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CT and clinical assessment in asymptomatic and pre-symptomatic patients with early SARS-CoV-2 in outbreak settings.
Varble, Nicole; Blain, Maxime; Kassin, Michael; Xu, Sheng; Turkbey, Evrim B; Amalou, Amel; Long, Dilara; Harmon, Stephanie; Sanford, Thomas; Yang, Dong; Xu, Ziyue; Xu, Daguang; Flores, Mona; An, Peng; Carrafiello, Gianpaolo; Obinata, Hirofumi; Mori, Hitoshi; Tamura, Kaku; Malayeri, Ashkan A; Holland, Steven M; Palmore, Tara; Sun, Kaiyuan; Turkbey, Baris; Wood, Bradford J.
  • Varble N; Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center and National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA.
  • Blain M; Philips Research North America, Cambridge, MA, USA.
  • Kassin M; Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center and National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA.
  • Xu S; Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center and National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA.
  • Turkbey EB; Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA.
  • Amalou A; Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center and National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA.
  • Long D; Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA.
  • Harmon S; Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center and National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA.
  • Sanford T; Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center and National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA.
  • Yang D; National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
  • Xu Z; Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA.
  • Xu D; Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center and National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA.
  • Flores M; National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
  • An P; State University of New York Upstate Medical University, Syracuse, NY, USA.
  • Carrafiello G; Nvidia Corporation, Bethesda, MD, USA.
  • Obinata H; Nvidia Corporation, Bethesda, MD, USA.
  • Mori H; Nvidia Corporation, Bethesda, MD, USA.
  • Tamura K; Nvidia Corporation, Bethesda, MD, USA.
  • Malayeri AA; Department of Radiology, Xiangyang NO. 1 People's Hospital Affiliated to Hubei University of Medicine, Xiangyang, Hubei, China.
  • Holland SM; Department of Radiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Palmore T; Department of Health Sciences, University of Milano, Milan, Italy.
  • Sun K; Self-Defense Forces Central Hospital, Tokyo, Japan.
  • Turkbey B; Self-Defense Forces Central Hospital, Tokyo, Japan.
  • Wood BJ; Self-Defense Forces Central Hospital, Tokyo, Japan.
Eur Radiol ; 31(5): 3165-3176, 2021 May.
Article in English | MEDLINE | ID: covidwho-910288
ABSTRACT

OBJECTIVES:

The early infection dynamics of patients with SARS-CoV-2 are not well understood. We aimed to investigate and characterize associations between clinical, laboratory, and imaging features of asymptomatic and pre-symptomatic patients with SARS-CoV-2.

METHODS:

Seventy-four patients with RT-PCR-proven SARS-CoV-2 infection were asymptomatic at presentation. All were retrospectively identified from 825 patients with chest CT scans and positive RT-PCR following exposure or travel risks in outbreak settings in Japan and China. CTs were obtained for every patient within a day of admission and were reviewed for infiltrate subtypes and percent with assistance from a deep learning tool. Correlations of clinical, laboratory, and imaging features were analyzed and comparisons were performed using univariate and multivariate logistic regression.

RESULTS:

Forty-eight of 74 (65%) initially asymptomatic patients had CT infiltrates that pre-dated symptom onset by 3.8 days. The most common CT infiltrates were ground glass opacities (45/48; 94%) and consolidation (22/48; 46%). Patient body temperature (p < 0.01), CRP (p < 0.01), and KL-6 (p = 0.02) were associated with the presence of CT infiltrates. Infiltrate volume (p = 0.01), percent lung involvement (p = 0.01), and consolidation (p = 0.043) were associated with subsequent development of symptoms.

CONCLUSIONS:

COVID-19 CT infiltrates pre-dated symptoms in two-thirds of patients. Body temperature elevation and laboratory evaluations may identify asymptomatic patients with SARS-CoV-2 CT infiltrates at presentation, and the characteristics of CT infiltrates could help identify asymptomatic SARS-CoV-2 patients who subsequently develop symptoms. The role of chest CT in COVID-19 may be illuminated by a better understanding of CT infiltrates in patients with early disease or SARS-CoV-2 exposure. KEY POINTS • Forty-eight of 74 (65%) pre-selected asymptomatic patients with SARS-CoV-2 had abnormal chest CT findings. • CT infiltrates pre-dated symptom onset by 3.8 days (range 1-5). • KL-6, CRP, and elevated body temperature identified patients with CT infiltrates. Higher infiltrate volume, percent lung involvement, and pulmonary consolidation identified patients who developed symptoms.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study Limits: Humans Country/Region as subject: Asia Language: English Journal: Eur Radiol Journal subject: Radiology Year: 2021 Document Type: Article Affiliation country: S00330-020-07401-8

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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study Limits: Humans Country/Region as subject: Asia Language: English Journal: Eur Radiol Journal subject: Radiology Year: 2021 Document Type: Article Affiliation country: S00330-020-07401-8