Chest X-ray findings in a large cohort of 1117 patients with SARS-CoV-2 infection: a multicenter study during COVID-19 outbreak in Italy

Abstract

To describe radiographic key patterns on Chest X-ray (CXR) in patients with SARS-CoV-2 infection, assessing the prevalence of radiographic signs of interstitial pneumonia. To evaluate pattern variation between a baseline and a follow-up CXR. 1117 patients tested positive for SARS-CoV-2 infection were retrospectively enrolled from four centers in Lombardy region. All patients underwent a CXR at presentation. Follow-up CXR was performed when clinically indicated. Two radiologists in each center reviewed images and classified them as suggestive or not for interstitial pneumonia, recording the presence of ground-glass opacity (GGO), reticular pattern or consolidation and their distribution. Pearson’s χ2 test for categorical variables and McNemar test (χ2 for paired data) were performed. Patients mean age 63.3 years, 767 were males (65.5%). The main result is the large proportion of positive CXR in COVID-19 patients. Baseline CXR was positive in 940 patients (80.3%), with significant differences in age and sex distribution between patients with positive and negative CXR. 382 patients underwent a follow-up CXR. The most frequent pattern on baseline CXR was the GGO (66.1%), on follow-up was consolidation (53.4%). The most common distributions were peripheral and middle-lower lung zone. We described key-patterns and their distribution on CXR in a large cohort of COVID-19 patients: GGO was the most frequent finding on baseline CXR, while we found an increase in the proportion of lung consolidation on follow-up CXR. CXR proved to be a reliable tool in our cohort obtaining positive results in 80.3% of the baseline cases.

Descriptive analysis of a comparison between lung ultrasound and chest radiography in patients suspected of COVID-19

“…The recommendation to limit the use of CT studies in the time of a pandemic surge is also supported by societal guidelines [4,5]. Lung ultrasound (LUS) and chest radiography (CXR) are valid alternatives to be applied in the frontline [1,[6][7][8][9][10][11][12][13][14]. Particularly, LUS demonstrated highly feasible and sensitive for COVID-19 pneumonia, with a specificity that increases during the peaks of prevalence [15].…”

A Pictorial Review of the Role of Imaging in the Detection, Management, Histopathological Correlations, and Complications of COVID-19 Pneumonia

“…Chest computed tomography (CT) and chest radiography (chest X-ray, CXR) are the imaging modalities generally performed to detect lung abnormalities in early infection, and to assess the severity and monitor the progression of COVID-19 pneumonia [ 25 , 26 ]. CT has been mainly used for diagnosing COVID-19 pneumonia [ 27 , 28 , 29 ].…”

“…CT has been mainly used for diagnosing COVID-19 pneumonia [ 27 , 28 , 29 ]. This is due to the experience of China, where access to CT was relatively easy at the outbreak of the pandemic [ 28 ], and the low sensitivity of CXR in revealing pulmonary involvement, particularly in the early stage of the disease [ 25 , 27 ]. Using RT-PCR as the gold standard, the sensitivity of CRX, which depends not only on the disease stage, but also on its severity, the prevalence of COVID-19 in the area, and the expertise of radiologists, with possible support of artificial intelligence (AI), differs widely from 41.7 to 90% and is still lower than CT (60 to 98%) [ 30 , 31 , 32 ].…”

“…Furthermore, the effective dose (mSv) is lower for CXR than CT [ 38 ]. Therefore, some limitations including higher ionizing radiation exposure for CT than CRX, as well as the restricted availability of dedicated CT scanners, difficulties in speeding up CT room sanitization, the risk of transmitting SARS-CoV2 infection during patient transfer to the CT room, and the complexity of transporting unstable patients reduce the predominance of CT over CXR [ 11 , 23 , 25 , 35 ]. Moreover, the rise in radiological examinations that comes with the increase in hospitalized patients makes the continuous use of chest CT throughout the course of the disease problematic [ 26 ].…”

“…In addition, the American College of Radiology (ACR) noted that CT room decontamination after scanning patients with COVID-19 may disrupt the availability of radiological services and suggested that portable CXR might be considered the optimal tool to minimize the risk of cross-infection [ 23 ]. Therefore, European hospitals, particularly in Italy and Great Britain ( Table 1 ), are beginning to employ CXR (bedside or standard) as the first radiological modality in patients presenting with respiratory distress and possible COVID-19 and for monitoring the evolution of lung abnormalities, particularly in critically ill patients admitted to the ICU, where CXR can also be used to evaluate chest tube positioning ( Figure 1 ) [ 12 , 13 , 23 , 25 , 27 , 35 ].…”