Then the degree of lung involvement was evaluated for 6 lung regions: upper, middle and lower lung on each side and graded using a 5-point scale: 0 no involvement, 1 less than 25%, 2: 25–50%, 3: 50–75% and 4 > 75%. The CT score in this study was calculated as follows: CT attenuation was graded using a 3-point scale, with 1 for normal attenuation, 2 for ground glass and 3 for consolidation. evaluated imaging findings associated with mortality and reported that the frequency of consolidations as well as the median CT score were both higher in the group of patients who died at the hospital, as compared to patients who could be discharged. ) to severe disease extent with a “white lung” appearance on CT ( Fig. Patients with COVID-19 pneumonia present with variable disease extent, ranging from mild involvement, affecting less than 10% of the lung parenchyma ( Fig.
In this pictorial review, we present the typical CT features of COVID-19 pneumonia, their changes during follow-up, together with the main differential diagnosis and clues for their recognition. Given the important role of chest CT, it is important for radiologists to become familiar with the typical CT features associated with this new infection, as well as the imaging criteria for an alternative diagnosis. Indeed, 56% of patients imaged during the first 2 days following symptom onset may have normal CT findings. Thus, CT can play a pivotal role in the early detection and management of COVID-19 pneumonia, at least for patients who have been symptomatic for more than three days.
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A large series based on 1014 patients reported a 97% sensitivity of chest CT for the diagnosis of COVID-19, while the mean time interval between initial negative and positive RT-PCR was approximately 5 days. Indeed, when the viral load is insufficient, RT-PCR can be falsely negative while chest CT shows suggestive abnormalities. Computed tomography (CT) can be used as an important complement to RT-PCR for diagnosing COVID-19 pneumonia in the current epidemic context. However, these tests might not be available in an emergency setting and their results are not immediately available. The standard of reference for confirming COVID-19 relies on microbiological tests such as real-time polymerase chain reaction (RT-PCR) or sequencing.
However, these numbers are probably underestimated as not all patients are tested, especially those who are asymptomatic, or with only mild symptoms and no associated comorbidities. As of April 8 th, 2020, the epidemic had spread to more than 199 countries and more than one million individuals have contracted the virus worldwide with 81,478 reported deaths, including 82,048 confirmed cases in France and 10,869 deaths. Since March 11, 2020, the World Health Organization has declared Coronavirus disease 2019 (COVID-2019) caused by SARS-CoV-2 to be a pandemic and public health emergency of international concern.
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