The role of chest imaging in the diagnosis, management, and monitoring of coronavirus disease 2019 (COVID-19)

Abstract

Coronavirus disease 2019 (COVID-19) pandemic has posed a major public health crisis all over the world. The role of chest imaging, especially computed tomography (CT), has evolved during the pandemic paralleling the accumulation of scientific evidence. In the early stage of the pandemic, the performance of chest imaging for COVID-19 has widely been debated especially in the context of comparison to real-time reverse transcription polymerase chain reaction. Current evidence is against the use of chest imaging for routine screening of COVID-19 contrary to the initial expectations. It still has an integral role to play, however, in its work up and staging, especially when assessing complications or disease progression. Chest CT is gold standard imaging modality for COVID-19 pneumonia; in some situations, chest X-ray or ultrasound may be an effective alternative. The most important role of radiologists in this context is to be able to identify those patients at greatest risk of imminent clinical decompensation by learning to stratify cases of COVID-19 on the basis of radiologic imaging in the most efficient and timely fashion possible. The present availability of multiple and more refined CT grading systems and classification is now making this task easier and thereby contributing to the recent improvements achieved in COVID-19 treatment and outcomes. In this article, evidence of chest imaging regarding diagnosis, management and monitoring of COVID-19 will be chronologically reviewed.

Impact of COVID-19 Pandemic on the Workload of Diagnostic Radiology: A 2-Year Observational Study in a Tertiary Referral Hospital

“…In this situation, CT scan became valuable to determine whether the patient really had interstitial pneumonia or was symptomatic for other causes unrelated to the infection. CT imaging was also largely used to stratify patients based on the extent of the pulmonary involvement and the presence of complications, such as superinfection or pulmonary thromboembolism (26,27). In a setting of overcrowding in the ED and shortage of intensive care beds, mechanical ventilation devices and oxygen, it was essential to discriminate between patients needing hospital admission, or at least close monitoring in a protected medical environment, and patients that could be discharged for home follow-up.…”

Computed Tomographic Imaging Features of COVID-19 Pneumonia Caused by the Delta (B.1.617.2) and Omicron (B.1.1.529) Variant in a German Nested Cohort Pilot Study Group

“…Chest CT plays a crucial role in COVID-19 infection diagnostics [ 15 ], although real-time reverse transcriptase polymerase chain reaction (RT-PCR) testing is considered the gold standard for the diagnosis of COVID-19 infection [ 16 ]. However, especially in the early phase of the pandemic, CT examination has played an important role for the triage at emergency departments, when the use of RT-PCR was limited because of logistical issues such as the development, mass production, and distribution of the examination kit [ 17 ]. In addition, in some cases, interpretation of chest CT can accelerate diagnosis.…”

Challenges in COVID-19 Chest X-Ray Classification: Problematic Data or Ineffective Approaches?

“…Nevertheless, the limited number of tests and high rate of false negatives i.e. 100% false negative on infection day, which decreases to 38% on day 5 when first symptoms appear, gave radiographers ground to define chest imaging, not as a routine screening standard, but as an integral tool for assessing complications and disease progression (Inui et al, 2021). Chest imaging is especially necessary for symptomatic patients that develop pneumonia, which is characterized by an increase in lung density due to inflammation and fluid in the lungs (Cleverley et al, 2020).…”