par John R. Fischer
, Senior Reporter | February 06, 2020
The initial CT assessed each patient for the following:
• presence of ground-glass opacities
• presence of consolidation
• number of lobes affected by ground-glass or consolidative opacities
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• degree of lobe involvement, in addition to overall lung “total severity score”
• presence of nodules
• presence of a pleural effusion
• presence of thoracic lymphadenopathy (lymph nodes of abnormal size or morphology)
• presence of underlying lung disease such as emphysema or fibrosis
The analysis found that the virus appears on CT scans with bilateral ground-glass and consolidative pulmonary opacities. Other findings that may be helpful for early diagnosis are nodular opacities, crazy-paving pattern, and a peripheral distribution of the disease. In addition, lung cavitation, discrete pulmonary nodules, pleural effusions and lymphadenopathy are characteristically absent in cases of 2019-nCoV.
Follow-up imaging in seven of eight patients showed increasing extent and density of airspace opacities, signifying mild or moderate progression of the disease. Chung and Bernheim warn, however, that CT alone is not enough to rule out the presence of the virus, as one of three patients who had a normal initial chest CT progressed three days later and developed a solitary nodular ground-glass lesion in the right lower lobe. They say this pattern may represent the very first radiologically visible manifestation of the disease in some patients.
A second patient, in contrast, had a normal follow-up chest CT four days after receiving a normal initial imaging exam. Such findings, they say, may be due to the infection being characterized by an incubation period of several days, and there may be a phase where the viral infection exhibits symptoms prior to visible abnormalities on CT.
“While CT imaging serves as a powerful screening tool, especially in the center of the epidemic, the gold standard for diagnosis is the laboratory tests that are performed by clinicians,” they said.
Further study is required to understand how patients fare after treatment. Experience and imaging findings from the MERS and SARS epidemics may help to address the current outbreak, say Chung and Bernheim.
Any other thoracic abnormalities found in each were also noted.
The findings were published in the journal, Radiology
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