Kocaeli Üniversitesi’ndeki COVID-19 Hastalarının Toraks Bilgisayarlı Tomografi Bulguları

Amaç: Bu çalışmanın amacı, Kocaeli Üniversitesi’nde Mart-Haziran 2020 tarihleri arasında gerçek zamanlı ters transkriptaz-polimeraz zincir reaksiyonu (RT-PCR) testi pozitif olan koronavirüs hastalığı 2019’un (COVID-19) toraks bilgisayarlı tomografi (BT) görüntüleme bulguları ve farklılıklarını değerlendirmektir. Yöntem: Belirtilen tarihlerde COVID-19 şüphesi ile başvuran 1875 hastadan RT-PCR testi pozitif olan 189 hasta değerlendirildi. Dahil etme kriterlerine uygun 114 hastanın sosyodemografik verileri, semptom başlangıcı ile BT çekimi arasındaki süre, BT’deki akciğer bulguları Microsoft Office Excel'e kaydedildi. BT bulguları Radiological Society of North America (RSNA)’nın önerdiği raporlama diline uygun kategorize edildi. Bulgular: Çalışmaya dahil olan 114 hastanın 52’si (%45,6) kadın, 62’si (%54,4) erkekti. Tüm hastaların yaş ortalaması 46,4 (±17,2) olup 41 hastada (%35,9) tipik görünüm, 3 hastada (%2,6) atipik görünüm, 18 hastada (%15,7) belirsiz görünüm, 52 hastada (%45,6) ise normal BT bulguları mevcuttu. BT bulguları olan 62 hastanın 42’sinde (%67,7) bilateral akciğer tutulumu, 20’sinde (%32,3) unilateral akciğer tutulumu mevcuttu.15 hastada (%24,2) tek akciğer lobu tutulumu, 47 hastada (%75,8) birden fazla lob tutulumu izlendi. Tutulan loblardan en sık alt loblarda tutulum mevcuttu (%77,4, n=48). Hastaların %3,2’sinde (n=2) santral buzlu cam opasiteleri mevcut iken %96,8’inde (n=60) periferal buzlu cam opasiteleri izlendi. COVID-19 BT duyarlılığı %42,7 idi. Sonuç: Çalışmamızda COVID-19’un BT bulguları literatürle benzer şekilde multiple, bilateral ve periferal yerleşimli buzlu cam opasiteleri şeklinde iken duyarlılığı yeterli düzeyde değildir. Bu nedenle özellikle hastalığın erken dönemlerinde BT bulgusunun olmaması hastalığı dışlatmamalıdır.

Anahtar Kelimeler:

COVID-19, RT-PCR, toraks BT

Thorax Computed Tomography Imaging Findings of COVID-19 at Kocaeli University

Objective: The objective of this study was to evaluate imaging findings and differences of thorax computed tomography (CT) of coronavirus disease 2019 (COVID-19) at Kocaeli University. Methods: 114 patient’s sociodemographic data, the time between onset of symptoms and CT, lung findings in CT were recorded in Microsoft Office Excel. CT findings were categorized according to the reporting language suggested by the Radiological Society of North America (RSNA). Results: 52 (45.6%) patients were female and 62 (54.4%) were male. The average age of all patients was 46.4 (± 17.2). Typical appearance in 41 patients (35.9%), atypical appearance in 3 patients (2.6%), indetermine appearance in 18 patients (15.7%), and normal CT findings in 52 patients (45.6%) were observed. 42 (67.7%) patients had bilateral lung involvement, 20 (32.3%) had unilateral lung involvement. Single lung lobe involvement was observed in 15 patients (24.2%), and multiple lobe involvement was observed in 47 patients (75.8%). Of the lobes that were involved, the most common involvement was in the lower lobes (77.4%, n = 48). While central ground glass opacities were present in 3.2% (n = 2) of the patients, peripheral ground glass opacities were observed in 96.8% (n = 60). CT sensitivity in COVID-19 was 42.7%. Conclusion: In our study, CT findings of COVID-19 were similar to the literature, meaning CT sensitivity was not sufficient. Therefore, the absence of CT findings especially in the early stages of the disease should not exclude the disease.

Keywords:

COVID-19, RT-PCR, thorax CT,

PDF

___

Zhu N, Zhang D, Wang W, et al. A novel Coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382:727-733. doi:10.1056/NEJMoa2001017.
COVID C, Team R. Severe outcomes among patients with coronavirus disease 2019 (COVID-19) United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:343-346.
Akçay Ş, Özlü T, Yılmaz A. Radiological approaches to COVID-19 pneumonia. Turk J Med Sci. 2020;50:604-610. doi:10.3906/sag-2004-160.
Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J. Chest CT for typical Coronavirus disease 2019 (COVID-19) pneumonia: Relationship to negative RT-PCR testing. Radiology. 2020;296:E41-E45. doi:10.1148/radiol.2020200343.
Fang Y, Zhang H, Xie J, et al. Sensitivity of chest CT for COVID-19: Comparison to RT-PCR. Radiology. 2020;296:E115-E117. doi:10.1148/radiol.2020200432.
Ai T, Yang Z, Hou H, et al. Correlation of chest CT and RT-PCR testing in Coronavirus disease 2019 (COVID-19) in China: A Report of 1014 cases. Radiology. 2020;296:E32-E40. doi:10.1148/radiol.2020200642.
Simpson S, Kay F.U, Abbara S, et al. 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. Radiology: Cardiothoracic Imaging. 2020;2. doi:10.1148/ryct.2020200152.
Xu X, Chen P, Wang J, et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci. 2020;63:457-460. doi:10.1007/s11427-020-1637-5.
Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): A systematic review of imaging findings in 919 patients. AJR Am J Roentgenol. 2020;215:87-93. doi: 10.2214/AJR.20.23034.
Cheng Z, Lu Y, Cao Q, et al. Clinical features and chest CT manifestations of Coronavirus disease 2019 (COVID-19) in a single-center study in Shanghai, China. AJR Am J Roentgenol. 2020;215:121-126. doi: 10.2214/AJR.20.22959.
Wang Y, Dong C, Hu Y, et al. Temporal changes of CT findings in 90 patients with COVID-19 pneumonia: a longitudinal study. Radiology. 2020;296:E55-E64. doi: 10.1148/radiol.43.20202008.
Ye Z, Zhang Y, Huang Z, et al. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. European Radiology. 2020;30:4381-4389. doi: 10.1007/s00330-020-06801-0.
Pan Y, Guan H, Zhou S, et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019 nCoV): a study of 63 patients in Wuhan, China. European Radiology. 2020;30:3306-3309. doi: 10.1007/s00330-020-06731-x.
Li B, Li X, Wang Y, et al. Diagnostic value and key features of computed tomography in Coronavirus Disease 2019. Emerg Microbes Infect. 2020;9:787-793. doi: 10.1080/22221751.2020.1750307
Kanne, JP. Chest CT findings in 2019 novel coronavirus (2019-nCoV) infections from Wuhan, China: key points for the radiologist. Radiology. 2020;295:16-17. doi:10.1148/radiol.2020200241.
Bernheim A, Mei X, Huang M, et al. Chest CT Findings in Coronavirus disease-19 (COVID19): Relationship to duration of infection. Radiology. 2020;295:202-207. doi:10.1148/radiol.2020200463
Li Y, Xia L. Coronavirus disease 2019 (COVID-19): role of chest CT in diagnosis and management. AJR Am J Roentgenol. 2020;214:1280-1286. doi:10.2214/AJR.20.22954