Visual and Quantitative Assessment of COVID-19 Pneumonia on Chest CT: The Relationship with Disease Severity and Clinical Findings

Abstract

Background: Lungs are the primary organ of involvement of COVID-19, and the severity of pneumonia in COVID-19 patients is an important cause of morbidity and mortality. Aim: We aimed to evaluate the visual and quantitative pneumonia severity on chest computed tomography (CT) in patients with coronavirus disease 2019 (COVID-19) and compare the CT findings with clinical and laboratory findings. Methods: We retrospectively evaluated adult COVID-19 patients who underwent chest CT, clinical scores, laboratory findings, and length of hospital stay. Two independent radiologists visually evaluated the pneumonia severity on chest CT (VSQS). Quantitative CT (QCT) assessment was performed using a free DICOM viewer, and the percentage of the well-aerated lung (%WAL), high-attenuation areas (%HAA) at different threshold values, and mean lung attenuation (MLA) values were calculated. The relationship between CT scores and the clinical, laboratory data, and length of hospital stay were evaluated in this cross-sectional study. The student's t-test and chi-square test were used to analyze the differences between variables. The Pearson correlation test analyzed the correlation between variables. The diagnostic performance of the variables was assessed using receiver operating characteristic (ROC) analysis was used. Results: The VSQS and QCT scores were significantly correlated with procalcitonin, d-dimer, ferritin, and C-reactive protein levels. Both VSQ and QCT scores were significantly correlated with disease severity (p<0.001). Among the QCT parameters, the %HAA-600 value showed the best correlation with the VSQS (r=730,p<0.001). VSQS and QCT scores had high sensitivity and specificity in distinguishing disease severity and predicting prolonged hospitalization. Conclusion: The VSQS and QCT scores can help manage the COVID-19 and predict the duration of hospitalization.

Prevalence and prognostic role of thoracic lymphadenopathy in Covid-19

“…In total, 21 studies were included in the analysis 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 .…”

COVID-19 pneumonia: lessons learned, challenges, and preparing for the future

“…In semiquantitative evaluation, each lung lobe’s involvement percentage is calculated visually, and the pneumonia severity score of the whole lung is determined by summing up the involvement rates. 5 , 46 Quantitative CT evaluation is a method that provides an objective and rapid assessment of COVID-19 pneumonia extent and predicts patient prognosis 47 - 49 ( Figure 3 ). Ufuk et al 46 demonstrated that pneumonia severity was an independent predictor of prolonged hospitalization (adjusted odds ratio [OR]: 1.20, P < .001), intubation (OR: 1.73, P < .001), and death (OR: 2.13, P = .026).…”

“…Ufuk et al 46 demonstrated that pneumonia severity was an independent predictor of prolonged hospitalization (adjusted odds ratio [OR]: 1.20, P < .001), intubation (OR: 1.73, P < .001), and death (OR: 2.13, P = .026). Kaya et al 47 reported that quantitative CT assessment had high sensitivity and specificity in distinguishing disease severity and predicting prolonged hospitalization. Salvatore et al 50 reported that an overall pneumonia severity score of ≥50% indicates a poor prognosis.…”

Evaluation of hospitalized patients with a possible diagnosis of COVID-19

“…Computed tomography (CT) is an essential diagnostic criterion as well as for follow-up of the disease, especially in RT-PCR negative patients, who typically present a bilateral groundglass view in lower zones with multiple foci and peripheral or subpleural patch-like consolidation areas [3][4][5].…”