Role of Chest CT in COVID-19

Malguria, Nagina; Yen, Li-Hsiang; Lin, Tony; Hussein, Amira; Fishman, Elliot K.

In December 2019, a disease attributed to a new severe acute respiratory syndrome coronavirus 2, and named coronavirus disease 2019 (COVID-19), broke out in Wuhan, China and has spread rapidly throughout the world. CT has been advocated in selected indications as a tool toward rapid and early diagnosis. The CT patterns of COVID-19 include ground glass opacities GGO, consolidation, and crazy paving. Additional signs include a “rounded morphology” of lesions, vascular enlargement sign, nodules, and fibrous stripe. Signs of healing and organization include subpleural bands, a reticular pattern, reversed halo sign and traction bronchiectasis. Cavitation and tree in bud signs are absent and pleural effusions are rare. There is a high incidence of pulmonary embolism associated with COVID-19. CT findings in COVID-19 appear to follow a predictable timeline with maximal involvement approximately 6–11 days after symptom onset. The stages of evolution include early stage (days 0–4) with GGO being the predominant abnormality, progressive stage (days 5–8) with increasing crazy paving; and peak stage (days 9–13) with predominance of consolidation and absorption phase (after day 14) with gradual absorption of consolidation with residual GGO and subpleural bands. CT findings in COVID-19 have a high sensitivity and low specificity, determined to be 98% and 25% in a retrospective study of 1014 patients. The low specificity of CT for the diagnosis of COVID-19 pneumonia is due to the overlap of CT findings with other viral pneumonias and other infections, lung involvement in connective tissue disorders, drug reaction, pulmonary edema, and hemorrhage.