci ; 35(34): e316, 2020 Aug 31.
Article in English | MEDLINE | ID: covidwho-736661

ABSTRACT

BACKGROUND: The predictors of poor prognosis in patients with coronavirus disease 2019 (COVID-19) using computed tomography (CT) have not been investigated in a large cohort. Therefore, the purpose of this study was to investigate the adverse initial CT features to predict poor prognosis in COVID-19. METHODS: From February to April 2020, 281 COVID-19 patients who underwent CT at the time of admission were included. We divided the patients into the severe and non-severe disease groups. The severe group included patients with severe pneumonia or critical events. Intensive care unit admission or death were the critical events in this study. We compared the clinical and CT findings between the severe and non-severe groups and investigated the prognostic factors and critical events of the severe group using the regression analysis. RESULTS: Among the 281 patients, 36 (12.8%) patients were in the severe group and 245 (87.2%) patients were in the non-severe group. Critical events occurred in 10 patients (3.6%). In the severe group, patients showed significantly more pneumonia with consolidation, crazy-paving appearance, pleural effusion, and higher CT scores than those in the non-severe group (all, P < 0.05). In the multivariate regression, pleural effusion (odds ratio [OR], 8.96; 95% confidence interval [CI], 1.81-44.42; P = 0.007), CT score > 5 (OR, 3.70; 95% CI, 1.44-9.53; P = 0.007), old age (> 77 years, OR, 9.96; 95% CI, 3.78-26.28; P < 0.001), and elevated C-reactive protein (OR, 4.15; 95% CI, 1.62-10.6; P = 0.003) were significant prognostic factors of severe disease. CT score > 5 (OR, 7.29; 95% CI, 1.37-38.68; P = 0.020), pleural effusion (OR, 5.67; 95% CI, 1.04-30.8; P = 0.045) and old age (OR, 8.6; 95% CI, 1.80-41.0; P = 0.007) were also significant predictors of critical events. CONCLUSION: Pleural effusion and the extent of pneumonia on initial CT scans are associated with poor prognosis in patients with COVID-19.


Subject(s)
Coronavirus Infections/diagnostic imaging , Coronavirus Infections/pathology , Lung/diagnostic imaging , Lung/pathology , Pleural Effusion/diagnostic imaging , Pleural Effusion/pathology , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/pathology , Aged , Aged, 80 and over , Aging , Betacoronavirus , C-Reactive Protein/analysis , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Female , Humans , Intensive Care Units , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Prognosis , Retrospective Studies , Severity of Illness Index , Tomography, X-Ray Computed
9.
BMJ Case Rep ; 13(8)2020 Aug 27.
Article in English | MEDLINE | ID: covidwho-733175

ABSTRACT

During the previous months, we have seen the rapid pandemic spread of SARS-CoV-2. Despite being considered a respiratory virus, it has become clear that other clinical presentations are possible and some of these are quite frequent. In this paper, a case of a man in his late 70s showing atypical symptoms in general practice is presented. Apart from fever, the patient complained of diarrhoea, borborygmus, loss of appetite and nausea. He developed no respiratory symptoms during his disease. Due to his symptoms, malignant disease was suspected, and he was referred for further testing which revealed typical COVID-19 findings on a chest CT scan. The occurrence of atypical symptoms is discussed, including the importance of recognising these in an ongoing pandemic.


Subject(s)
Anorexia/physiopathology , Coronavirus Infections/physiopathology , Diarrhea/physiopathology , Hypoxia/physiopathology , Lung/diagnostic imaging , Nausea/physiopathology , Pneumonia, Viral/physiopathology , Aged , Betacoronavirus , C-Reactive Protein/metabolism , Coronavirus Infections/diagnosis , General Practice , Humans , Male , Pandemics , Pneumonia, Viral/diagnosis , Tomography, X-Ray Computed
10.
Biomed Res Int ; 2020: 3149020, 2020.
Article in English | MEDLINE | ID: covidwho-733121

ABSTRACT

An outbreak of pneumonia, caused by a novel coronavirus (SARS-CoV-2), was identified in China in December 2019. This virus expanded worldwide, causing global concern. Although clinical, laboratory, and imaging features of COVID-19 are characterized in some observational studies, we undertook a systematic review and meta-analysis to assess the frequency of these features. We did a systematic review and meta-analysis using three databases to identify clinical, laboratory, and computerized tomography (CT) scanning features of rRT-PCR confirmed cases of COVID-19. Data for 3420 patients from 30 observational studies were included. Overall, the results showed that fever (84.2%, 95% CI 82.6-85.7), cough (62%, 95% CI 60-64), and fatigue (39.4%, 95% CI 37.2-41.6%) are the most prevalent symptoms in COVID-19 patients. Increased CRP level, decreased lymphocyte count, and increased D-dimer level were the most common laboratory findings. Among COVID-19 patients, 92% had a positive CT finding, most prevalently ground-glass opacification (GGO) (60%, 95% CI 58-62) and peripheral distribution opacification (64%, 95% CI 60-69). These results demonstrate the clinical, paraclinical, and imaging features of COVID-19.


Subject(s)
Coronavirus Infections , Pandemics , Pneumonia, Viral , Adolescent , Adult , Aged , Aged, 80 and over , Betacoronavirus , Child , Child, Preschool , Comorbidity , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/pathology , Cough/etiology , Female , Fever/etiology , Humans , Infant , Infant, Newborn , Lung/diagnostic imaging , Lung/pathology , Male , Middle Aged , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/pathology , Tomography, X-Ray Computed , Young Adult
11.
Biomed Res Int ; 2020: 5436025, 2020.
Article in English | MEDLINE | ID: covidwho-733118

ABSTRACT

Background: COVID-19 first broke out in China and spread rapidly over the world. Objectives: To describe the CT features of COVID-19 pneumonia and to share our experience at initial diagnoses. Patients and Methods. Data from 53 patients (31 men, 22 women; mean age, 53 years; age range, 16-83 years) with confirmed COVID-19 pneumonia were collected. Their complete clinical data was reviewed, and their CT features were recorded and analyzed. Results: The average time between onset of illness and the initial CT scan was six days (range, 1-42 days). A total of 399 segments were involved and distributed bilaterally (left lung: 186 segments [46.6%], right lung: 213 segments [53.4%]) and peripherally (38 [71.7%] patients). Multiple lobes (45 [84.9%]) and bilateral lower lobes (left lower lobe: 104 [26.1%], right lower lobe: 107 [26.8%], and total: 211 [52.9%]) were the most commonly involved. Ground-glass opacity with consolidation (24 [45.3%]) and pure ground-glass opacity (28 [52.8%]) were the main findings. The other findings were crazy-paving (14 [26.4%]), bronchiectasis (12 [22.6%]), atelectasis (7 [13.2%]), parenchymal bands (6 [11.3%]), air bronchogram (6 [11.3%]), interlobular thickening (5 [9.4%]), reticular pattern (1 [1.9%]), and pleural effusion (1 [1.9%]). Conclusions: Most COVID-19 pneumonia patients had abnormalities on chest CT images at initial presentation. Imaging features combined with patient's exposure history and onset symptoms could facilitate the identification of the suspected patient for further examinations.


Subject(s)
Coronavirus Infections , Lung , Pandemics , Pneumonia, Viral , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Aged, 80 and over , Betacoronavirus , China/epidemiology , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/epidemiology , Coronavirus Infections/pathology , Female , Humans , Lung/diagnostic imaging , Lung/pathology , Male , Middle Aged , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/epidemiology , Pneumonia, Viral/pathology , Retrospective Studies , Young Adult
12.
PLoS One ; 15(8): e0237302, 2020.
Article in English | MEDLINE | ID: covidwho-729562

ABSTRACT

BACKGROUND: As the current outbreak of COVID-2019 disease has spread to the other more than 150 countries besides China around the world and the death number constantly increased, the clinical data and radiological findings of death cases need to be explored so that more physicians, radiologists and researchers can gain important information to save more lives. METHODS: 73 patients who died from COVID-19 were retrospectively included. The clinical and laboratory data of the patients were extracted from electronic medical records. The clinical data, inflammation-related laboratory results, and CT imaging features were summarized. The laboratory results and dynamic changes of imaging features and severity scores of lung involvement based on chest CT were analyzed. RESULTS: The mean age was 67±12 years. The typical clinical symptoms included fever (88%), cough (62%) and dyspnea (23%). 65% patients had at least one underlying disease. GGO with consolidation was the most common feature for the five lung lobes (47%-53% among the various lobes), with total severity score of 12.97±5.87 for the both lungs. The proportion of GGO with consolidation is markedly increased on follow-up chest CT compared with initial CT scans, as well as the averaging total CT scores (14.53±5.76 vs. 6.60±5.65; P<0.001). The severity score was rated as severe (white lung) in 13% patients on initial CT scans, and in 60% on follow-up CT scans. Moderate positive correlations were found between CT scores and leucocytes, neutrophils and IL-2R (r = 0.447-0581, P<0.001). CONCLUSION: Chest CT findings and laboratory test results were worsening in patients who died of COVID-19, with moderate positive correlations between CT severity scores and inflammation-related factors of leucocytes, neutrophils, and IL-2R. Chest CT imaging may play an more important role in monitoring disease progression and predicting prognosis.


Subject(s)
Coronavirus Infections/diagnostic imaging , Coronavirus Infections/mortality , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/mortality , Tomography, X-Ray Computed , Adult , Aged , Aged, 80 and over , Betacoronavirus , China , Female , Humans , Lung/diagnostic imaging , Lung/pathology , Male , Middle Aged , Pandemics , Radiography, Thoracic , Retrospective Studies
13.
Radiology ; 296(3): E156-E165, 2020 09.
Article in English | MEDLINE | ID: covidwho-729427

ABSTRACT

Background Coronavirus disease 2019 (COVID-19) and pneumonia of other diseases share similar CT characteristics, which contributes to the challenges in differentiating them with high accuracy. Purpose To establish and evaluate an artificial intelligence (AI) system for differentiating COVID-19 and other pneumonia at chest CT and assessing radiologist performance without and with AI assistance. Materials and Methods A total of 521 patients with positive reverse transcription polymerase chain reaction results for COVID-19 and abnormal chest CT findings were retrospectively identified from 10 hospitals from January 2020 to April 2020. A total of 665 patients with non-COVID-19 pneumonia and definite evidence of pneumonia at chest CT were retrospectively selected from three hospitals between 2017 and 2019. To classify COVID-19 versus other pneumonia for each patient, abnormal CT slices were input into the EfficientNet B4 deep neural network architecture after lung segmentation, followed by a two-layer fully connected neural network to pool slices together. The final cohort of 1186 patients (132 583 CT slices) was divided into training, validation, and test sets in a 7:2:1 and equal ratio. Independent testing was performed by evaluating model performance in separate hospitals. Studies were blindly reviewed by six radiologists without and then with AI assistance. Results The final model achieved a test accuracy of 96% (95% confidence interval [CI]: 90%, 98%), a sensitivity of 95% (95% CI: 83%, 100%), and a specificity of 96% (95% CI: 88%, 99%) with area under the receiver operating characteristic curve of 0.95 and area under the precision-recall curve of 0.90. On independent testing, this model achieved an accuracy of 87% (95% CI: 82%, 90%), a sensitivity of 89% (95% CI: 81%, 94%), and a specificity of 86% (95% CI: 80%, 90%) with area under the receiver operating characteristic curve of 0.90 and area under the precision-recall curve of 0.87. Assisted by the probabilities of the model, the radiologists achieved a higher average test accuracy (90% vs 85%, Δ = 5, P < .001), sensitivity (88% vs 79%, Δ = 9, P < .001), and specificity (91% vs 88%, Δ = 3, P = .001). Conclusion Artificial intelligence assistance improved radiologists' performance in distinguishing coronavirus disease 2019 pneumonia from non-coronavirus disease 2019 pneumonia at chest CT. © RSNA, 2020 Online supplemental material is available for this article.


Subject(s)
Artificial Intelligence , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Radiologists , Tomography, X-Ray Computed/methods , Adolescent , Adult , Aged , Aged, 80 and over , Betacoronavirus , Child , Child, Preschool , China , Diagnosis, Differential , Female , Humans , Infant , Infant, Newborn , Lung/diagnostic imaging , Male , Middle Aged , Pandemics , Philadelphia , Pneumonia/diagnostic imaging , Radiography, Thoracic , Radiologists/standards , Radiologists/statistics & numerical data , Retrospective Studies , Rhode Island , Sensitivity and Specificity , Young Adult
16.
Signal Transduct Target Ther ; 5(1): 157, 2020 10 19.
Article in English | MEDLINE | ID: covidwho-724972

ABSTRACT

Identification of a suitable nonhuman primate (NHP) model of COVID-19 remains challenging. Here, we characterized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in three NHP species: Old World monkeys Macaca mulatta (M. mulatta) and Macaca fascicularis (M. fascicularis) and New World monkey Callithrix jacchus (C. jacchus). Infected M. mulatta and M. fascicularis showed abnormal chest radiographs, an increased body temperature and a decreased body weight. Viral genomes were detected in swab and blood samples from all animals. Viral load was detected in the pulmonary tissues of M. mulatta and M. fascicularis but not C. jacchus. Furthermore, among the three animal species, M. mulatta showed the strongest response to SARS-CoV-2, including increased inflammatory cytokine expression and pathological changes in the pulmonary tissues. Collectively, these data revealed the different susceptibilities of Old World and New World monkeys to SARS-CoV-2 and identified M. mulatta as the most suitable for modeling COVID-19.


Subject(s)
Betacoronavirus/pathogenicity , Callithrix/virology , Coronavirus Infections/epidemiology , Disease Models, Animal , Macaca fascicularis/virology , Macaca mulatta/virology , Pandemics , Pneumonia, Viral/epidemiology , Animals , Antibodies, Viral/biosynthesis , Betacoronavirus/immunology , Body Temperature , Body Weight , Callithrix/immunology , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/immunology , Coronavirus Infections/pathology , Cytokines/biosynthesis , Cytokines/classification , Cytokines/immunology , Disease Susceptibility , Female , Humans , Lung/diagnostic imaging , Lung/immunology , Lung/pathology , Lung/virology , Macaca fascicularis/immunology , Macaca mulatta/immunology , Male , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/immunology , Pneumonia, Viral/pathology , Species Specificity , Tomography, X-Ray Computed , Viral Load , Virus Replication
17.
Korean J Radiol ; 21(8): 998-1006, 2020 08.
Article in English | MEDLINE | ID: covidwho-723534

ABSTRACT

OBJECTIVE: To compare the accuracies of quantitative computed tomography (CT) parameters and semiquantitative visual score in evaluating clinical classification of severity of coronavirus disease (COVID-19). MATERIALS AND METHODS: We retrospectively enrolled 187 patients with COVID-19 treated at Tongji Hospital of Tongji Medical College from February 15, 2020, to February 29, 2020. Demographic data, imaging characteristics, and clinical data were collected, and based on the clinical classification of severity, patients were divided into groups 1 (mild) and 2 (severe/critical). A semiquantitative visual score was used to estimate the lesion extent. A three-dimensional slicer was used to precisely quantify the volume and CT value of the lung and lesions. Correlation coefficients of the quantitative CT parameters, semiquantitative visual score, and clinical classification were calculated using Spearman's correlation. A receiver operating characteristic curve was used to compare the accuracies of quantitative and semi-quantitative methods. RESULTS: There were 59 patients in group 1 and 128 patients in group 2. The mean age and sex distribution of the two groups were not significantly different. The lesions were primarily located in the subpleural area. Compared to group 1, group 2 had larger values for all volume-dependent parameters (p < 0.001). The percentage of lesions had the strongest correlation with disease severity with a correlation coefficient of 0.495. In comparison, the correlation coefficient of semiquantitative score was 0.349. To classify the severity of COVID-19, area under the curve of the percentage of lesions was the highest (0.807; 95% confidence interval, 0.744-0.861: p < 0.001) and that of the quantitative CT parameters was significantly higher than that of the semiquantitative visual score (p = 0.001). CONCLUSION: The classification accuracy of quantitative CT parameters was significantly superior to that of semiquantitative visual score in terms of evaluating the severity of COVID-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Adult , Aged , Female , Humans , Lung/diagnostic imaging , Male , Middle Aged , Pandemics , ROC Curve , Retrospective Studies , Severity of Illness Index , Tomography, X-Ray Computed/methods
19.
Am J Case Rep ; 21: e925849, 2020 Aug 17.
Article in English | MEDLINE | ID: covidwho-721633

ABSTRACT

BACKGROUND Pneumonia caused by coronavirus originated in Wuhan, China in late 2019 and has spread around the world, becoming a pandemic. Many patients deteriorate rapidly and require intubation and mechanical ventilation, which is causing the collapse of healthcare systems in many countries. Coronavirus infection is associated with extensive lung inflammation and microvascular thrombosis, which can result in hypoxia. It can also cause severe and lasting harm in other organs, including the heart and kidneys. At present, there is no proven and efficacious treatment for this new disease. Consequently, there is a growing tendency to use novel methods. Ozone therapy consists of administration of a mixture of oxygen and ozone (a molecule consisting of 3 oxygen atoms). The potential benefits of this therapy include reduced tissue hypoxia, decreased hypercoagulability, renal and heart protection, modulated immune function, improved phagocytic function, and impaired viral replication. CASE REPORT We report rapidly improved hypoxia with associated decreases in inflammatory markers and D-dimer immediately after 1-4 sessions of oxygen-ozone (O2-O3) therapy in 3 patients with COVID-19 pneumonia who presented with respiratory failure. Invasive mechanical ventilation was not required in these 3 patients. All patients were discharged home on days 3-4 after O2-O3 therapy. CONCLUSIONS O2-O3 therapy appears to be an effective therapy for COVID-19 patients with severe respiratory failure. Large controlled clinical trials are required to study the efficacy and safety of using O2-O3 therapy compared with the standard supportive case in patients with COVID-19 in terms of the need for invasive ventilation and length of hospital and intensive care unit stays.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Oxygen/therapeutic use , Ozone/therapeutic use , Pneumonia, Viral/therapy , Blood Transfusion, Autologous , C-Reactive Protein/analysis , Coronavirus Infections/diagnosis , Female , Ferritins/blood , Fibrin Fibrinogen Degradation Products/analysis , Humans , Hypoxia/therapy , Hypoxia/virology , Infusions, Intravenous , L-Lactate Dehydrogenase/blood , Lung/diagnostic imaging , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Radiography , Respiratory Insufficiency/therapy , Respiratory Insufficiency/virology
20.
Br J Radiol ; 93(1113): 20200643, 2020 Sep 01.
Article in English | MEDLINE | ID: covidwho-721360

ABSTRACT

OBJECTIVE: To investigate the diagnostic performance of chest CT in screening patients suspected of Coronavirus disease 2019 (COVID-19) in a Western population. METHODS: Consecutive patients who underwent chest CT because of clinical suspicion of COVID-19 were included. CT scans were prospectively evaluated by frontline general radiologists who were on duty at the time when the CT scan was performed and retrospectively assessed by a chest radiologist in an independent and blinded manner. Real-time reverse transcriptase-polymerase chain reaction was used as reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Sensitivity and specificity of the frontline general radiologists were compared to those of the chest radiologist using the McNemar test. RESULTS: 56 patients were included. Sensitivity, specificity, PPV, and NPV for the frontline general radiologists were 89.3% [95% confidence interval (CI): 71.8%, 97.7%], 32.1% (95% CI: 15.9%, 52.4%), 56.8% (95% CI: 41.0%, 71.7%), and 75.0% (95% CI: 42.8%, 94.5%), respectively. Sensitivity, specificity, PPV, and NPV for the chest radiologist were 89.3% (95% CI: 71.8%, 97.7%), 75.0% (95% CI: 55.1%, 89.3%), 78.1% (95% CI: 60.0%, 90.7%), and 87.5% (95% CI: 67.6%, 97.3%), respectively. Sensitivity was not significantly different (p = 1.000), but specificity was significantly higher for the chest radiologist (p = 0.001). CONCLUSION: Chest CT interpreted by frontline general radiologists achieves insufficient screening performance. Although specificity of a chest radiologist appears to be significantly higher, sensitivity did not improve. A negative chest CT result does not exclude COVID-19. ADVANCES IN KNOWLEDGE: Our study shows that chest CT interpreted by frontline general radiologists achieves insufficient diagnostic performance to use it as an independent screening tool for COVID-19. Although specificity of a chest radiologist appears to be significantly higher, sensitivity is still insufficiently high.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , Female , Humans , Lung/diagnostic imaging , Male , Middle Aged , Pandemics , Prospective Studies , Radiography, Thoracic/methods , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity
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