Temporal Changes of CT Findings in 90 Patients with COVID-19 Pneumonia: A Longitudinal Study

Background CT may play a central role in the diagnosis and management of COVID-19 pneumonia. Purpose To perform a longitudinal study to analyze the serial CT findings over time in patients with COVID-19 pneumonia. Materials and Methods During January 16 to February 17, 2020, 90 patients (male:female, 33:57; mean age, 45 years) with COVID-19 pneumonia were prospectively enrolled and followed up until they were discharged or died, or until the end of the study. A total of 366 CT scans were acquired and reviewed by 2 groups of radiologists for the patterns and distribution of lung abnormalities, total CT scores and number of zones involved. Those features were analyzed for temporal change. Results CT scores and number of zones involved progressed rapidly, peaked during illness days 6-11 (median: 5 and 5), and followed by persistence of high levels. The predominant pattern of abnormalities after symptom onset was ground-glass opacity (35/78 [45%] to 49/79 [62%] in different periods). The percentage of mixed pattern peaked (30/78 [38%]) on illness days 12-17, and became the second most predominant pattern thereafter. Pure ground-glass opacity was the most prevalent sub-type of ground-glass opacity after symptom onset (20/50 [40%] to 20/28 [71%]). The percentage of ground-glass opacity with irregular linear opacity peaked on illness days 6-11 (14/50 [28%)]) and became the second most prevalent subtype thereafter. The distribution of lesions was predominantly bilateral and subpleural. 66/70 (94%) patients discharged had residual disease on final CT scans (median CT scores and zones involved: 4 and 4), with ground-glass opacity (42/70 [60%]) and pure ground-glass opacity (31/42 [74%]) the most common pattern and subtype. Conclusion The extent of lung abnormalities on CT peaked during illness days 6-11. The temporal changes of the diverse CT manifestations followed a specific pattern, which might indicate the progression and recovery of the illness.

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