Chest CT Severity Score as an Auxiliary Grading Tool to COVID-19 Pneumonia Imaging Classification: A Tertiary Care Experience in Pakistan.

OBJECTIVE:   To identify utility of chest computed tomography severity score (CT-SS) as an additional tool to COVID-19 pneumonia imaging classification in assessing severity of COVID-19. STUDY DESIGN: Descriptive analytical study Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, (AFIRI) Rawalpindi, from April 2020 to June 2020. METHODOLOGY: Five hundred suspected COVID-19 cases referred for high resolution computed tomography - chest were included in the study. Cases were categorised by radiological findings using COVID-19 pneumonia imaging classification, proposed in the radiological society of North America expert consensus statement on reporting chest CT findings related to COVID-19. CT-SS was calculated for all scans. Patients were clinically classified according to disease severity as per 'Diagnosis And Treatment Program of Pneumonia of New Coronavirus Infection' recommended by China's National Health Commission. The relationships between radiological findings, CT-SS, and clinical severity were explored. RESULTS: Based on the radiological findings, 298 cases were graded as typical, 34 as indeterminate, 15 as atypical, and 153 as negative for pneumonia. The apical and posterior basal segments of lower lobes were most commonly involved. The CT-SS showed higher values in patients of severe group as compared to those in moderate group (p < 0.05). CT-SS threshold for recognising severe COVID-19 was 18.5 (area under curve, 0.960), with 84.3% sensitivity and 92.5% specificity. CONCLUSION: In coherence with COVID-19 pneumonia imaging classification, CT-SS may provide a comprehensive and objective assessment of COVID-19 severity. Key Words: COVID-19, COVID-19 pneumonia, CT-SS, High resolution computed tomography.

SPECTRUM OF CHEST X-RAY FINDINGS IN COVID-19 POSITIVE PATIENTS UTILIZING MODIFIED RALE SCORE FOR SEVERITY ASSESSMENT

ABSTRACT Objective: To assess chest x-ray appearance of patients with positive RT-PCR test for SARS-Cov-2 and utilize modified RALE score for severity assessment of chest x-ray findings for correlation with clinical spectrum of disease. Study Design: Prospective observational study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Pak Emirates Military Hospital, Rawalpindi, from Apr 2020 to May 2020. Methodology: First 1000 consecutive chest x-rays of COVID-19 patients with RT-PCR confirmation at our setup were analyzed. Positive chest x-rays were assessed for consolidation, ground glass opacities and location of involvement. A severity index using modified RALE score was calculated for each and both lungs. Results: Nine hundred and thirty two patients were males and 68 were females with an average age of 40.77 years ± 13.58. Out of 1000 patients, 759 (75.9%) had normal chest x-rays. Two hundred and forty one patients had positive findings, ground glass opacities being the most frequent feature 211 (87.6%) showing peripheral 219 (90.9%), bilateral 182 (75.5%) and lower zone predominance 221 (91.7%). The optimal modified RALE score threshold for recognizing severe disease was 4.5 (area under curve, 0.943), with 79.2% sensitivity and 96.3% specificity. Conclusion: COVID-19 patients with positive chest x-ray findings frequently showed ground glass opacities with bilateral lower zone involvement in peripheral distribution. Modified RALE score can be used for objective evaluation of clinically severe patients.