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Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive studyIssuing time:2020-03-31 18:54Source:The LancetLink:https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30086-4/fulltext#articleInformation BackgroundA cluster of patients with coronavirus disease 2019 (COVID-19) pneumonia caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were successively reported in Wuhan, China. We aimed to describe the CT findings across different timepoints throughout the disease course. MethodsPatients with COVID-19 pneumonia (confirmed by next-generation sequencing or RT-PCR) who were admitted to one of two hospitals in Wuhan and who underwent serial chest CT scans were retrospectively enrolled. Patients were grouped on the basis of the interval between symptom onset and the first CT scan: group 1 (subclinical patients; scans done before symptom onset), group 2 (scans done ≤1 week after symptom onset), group 3 (>1 week to 2 weeks), and group 4 (>2 weeks to 3 weeks). Imaging features and their distribution were analysed and compared across the four groups. Findings81 patients admitted to hospital between Dec 20, 2019, and Jan 23, 2020, were retrospectively enrolled. The cohort included 42 (52%) men and 39 (48%) women, and the mean age was 49·5 years (SD 11·0). The mean number of involved lung segments was 10·5 (SD 6·4) overall, 2·8 (3·3) in group 1, 11·1 (5·4) in group 2, 13·0 (5·7) in group 3, and 12·1 (5·9) in group 4. The predominant pattern of abnormality observed was bilateral (64 [79%] patients), peripheral (44 [54%]), ill-defined (66 [81%]), and ground-glass opacification (53 [65%]), mainly involving the right lower lobes (225 [27%] of 849 affected segments). In group 1 (n=15), the predominant pattern was unilateral (nine [60%]) and multifocal (eight [53%]) ground-glass opacities (14 [93%]). Lesions quickly evolved to bilateral (19 [90%]), diffuse (11 [52%]) ground-glass opacity predominance (17 [81%]) in group 2 (n=21). Thereafter, the prevalence of ground-glass opacities continued to decrease (17 [57%] of 30 patients in group 3, and five [33%] of 15 in group 4), and consolidation and mixed patterns became more frequent (12 [40%] in group 3, eight [53%] in group 4). InterpretationCOVID-19 pneumonia manifests with chest CT imaging abnormalities, even in asymptomatic patients, with rapid evolution from focal unilateral to diffuse bilateral ground-glass opacities that progressed to or co-existed with consolidations within 1–3 weeks. Combining assessment of imaging features with clinical and laboratory findings could facilitate early diagnosis of COVID-19 pneumonia.
Results 81 patients who were admitted to Wuhan Jinyintan hospital (n=49) or Union Hospital of Tongji Medical College (n=32) between Dec 20, 2019, and Jan 23, 2020, and who had confirmed COVID-19 pneumonia were retrospectively enrolled in our study. Epidemiologically, there were four main clusters of patients: 31 (38%) patients had direct exposure to Huanan seafood market, 15 (19%) were health-care workers who had close contact with patients at the hospital who had confirmed COVID-19 pneumonia, seven (9%) were familial clusters, and the remaining 28 (35%) did not have any obvious history of exposure. Patients were assigned to groups on the basis of time between symptom onset and first CT scan: 15 (19%) patients (including health-care workers who had had close contact with patients with confirmed COVID-19 pneumonia) were assigned to group 1, 21 (26%) to group 2, 30 (37%) to group 3, and 15 (19%) to group 4. The clinical characteristics and laboratory results of patients by group are summarised in the table (see appendix 2 [pp 1–3] for additional data). In the full cohort, the mean age was 49·5 years (SD 11; range 25–81), and there was no gender difference (42 [52%] men and 39 [48%] women). No significant differences in age (p=0·2778) or sex distribution (p=0·0871) between groups were identified. The most common symptoms at onset were fever (59 [73%] patients) and dry cough (48 [59%]). Other non-specific symptoms included dizziness (two [2%] patients), diarrhoea (three [4%]), vomiting (four [5%]), headache (five [6%]), and generalised weakness (seven [9%]). Among groups 2–4 (symptomatic patients), no significant differences in clinical parameters were found. Patients in group 1 had significantly lower mean concentrations of C-reactive protein (6·9 mg/L, p=0·0051) and aspartate aminotransferase (30·2 U/L, p=0·0026) than patients in the other three groups. Other laboratory findings did not significantly differ among groups, and the prevalence of underlying diseases was similar in all groups. |
