Radiological role in the detection, diagnosis and monitoring for the coronavirus disease - 2019 (COVID-19) - European Review for Medical and ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
European Review for Medical and Pharmacological Sciences 2020; 24: 4523-4528
Radiological role in the detection, diagnosis
and monitoring for the coronavirus disease
2019 (COVID-19)
L. HU1, C. WANG2
Department of Ultrasound, Hangzhou Women’s Hospital, Hangzhou, Zhejiang, China
1
Department of Radiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University,
2
Hangzhou, Zhejiang, China
Abstract. – OBJECTIVE: Coronavirus dis- patients was highly similar to that identified in
ease 2019 (COVID-19) has officially been de- bats3. On Jan 7, 2020, this disease was ultimately
clared a pandemic by the World Health Organi- found to be caused by a new severe acute respi-
zation (WHO). Radiological examinations, espe-
cially computed tomography (CT), play an im-
ratory syndrome coronavirus 2 (SARS-CoV-2;
portant role in the fight against COVID-19. A previously known as 2019nCoV) formally named
comprehensive and timely review of radiolog- by the World Committee on Virus Classification4.
ical role in the fight against COVID-19 remains On February 12, 2020, the disease caused by this
urgent and mandatory. Hence, the aim of this re- virus was named as Coronavirus Disease 2019
view is to summarize the radiological role in the (COVID-19) by the World Health Organization
fight against COVID-19. This review of current
(WHO). This virus has spread to over 100 coun-
studies on COVID-19 provides insight into the
radiological role in the detection, diagnosis, and tries, with more than 180,000 cases and over
monitoring for COVID-19. The typical radiologi- 7,000 deaths reported as of 17 March. Therefore,
cal features of COVID-19 include bilateral, mul- COVID-19 has officially been declared a pan-
tifocal, and multilobar ground glass opacifica- demic by the WHO.
tion with patchy consolidation, a peripheral/sub- At present, the Real-Time Reverse Transcrip-
pleural or posterior distribution (or both), main- tion-Polymerase Chain Reaction (RT-PCR) de-
ly in the lower lobes. A combination of chest CT
and repeat Reverse Transcription-Polymerase
tection method for COVID-19 has been devel-
Chain Reaction (RT-PCR) testing may be benefi- oped and applied in clinics.
cial for the diagnosis of COVID-19 in the setting RT-PCR remains the reference standard for the
of strongly clinical suspicion. Chest CT may im- final diagnosis of COVID-19 infection, howev-
prove the sensitivity for COVID-19 diagnosis, but er, especially in the early stage of the outbreak
patients’ exposure to radiation should be kept in some countries, the high false negative rate5
as low as possible especially for children and
and the lack of RT-PCR assay limited the time-
pregnant women patients.
ly diagnosis of infected patients. Radiological
Key Words: examinations, especially chest computed tomog-
COVID-19, Radiological features, Computed to- raphy (CT), play an important role in the fight
mography, Ground glass opacification. against COVID-196. Chest CT plays an important
role in the timely detection of lung infection
abnormalities in the early phase and facilitates
Introduction a larger public health surveillance and response
systems7,8. Recent emerging studies have report-
In December 2019, a group of patients with ed that the sensitivity of chest CT may be great-
pneumonia of unknown reasons was reported in er than RT-PCR9,10. Since February 13, 2020,
Wuhan, Hubei province, China. Epidemiological chest CT findings have been recommended as the
evidence revealed that most of these patients major evidence for confirmed clinical diagnosis
were linked to a local seafood wholesale market especially in the severely epidemic area, such as
in Wuhan, where poultry, snake, bats, and other Hubei. A comprehensive and timely review of the
live animals were also on sale illegally1,2. The radiological role in the fight against COVID-19
gene sequence of the virus obtained from these remains urgent and mandatory. Hence, the aim
Corresponding Author: Chao Wang, MD; e-mail: 2514110@zju.edu.cn 4523L. Hu, C. Wang
of this review is to summarize the radiological patients had initially positive RT-PCR results.
role in fighting with COVID-19. To evaluate They also demonstrated that the sensitivity of
the recent trends in the radiological findings of chest CT was higher than RT-PCR. Moreover,
COVID-19, we used PubMed and Web of Science Ai et al12 investigated correlation of chest CT
with key search terms, including ‘‘COVID-19’’, and RT-PCR testing in 1014 cases of COVID-19.
‘‘SARS-Cov-2’’, or ‘‘2019 nCoV’’, with “radiol- They concluded that chest CT had a high sen-
ogy”, ‘‘imaging’’, ‘‘computed tomography’’, or sitivity for diagnosis of COVID-19. In addition,
‘‘CT’’. We summarize the radiological findings Xie et al9 included a group of 167 patients who
of COVID-19 researches for the following three underwent both initial RT-PCR assay and chest
main areas: (1) radiological role in the detection CT scanning on the same day. They found that
of COVID-19; (2) radiological role in the diagno- 5/167 (3%) patients initially had negative RT-
sis of COVID-19; and (3) radiological role in the PCR results but positive CT results. In contrast,
monitoring of COVID-19. 7/167 (4%) patients had negative CT results but
positive RT-PCR results9. Similarly, another ret-
Radiological Role in the Detection of rospective study found that 3/21 (4%) patients
COVID-19 showed negative findings on first-time chest CT
CT has become an important imaging method in RT-PCR-confirmed patients, for whom a fol-
for the early detection of patients with COVID-19 low-up chest CT revealed positive findings in 2
pneumonia. Song et al11 reviewed the CT findings patients16. Furthermore, Xu et al17 reported that
in 51 confirmed patients. They found that pure first-time baseline chest CT did not show any
ground-glass opacification (GGO) pattern was in abnormalities in 21/90 patients (23%). The role of
77% patients, GGO with interstitial and/or inter- CT in the detection of COVID-19 remains totally
lobular septal thickening in 75% patients, GGO undefined. However, CT scanning may serve as
with consolidation in 59% patients. GGO is a an important supplementary examination method
predominant CT imaging feature in COVID-19 for RT-PCR screening in the highly suspected
pneumonia, especially in patients with few symp- patients of COVID-19 infection. RT-PCR remains
toms or low severity. However, GGO is often the reference standard for the final diagnosis of
imperceivable on the chest radiography, on which COVID-19 infection.
the detection of this type of abnormality is very
challenging even for a senior radiologist. In the Radiological Role in the Diagnosis of
future, the application of artificial intelligence in COVID-19
screening chest radiographs of suspected cases To date, a total of 26 case series6,9-12,16-36 have
needs further research. investigated the radiological characteristics of
Chest CT was included into the new diagnostic COVID-19. The typical radiological features of
criteria that by the National Health and Health initial CT in COVID-19 cases include bilateral,
Commission of China in Hubei province on Feb- multifocal, multilobar GGO with patchy con-
ruary 12, 2020. On that day, the diagnoses of solidations, a peripheral/subpleural or posterior
COVID-19 surged in Hubei Province. This new distribution (or both), mainly in the lower lobes
diagnostic criteria were employed to ensure time- (Figure 1)6,9-12,16-35. GGO is a fuzzy increase in
ly treatment and isolation measures due to the attenuation that occurs in various interstitial
delays of RT-PCR testing and the large group of and alveolar processes preserving the bronchial
patients with respiratory symptoms in the Hubei and vascular margins37, while consolidation is
province. Chest CT may have higher sensitivity a region of opacification obscuring the bron-
for diagnosis of COVID-19 than initial RT-PCR12, chial and vascular margins38. GGO or GGO
because RT-PCR can be affected by low patient with consolidation were the most common ra-
viral load and improper clinical sampling13,14. diological features. Other common radiological
Two studies9,15 indicated that many cases eventu- features include interlobular septal thickening,
ally confirmed with COVID-19 might be initially crazy-paving pattern, air bronchogram/traction
negative in several times RT-PCR tests, but lung bronchiectasis, halo sign/reverse halo sign, pe-
abnormal lesions might be initially detected by ripheral/subpleural involvement, and pleural
chest CT. Fang et al10 recruited 51 patients who thickening6,11,16-18,21,23,26,28-30,34,36. Pleural effusion,
performed RT-PCR assay and chest CT within pericardial effusion, lymphadenopathy, cavita-
3 days. They found that 50/51 (98%) patients tion, and pulmonary emphysema, pneumothorax
had positive CT results while only 36/51 (71%) are uncommon findings11,17. Furthermore, a PET/
4524Radiological role in the detection, diagnosis and monitoring for the COVID-19
tive choice for imaging, particularly for serial
monitoring, as demonstrated in the case report
from United States39. Furthermore, ultrasound
imaging can be another alternative technique for
chest imaging40, as demonstrated in the case re-
port from Italy41. For CT scanning, low radiation
dose mode should always be applied to minimize
the radiation dosage42.
Radiological Role in the Monitoring of
COVID-19
Chest CT can be used to evaluate the disease
severity of COVID-19 to guide clinical man-
agement. Huang et al2 reported that severe pa-
tients on admission often presented with bilateral
Figure 1. Patchy ground-glass opacity pattern. A 43-old- multiple lobular and subsegmental consolidation
year woman with close contact history presenting with on their chest CT, while mild patients often
fever. Scan obtained on illness days 2 showed patchy pure
ground-glass opacity in bilateral lower lobes.
presented bilateral GGO and subsegmental con-
solidation on their chest CT. Many radiological
studies6,11,18,19,23,28,35 have investigated the temporal
CT study revealed that pulmonary lesions typi- changes of imaging findings following the stage
cally showed high 18 F-FDG uptake and lymph of the disease. Song et al11 found that an increased
node could be involved32. rate of consolidative opacities were associated
In the early period of the outbreak, the elder- with disease progression of COVID-19. Further,
ly patients made up the majority and pediatric Shi et al6 classified their patients into four groups
patients were rather rare, thus children were according to the interval between symptom onset
thought to be not susceptible to COVID-19 virus. and the first CT scan: group 1 (scans done before
Nevertheless, along with the emerging of familial symptom onset), group 2 (scans done ≤7 days af-
aggregation, children suffering from COVID-19 ter symptom onset), group 3 (>7 days to 14 days),
infection were gradually appeared. Li et al22 in- and group 4 (>14 days to 21 days). Radiologi-
cluded 5 children patients who performed chest cal characteristics were analyzed and compared
CT. They found similar but more modest lung ab- across the four groups. The predominant lesions
normalities (patchy GGO) in their small pediatric were unilateral and multifocal GGO in group
cohort relative to reports in adults. Additionally, 1, then, the lesions quickly evolved to bilateral,
Xia et al31 included 20 pediatric inpatients who and diffuse GGO predominance in group 2.
performed chest CT. They demonstrated that Thereafter, the prevalence of GGO continued to
the radiological findings included consolidation decrease, and consolidation and mixed patterns
with surrounding halo sign (10/20, 50%), GGO became more frequent in group 3 and group
(12/20, 60%), fine mesh shadow (4/20, 20%), and 46. Moreover, Pan et al18 performed a longitudi-
tiny nodules (3/20, 15%)31. Consolidation with nal follow-up study to observe the radiological
surrounding halo signs were common in chil- changes between initial CT and follow-up CT
dren compared to reports in adults. Thus, they with an interval of 3-14 days. The follow-up CT
concluded that consolidation with surrounding results showed that 85.7% patients progressed.
halo sign might be a typical radiological sign in The CT findings of disease progression included
children. In addition, Liu et al33 included 15 preg- an increase in number and size or consolidation
nant women patients of COVID-19 pneumonia. of GGO, enlarged fibrous stripe, and an increase
They found that pregnancy and childbirth did not in number and size or fusion of the nodules18.
aggravate the course of symptoms and chest CT Furthermore, Pan et al19 investigated the tempo-
features. ral course of CT changes in 4 stages with 4 day
Chest CT may improve the sensitivity for intervals. In early stages, most of their patients
COVID-19 diagnosis, but patients’ exposure to showed more GGO and fewer lobes number
radiation should be kept as low as possible, than that of the subsequent follow-up scans (Fig-
especially for children and pregnant women pa- ure 2A, 2B). Nevertheless, increased number of
tients. Therefore, chest X-ray can be an alterna- involved lobes, increased crazy-paving pattern,
4525L. Hu, C. Wang Figure 2. Series CT scans in a 66-year-old man with COVID-19 pneumonia. A, B, Scan obtained on illness days 2 showed ground-glass opacity with intralobular septal thickening (crazy-paving pattern) that affected posterior segment of right upper lobe. C, D, Scan obtained on illness days 8 showed increased consolidative opacities. Note that patchy ground-glass opacity newly developed in left lower lobe. E, F, Scan obtained on illness days 13 showed absorption of abnormalities, with pure ground-glass opacity left in the posterior segment of right upper lobe and posterior basal segment of left lower lobe. and appearance of consolidation appeared in the symptoms. In the stage-4 (≥14 days), 75% of the majority of patients over time (Figure 2C, 2D)19. patients showed disease improvement, including They concluded that the extent of lung abnormal- decreased number of involved lobes and resolu- ities on CT peaked on day 10 after initial onset of tion of crazy paving pattern and consolidation 4526
Radiological role in the detection, diagnosis and monitoring for the COVID-19
(Figure 2E, 2F)19. As a support, another longitu- 5) Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, Xing
dinal study35 analyzed the serial CT findings of F, L iu J, Yip CC, Poon R W, Tsoi HW, Lo SK, Chan KH,
Poon VK, Chan WM, Ip JD, C ai JP, Cheng VC, Chen
90 patients over time. They demonstrated that H, Hui CK, Yuen KY. A familial cluster of pneumo-
lung abnormalities were severest during illness nia associated with the 2019 novel coronavirus in-
days 6-11. The early follow-up CT often showed dicating person-to-person transmission: a study
increased number of involved lobes, mixed pat- of a family cluster. Lancet 2020; 395: 514-523.
tern of GGOs, increased consolidative opacities, 6) Shi H, Han X, Jiang N, C ao Y, A lwalid O, Gu J, Fan
and pleural effusion because of disease progres- Y, Zheng C. Radiological findings from 81 patients
sion23,28. Then, the later follow-up CT showed the with COVID-19 pneumonia in Wuhan, China: a
descriptive study. Lancet Infect Dis 2020; 20:
resolution of GGO and appearance of fibrosis 425-434.
because of disease recovery28. 7) K anne JP. Chest CT. Findings in 2019 Novel Coro-
navirus (2019-nCoV) infections from Wuhan, Chi-
na: key points for the radiologist. Radiology 2020;
Conclusions 295: 16-17.
8) Pan Y, Guan H. Imaging changes in patients
Summarily, the typical radiological features of with 2019-nCov. Eur Radiol 2020. doi: 10.1007/
COVID-19 include bilateral, multifocal, multilo- s00330-020-06713-z. [Epub ahead of print].
bar ground glass opacification (GGO) with patchy 9) Xie X, Zhong Z, Zhao W, Zheng C, Wang F, L iu J.
Chest CT for typical 2019-nCoV pneumonia: re-
consolidations, a peripheral/subpleural or pos- lationship to negative RT-PCR testing. Radiology
terior distribution (or both), mainly in the lower 2020: 200343.
lobes. A combination of chest CT and repeat RT- 10) Fang Y, Zhang H, Xie J, L in M, Ying L, Pang P, Ji W.
PCR testing may be beneficial for the diagnosis of Sensitivity of chest CT for COVID-19: comparison
COVID-19 in the setting of strongly clinical sus- to RT-PCR. Radiology 2020: 200432.
picion. Chest CT may improve the sensitivity for 11) Song F, Shi N, Shan F, Zhang Z, Shen J, Lu H, L ing
COVID-19 diagnosis, but patients’ exposure to Y, Jiang Y, Shi Y. Emerging 2019 Novel Coronavirus
radiation should be kept as low as possible espe- (2019-nCoV) pneumonia. Radiology 2020; 295:
210-217.
cially for children and pregnant women patients.
12) A i T, Yang Z, Hou H, Zhan C, Chen C, Lv W, Tao Q,
Sun Z, Xia L. Correlation of chest CT and RT-PCR
testing in coronavirus disease 2019 (COVID-19)
Conflict of Interest in China: a report of 1014 cases. Radiology 2020:
The Authors declare that they have no conflict of interests. 200642.
13) Peiris JS, Chu CM, Cheng VC, Chan KS, Hung IF,
Poon LL, L aw KI, Tang BS, Hon TY, Chan CS, Chan
References KH, Ng JS, Zheng B J, Ng W L, L ai RW, Guan Y, Yuen
KY. Clinical progression and viral load in a com-
1) Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu munity outbreak of coronavirus-associated SARS
Y, Wang J, L iu Y, Wei Y, Xia J, Yu T, Zhang X, Zhang pneumonia: a prospective study. Lancet 2003;
L. Epidemiological and clinical characteristics of 361: 1767-72.
99 cases of 2019 novel coronavirus pneumonia in 14) Hui DSC, Zumla A. Severe acute respiratory syn-
Wuhan, China: a descriptive study. Lancet 2020; drome: historical, epidemiologic, and clinical fea-
395: 507-513. tures. Infect Dis Clin North Am 2019; 33: 869-889.
2) Huang C, Wang Y, L i X, Ren L, Zhao J, Hu Y, Zhang 15) Huang P, L iu T, Huang L, L iu H, Lei M, Xu W, Hu
L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu X, Chen J, L iu B. Use of chest CT in combination
W, Xie X, Yin W, L i H, L iu M, Xiao Y, G ao H, Guo L, with negative RT-PCR assay for the 2019 Novel
Xie J, Wang G, Jiang R, G ao Z, Jin Q, Wang J, C ao Coronavirus but high clinical suspicion. Radiolo-
B. Clinical features of patients infected with 2019 gy 2020; 295: 22-23.
novel coronavirus in Wuhan, China. Lancet 2020; 16) Chung M, Bernheim A, Mei X, Zhang N, Huang M,
395: 497-506. Zeng X, Cui J, Xu W, Yang Y, Fayad Z A, Jacobi A, L i
3) Ji W, Wang W, Zhao X, Z ai J, L i X. Cross-species K, L i S, Shan H. CT imaging features of 2019 Novel
transmission of the newly identified coronavirus Coronavirus (2019-nCoV). Radiology 2020; 295:
2019-nCoV. J Med Virol 2020; 92: 433-440. 202-207.
4) Xu X, Chen P, Wang J, Feng J, Zhou H, Li X, Zhong 17) Xu X, Yu C, Qu J, Zhang L, Jiang S, Huang D, Chen
W, Hao P. Evolution of the novel coronavirus from B, Zhang Z, Guan W, L ing Z, Jiang R, Hu T, Ding
the ongoing Wuhan outbreak and modeling of its Y, L in L, G an Q, Luo L, Tang X, L iu J. Imaging and
spike protein for risk of human transmission. Sci clinical features of patients with 2019 novel coro-
China Life Sci 2020. Doi: 10.1007/s11427-020- navirus SARS-CoV-2. Eur J Nucl Med Mol Imag-
1637-5. ing 2020; 47: 1275-1280.
4527L. Hu, C. Wang
18) Pan Y, Guan H, Zhou S, Wang Y, L i Q, Zhu T, Hu 30) Han R, Huang L, Jiang H, Dong J, Peng H, Zhang
Q, Xia L. Initial CT findings and temporal chang- D. Early clinical and CT manifestations of Coro-
es in patients with the novel coronavirus pneumo- navirus disease 2019 (COVID-19) pneumonia.
nia (2019-nCoV): a study of 63 patients in Wuhan, AJR Am J Roentgenol 2020: 1-6. Doi: 10.2214/
China. Eur Radiol 2020. doi: 10.1007/s00330- AJR.20.22961. [Epub ahead of print].
020-06731-x. [Epub ahead of print]. 31) Xia W, Shao J, Guo Y, Peng X, L i Z, Hu D.
19) Pan F, Ye T, Sun P, Gui S, L iang B, L i L, Zheng D, Clinical and CT features in pediatric patients
Wang J, Hesketh RL, Yang L, Zheng C. Time course with COVID-19 infection: different points from
of lung changes on chest CT during recovery adults. Pediatr Pulmonol 2020. Doi: https://doi.
from 2019 Novel Coronavirus (COVID-19) pneu- org/10.1002/ppul.24718.
monia. Radiology 2020: 200370. 32) Qin C, L iu F, Yen TC, L an X. (18)F-FDG PET/CT
20) Yoon SH, Lee K H, K im JY, L ee YK, Ko H, K im K H, findings of COVID-19: a series of four highly sus-
Park CM, K im YH. Chest radiographic and CT pected cases. Eur J Nucl Med Mol Imaging 2020;
findings of the 2019 Novel Coronavirus disease 47: 1281-1286.
(COVID-19): analysis of nine patients treated in 33) L iu D, L i L, Wu X, Zheng D, Wang J, Yang L, Zheng
Korea. Korean J Radiol 2020; 21: 494-500. C. Pregnancy and perinatal outcomes of women
21) Bernheim A, Mei X, Huang M, Yang Y, Fayad Z A, with Coronavirus disease (COVID-19) pneumo-
Zhang N, Diao K, L in B, Zhu X, L i K, L i S, Shan H, nia: a preliminary analysis. AJR Am J Roentgenol
Jacobi A, Chung M. Chest CT findings in Corona- 2020: 1-6.
virus disease-19 (COVID-19): relationship to dura- 34) Zhao W, Zhong Z, Xie X, Yu Q, L iu J. Relation be-
tion of infection. Radiology 2020: 200463. tween chest CT findings and clinical conditions
22) L i W, Cui H, L i K, Fang Y, L i S. Chest computed to- of coronavirus disease (COVID-19) pneumonia:
mography in children with COVID-19 respirato- a multicenter study. AJR Am J Roentgenol 2020:
ry infection. Pediatr Radiol 2020. Doi: 10.1007/ 1-6.
s00247-020-04656-7. [Epub ahead of print]. 35) Wang Y, Dong C, Hu Y, L i C, Ren Q, Zhang X, Shi H,
23) Xu YH, Dong JH, A n WM, Lv XY, Yin XP, Zhang Zhou M. Temporal changes of CT findings in 90
JZ, Dong L, M a X, Zhang HJ, G ao BL. Clinical and patients with COVID-19 pneumonia: a longitudinal
computed tomographic imaging features of novel study. Radiology 2020: 200843.
coronavirus pneumonia caused by SARS-CoV-2. 36) Dai WC, Zhang HW, Yu J, Xu H J, Chen H, Luo SP,
J Infect 2020; 80: 394-400. Zhang H, L iang LH, Wu L, L ei Y, L in F. CT Imaging
24) Yang W, C ao Q, Qin L, Wang X, Cheng Z, Pan A, Dai and differential diagnosis of COVID-19. Can As-
J, Sun Q, Zhao F, Qu J, Yan F. Clinical characteris- soc Radiol J 2020: 846537120913033.
tics and imaging manifestations of the 2019 nov- 37) Franquet T. Imaging of pulmonary viral pneumo-
el coronavirus disease (COVID-19): a multi-center nia. Radiology 2011; 260: 18-39.
study in Wenzhou city, Zhejiang, China. J Infect 38) Hansell DM, Bankier AA, M acM ahon H, McLoud T
2020; 80: 388-393. C, Muller N L, Remy J. Fleischner Society: glossa-
25) Hu Z, Song C, Xu C, Jin G, Chen Y, Xu X, Ma H, Chen ry of terms for thoracic imaging. Radiology 2008;
W, Lin Y, Zheng Y, Wang J, Hu Z, Yi Y, Shen H. Clinical 246: 697-722.
characteristics of 24 asymptomatic infections with 39) Holshue ML, DeBolt C, L indquist S, Lofy KH, Wies-
COVID-19 screened among close contacts in Nan- man J, Bruce H, Spitters C, Ericson K, Wilkerson S,
jing, China. Sci China Life Sci 2020; doi: 10.1007/ Tural A, Diaz G, Cohn A, Fox L, Patel A, Gerber SI,
s11427-020-1661-4. [Epub ahead of print]. K im L, Tong S, Lu X, L indstrom S, Pallansch MA, Wel-
26) Cheng Z, Lu Y, C ao Q, Qin L, Pan Z, Yan F, Yang W. don WC, Biggs H M, U yeki TM, Pillai SK. First case
Clinical features and chest CT manifestations of of 2019 novel coronavirus in the United States. N
Coronavirus disease 2019 (COVID-19) in a sin- Engl J Med 2020; 382: 929-936.
gle-center study in Shanghai, China. AJR Am J 40) Reali F, Sferrazza Papa G F, C arlucci P, Fracasso P,
Roentgenol 2020: 1-6. Di M arco F, M andelli M, Soldi S, Riva E, Centanni S.
27) Xiong Y, Sun D, Liu Y, Fan Y, Zhao L, Li X, Zhu Can lung ultrasound replace chest radiography
W. Clinical and high-resolution CT features of the for the diagnosis of pneumonia in hospitalized
COVID-19 infection: comparison of the initial and fol- children? Respiration 2014; 88: 112-115.
low-up changes. Invest Radiol 2020. doi: 10.1097/ 41) Buonsenso D, P iano A, R affaelli F, B onadia N, de
RLI.0000000000000674. [Epub ahead of print]. G aetano D onati K, Franceschi F. Point-of-care
28) L i Y, Xia L. Coronavirus disease 2019 (COVID-19): lung ultrasound findings in novel coronavirus
role of chest CT in diagnosis and management. disease-19 pnemoniae: a case report and po-
AJR Am J Roentgenol 2020: 1-7. Doi: 10.2214/ tential applications during COVID-19 outbreak.
AJR.20.22954. [Epub ahead of print]. Eur Rev Med Pharmacol Sci 2020; 24: 2776-
29) Zhou S, Wang Y, Zhu T, Xia L. CT features of Coro- 2780.
navirus disease 2019 (COVID-19) pneumonia in 42) K alra M K, M aher M M, Rizzo S, K anarek D, Shep -
62 patients in Wuhan, China. AJR Am J Roentge- ard J A. Radiation exposure from chest CT: issues
nol 2020: 1-8. Doi: 10.2214/AJR.20.22975. [Epub and strategies. J Korean Med Sci 2004; 19: 159-
ahead of print]. 166.
4528You can also read
