Chest CT Findings in 2019 Novel Coronavirus (2019-nCoV)
Radiological features for early detection and diagnosis of coronavirus
In a special report published in the journal Radiology, researchers describe CT imaging features that aid in the early detection and diagnosis of Wuhan coronavirus.
“Early disease recognition is important not only for prompt implementation of treatment, but also for patient isolation and effective public health surveillance, containment and response,” said the study’s lead author, Michael Chung, M.D., assistant professor in the Department of Diagnostic, Interventional and Molecular Radiology in the Mount Sinai Health System in New York, N.Y.
On December 31, 2019, the World Health Organization (WHO) learned of several cases of a respiratory illness clinically resembling viral pneumonia and manifesting as fever, cough, and shortness of breath. The newly discovered virus emerging from Wuhan City, Hubei Province of China, has been temporarily named “novel coronavirus” (2019-nCoV). This new coronavirus belongs to a family of viruses that include Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).
The outbreak is escalating quickly, with thousands of confirmed 2019-nCoV cases reported globally.
In this retrospective case series, Dr. Chung and colleagues set out to characterize the key chest CT imaging findings in a group of patients infected with 2019-nCoV in China with the goal of familiarizing radiologists and clinical teams with the imaging manifestations of this new outbreak.
From January 18, 2020, until January 27, 2020, 21 patients admitted to three hospitals in three provinces in China with confirmed 2019-nCoV infection underwent chest CT. The 21 patients consisted of 13 men and 8 women ranging in age from 29 to 77 years old, with a mean age of 51.2 years. All patients were confirmed positive for infection via laboratory testing of respiratory secretions.
For each of the 21 patients, the initial CT scan was evaluated for the following characteristics:
Dr. Chung cautioned that absence of abnormal CT findings upon initial examination does not rule out the presence of 2019-nCoV.
“Our patient population is unique from other published series on the Wuhan coronavirus in that three of our patients had normal initial chest CTs,” he said. “One of these patients progressed three days later and developed a solitary nodular ground-glass lesion in the right lower lobe, indicating this pattern may represent the very first radiologically visible manifestation of disease in some patients infected with Wuhan coronavirus.”
He added that a second patient had a normal follow-up chest CT four days after her initial normal imaging exam.
“This suggests that chest CT lacks complete sensitivity and does not have a perfect negative predictive value,” Dr. Chung said. “We can’t rely on CT alone to fully exclude presence of the virus.”
This finding may be related to the fact that infection with 2019-nCoV is characterized by an incubation period of several days, and there may be a phase where viral infection manifests with symptoms prior to visible abnormalities on CT.
Most patients with 2019-nCoV infection present with fever (98%), cough (76%), and myalgia or fatigue (44%). Dyspnea has been reported in 55% of patients, developing in a median of 8 days after onset of initial symptoms. Six of 41 patients (15%) in the largest published cohort to date died from their illness, and there are now 80 confirmed deaths
To know more details on the history, symptoms and much more, check out our previous blog on Coronavirus, click here
Note for Doctors: As the number of reported cases of 2019-nCoV infection continue to increase, doctors may encounter patients with this infection. A high index of suspicion and detailed exposure and travel history are critical to considering this diagnosis. In the correct clinical setting, bilateral ground-glass opacities or consolidation at chest imaging should prompt the radiologist to suggest 2019-nCoV as a possible diagnosis. Furthermore, a normal chest CT scan does not exclude the diagnosis of 2019-nCoV infection.
Source: Radiological Society Of North America