Nuray VOYVODA, Meral ARİFOĞLU, Ayşe BATIREL, Günay RONA

COVID-19’un Progresif Aşamasinda Toraks Bilgisayarli Tomografi Bulguları

GİRİŞ ve AMAÇ: Bu çalışmanın amacı COVID-19 pnömonisinin radyolojik bulgularındaki zamansal değişiklikleri değerlendirmektir.. YÖNTEM ve GEREÇLER: Çalışmaya COVID-19 tanısı almış ve kontrol toraks BT incelemesi olan hastalar dahil edildi. Her iki BT’de de tarama gününe göre evreleme kaydedildi. COVID19 pnömoni tipleri, BT şiddet skoru ve buzlu cam opasitelerin Hounsfield Ünite (HU) değerleri kaydedildi. Sonuçları karşılaştırmak için paired-sample t test kullanıldı. BULGULAR: Çalışmamıza 37 erkek (48.1%), 40 kadın(51.9%) olmak üzere toplam 77 hasta dahil edildi. İki BT arasındaki ortalama süre 12.64 gündü(min 3-maks 34). Buzlu cam dansitesi, konsolidasyon, crazypavingpatern, fibrotic bant, bronşektazi ve plevral kalınlaşma progresyon evresinde artmış bulgulardı. BT şiddet skoru ve buzlu cam dansitesi yoğunluğu açısından BT’ler arasında istatistiksel olarak anlamlı fark vardı(sırasıyla p=0.0001 ve 0.006). Takipte 54 hastada ilerleme olurken, 15 hastada kısmi/tam gerileme saptandı. Sekiz hastada bulgularda fark yoktu. TARTIŞMA ve SONUÇ: İlerleme, COVID-19 hastalığı semptomlarının başlamasından sonra 2 haftadan fazla sürer. İlerleyen aşamada, buzlu cam dansitesi yoğunluğu ve konsolidasyon alanlarındaki artış ile bronşektazi, crazypavingpatern, plevral kalınlaşma ve fibrotic bant dikkate değer radyolojik bulgulardır.

ChestComputedTomographyFindings in ProgressiveStage of COVID-19

INTRODUCTION: The aim of this study was to evaluate the temporal changes in the radiological findings of COVID-19 pneumonia. METHODS: The study included patients with the diagnosis of COVID-19 and repeat Chest CT examinations. On both CT examinations, staging by the day of scan was recorded. Types of COVID-19 pneumonia, CT severity score, and Hounsfieldunit (HU) values of ground-glassopacity (GGO) were evaluated. The paired-sample t test was used to compare the results. RESULTS: Our study included a total of 77 patients, 37 males (48.1%), 40 females (51.9%). The mean time between the two CTs was 12.64 days (min: 3-max: 34). Consolidation, GGO, crazy-paving pattern, fibrotic band, bronchiectasis, and pleural thickening were findings of increased progression. There was a statistically significant difference between the CTs in terms of CT severity score and GGO density (p=0.0001 and 0.006, respectively). At follow-up, 54 patients had progression, while 15 patients achieved partial/complete regression. Eight patients had no difference in findings. DISCUSSION AND CONCLUSION: Progression lasts more than two weeks after the onset of COVID-19 disease symptoms. In the progressive stage, an increase in the areas of GGO density and consolidation, as well as bronchiectasis, crazypaving pattern, pleural thickening, and fibrotic band are notable radiological findings.

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1. Zhu, N., Zhang, D., Wang, W., Li, X., Yang, B., Song, J. et al. China Novel Coronavirus Investigating and Research Team (2020). A Novel Coronavirus from Patients with Pneumonia in China, 2019. The New England journal of medicine, 382(8), 727-33. https://doi.org/10.1056/NEJMoa2001017
2. World Health Organization, Novel Coronavirus (2019-nCoV) Situation Report - 11,(2020) Sfvrsn = de7c0f7_4 https://www.who.int/docs/default-source/ coronaviruse/situationreports/20200131-sitrep-11- peak.pdf).
3. Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y. et al. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (London, England), 395 (10223), 497-506. https://doi.org/10.1016/S0140- 6736(20)30183-5
4. World Health Organization (2020) Novel coronavirus (2019-nCoV) technical guidance: laboratory testing for 2019-nCoV in humans. Available via https://www.who.int/emergencies/diseases/novelcor onavirus-2019/technical-guidance/laboratoryguidance. (Accessed 16 Mar 2020)
5. Loeffelholz, M. J.,&Tang, Y. W. (2020). Laboratory diagnosis of emerging human coronavirus infections – the state of the art. Emerging microbes & infections, 9(1), 747–56. https://doi.org/10.1080/22221751.2020.1745095
6. Ng, MY., Lee, EY., Yang,J., Yang, F., Li, X., Wang, H. et al. Imaging profile of the COVID-19 infection: radiologic findings and literatüre review. (2020) Radiol Cardiothorac Imaging Feb 13. https://doi.org/10.1148/ryct.2020200034.
7. Pan F, Ye T, Sun P, Gui S, Liang B, Li L et al. Time Course of Lung Changes at Chest Ct during Recovery from Coronovirus Disease 2019 (Covid -19 ) (2020) Radiology 295:3, 715-721 https://doi.org/10.1148/radiol.2020200370
8. Wang Y, Dong C, Hu Y, Li C, Ren Q, Zhang X et al. Temporal changes of CT Findings in 90 patients with Covid-19 Pneumonia : A Longitudinal Study (2020) Radiology, 200843. https://doi.org/10.1148/radiol.2020200843
9. Simpson, S., Kay, F. U., Abbara, S., Bhalla, S., Chung, J. H., Chung, M. et al. (2020). Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. Journal of thoracic imaging, 10.1097/RTI.0000000000000524. Advance online publication. https://doi.org/10.1097/RTI.0000000000000524
10. Chung, M., Bernheim, A., Mei, X., Zhang, N., Huang, M., Zeng, X. et al. (2020). CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV). Radiology, 295(1), 202–207. https://doi.org/10.1148/radiol.2020200230
11. Ai, T., Yang, Z., Hou, H., Zhan, C., Chen, C., Lv, W. et al. (2020). Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology, 200642. Advance online publication. https://doi.org/10.1148/radiol.2020200642
12. Wen Z, Chi Y, Zhang L, et al. Coronavirus disease 2019: initial detection on chest CT in a retrospective multicenter study of 103 Chinese subjects. (2020) Radiology: Cardiothoracic Imaging, RYCT-20-0092, https://doi.org/10.1148/ryct.2020200092
13. Inui, S., Fujikawa,A., Jitsu, M., Kunishima, N.,Watanabe, S., Suzuki, Y. et al. Chest CT findings in cases from the cruise ship "Diamond Princess" with coronavirus disease 2019 (COVID19). (2020) Radiology: Cardiothoracic Imaging, https://doi.org/10.1148/ryct.2020200110
14. Fang, Y., Zhang, H., Xie, J., Lin, M., Ying, L., Pang, P. et al. (2020). Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radiology, 200432. Advance online publication. https://doi.org/10.1148/radiol.2020200432
15. Li Y, Xia L. Coronavirus disease 2019 (COVID-19): role of chest CT in diagnosis and management. (2020) AJR Am J Roentgenol. https://doi.org/10.2214/AJR.20.22954
16. Bernheim, A., Mei, X., Huang, M., Yang, Y., Fayad, Z. A., Zhang, N., Diao, K., Lin, B., Zhu, X., Li, K., Li, S., Shan, H., Jacobi, A., Chung, M. (2020). Chest CT Findings in Coronavirus Disease19 (COVID-19): Relationship to Duration of Infection. Radiology, 295(3), 200463. https://doi.org/10.1148/radiol.2020200463
17. Xiong, Y., Sun, D., Liu, Y., Fan, Y., Zhao, L., Li, X. et al. (2020). Clinical and HighResolution CT Features of the COVID-19 Infection: Comparison of the Initial and Follow-up Changes. Investigative radiology, 55(6), 332–339. https://doi.org/10.1097/RLI.0000000000000674
18. Yang, R. Li, X., Liu, H., Zhen, Y., Zhang, X., Xiong, Q. et al. Chest CT Severity Score : An Imaging Tool for Assessing Severe COVID-19 (2020) Radiology: Cardiothoracic Imaging https://doi.org/10.1148/ryct.2020200047