Chest CT findings of coronavirus disease 2019 (COVID-19): A comprehensive meta-analysis of 9907 confirmed patients

Abstract

We performed a systematic review and meta-analysis of the prevalence of chest CT findings in patients with confirmed COVID-19 infection. Methods: Systematic review of the literature was performed using PubMed, Scopus, Embase, and Google Scholar to retrieve original studies on chest CT findings of patients with confirmed COVID-19, available up to 10 May 2020. Data on frequency and distribution of chest CT findings were extracted from eligible studies, pooled and meta-analyzed using random-effects model to calculate the prevalence of chest CT findings. Results: Overall, 103 studies (pooled population: 9907 confirmed COVID-19 patients) were meta-analyzed. The most common CT findings were ground-glass opacities (GGOs) (77.18%, 95%CI = 72.23-81.47), reticulations (46.24%, 95%CI = 38.51-54.14), and air bronchogram (41.61%, 95%CI = 32.78-51.01). Pleural thickening (33.35%, 95%CI = 21.89-47.18) and bronchial wall thickening (15.48%, 95%CI = 8.54-26.43) were major atypical and airway findings. Lesions were predominantly distributed bilaterally (75.72%, 95%CI = 70.79-80.06) and peripherally (65.64%, 95%CI = 58.21-72.36), while 8.20% (95%CI = 6.30-10.61) of patients had no abnormal findings and pre-existing lung diseases were present in 6.01% (95%CI = 4.37-8.23). Conclusions: The most common CT findings in COVID-19 are GGOs with/without consolidation, reticulations, and air bronchogram, which often involve both lungs with peripheral distribution. However, COVID-19 might present with atypical manifestations or no abnormal findings in chest CT, which deserve clinicians' notice.

Pulmonary cavitations as an atypical CT finding in COVID-19 patients

“…2,3 Pleural thickening, nodules, pleural effusion, lymphadenopathy, cavitation and pneumothorax were identified as atypical findings of COVID-19 pneumonia. 1 Recently, we observed an increase in the incidence of cavitary lung lesions during COVID-19 pandemia in our hospital which operates as a pandemic hospital in the region. Cavitary lung lesions detected in COVID-19 cases have started to emerge as only a few case reports in the literature.…”

“… 2 , 3 Pleural thickening, nodules, pleural effusion, lymphadenopathy, cavitation and pneumothorax were identified as atypical findings of COVID-19 pneumonia. 1 …”

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We read with great interest the excellent paper by Zarifian et al entitled: "Chest CT findings of coronavirus disease 2019 (COVID-19): A comprehensive meta-analysis of 9907 confirmed patients" published in Clinical Imaging on February 2021. 1 In this article, the authors provided comprehensive and useful research on the typical and atypical chest computed tomography (CT) findings of novel coronavirus disease (COVID-19) pneumonia. In addition to the findings described in the article, we would like to contribute to the article on an important issue.Although radiological imaging findings are not used as a criterion in the diagnosis of COVID-19, thoracic imaging methods have been used as useful examinations in practice.

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Role of High Resolution Computed Tomography chest in the diagnosis and evaluation of COVID -19 patients -A systematic review and meta-analysis

“…The most common classical finding in thoracic CT of SARS-CoV-2 infected patients was Ground Glass Opacities [55]. Meta-analysis conducted by Zarifian A. et al [56] In our review, the overall incidence of crazy cave pattern is observed in 24.47 % COVID-19 patients, while the recent meta-analysis conducted by Bao C. et al [57], Zheng Y. et al [58] and Zhu J. et al [59] and Zhou X. et al [70] showed pooled percentages as 14.81 %, 24 %, [42] 305 35.6 % and 20 % respectively. Sub-pleural bands is another typical radiological feature in SARS-CoV-2 infections, and was observed as 55.61 %, in our review while the meta-analysis conducted by Zheng Y. et al 58 % of the patients developed sub-pleural bands during coronavirus disease [58].…”

Clinical Factors Associated with COVID-19 Severity in Mexican Patients: Cross-Sectional Analysis from a Multicentric Hospital Study

“…Computerized tomography (CT) has also become a major diagnostic and assessment tool, and it is now considered as a practical and reliable method in COVID-19 patients [ 22 , 23 ]. Typical radiologic findings include chest CT anomalies [ 24 , 25 ] (e.g., multifocal groundglass opacities with or without consolidation in lung regions close to visceral pleural surfaces, crazy paving, patterns compatible with organizing pneumonia, and thickened vessels with parenchymal abnormalities). Patients are assessed using the 1-5 scale COVID-19 Reporting and Data System (CO-RADS) to determine the likelihood of infection, with CO-RADS 4 and 5 considered to be diagnostic [ 26 ].…”