The progression of computed tomographic (CT) images in patients with coronavirus disease (COVID-19) pneumonia
Authors: Pinggui Lei, Bing Fan, Jujiang Mao, Jiangping Wei, Pingxian Wang
Journal: Journal of Infection (2020)

•Of the 49 patients, 89.8% (44/49) patients had a typical transition from early stage to advanced stage, and then from advanced stage to dissipating stage.•With the evidence of fibrosis for progression of CT results, 42.9% (21/49) patients developed fibrosis whereas 57.1% (28/49) patients demonstrated no definite fibrosis.•Patients with fibrosis in follow CT were older (mean age, 45.4 vs. 33.8 years), with longer LOS (19.1 vs. 15.0 days), and higher rate of ICU admission (19.0% [4/21] vs. 3.6% [1/28]) than that of those without fibrosis. We read with interest the recent papers in Journal of Infection by Chen who described clinical progression of patients with COVID-19 in Shanghai, China1.Chen Jun Qi Tangkai Liu Li et al.Clinical progression of patients with COVID-19 in Shanghai, china.J Infection. 2020; https://doi.org/10.1016/j.jinf.2020.03.004Abstract Full Text Full Text PDF Scopus (539) Google Scholar. The radiological manifestations in disease progression they got were that radiological aggravation of initial image was observed in 65.7% (163/248) of patients on day 7 after onset of symptoms, 94.5% (154/163) of patients showed radiological improvement on day 141.Chen Jun Qi Tangkai Liu Li et al.Clinical progression of patients with COVID-19 in Shanghai, china.J Infection. 2020; https://doi.org/10.1016/j.jinf.2020.03.004Abstract Full Text Full Text PDF Scopus (539) Google Scholar, which means that the patients had a typical transition from early stage to advanced stage, and then from advanced stage to dissipating stage. We would like to share the progression of computed tomographic (CT) images in patients with COVID-19 pneumonia in our hospital after hospital discharge. Actually, pulmonary fibrosis may develop early in patients with COVID-19 pneumonia after hospital discharge. However, the older patients with severe illness were more prone to develop fibrosis during treatment. Recently, study on the early transmission dynamics had been reported that human-to-human was the epidemiologic characteristics for COVID-19 infection2.Li Q. Guan X. Wu P. et al.Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia.N Engl J Med. 2020; https://doi.org/10.1056/NEJMoa2001316Crossref Scopus (10588) Google Scholar. Until Mar. 14, 2020, the World Health Organization (WHO) reported 1,42,539 confirmed cases (9769 new) globally, and 5393 deaths (438 new) in 135 countries (13 new) (including China, Korea, Japan, USA, Canada, Italy, Iran, Thailand, Brazil, Algeria, etc.), and COVID-19 infection had been almost prevalent all around the world3.World Health Organization (WHO). Coronavirus disease (COVID-2019) situation reports-54. 2020. (https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/).Google Scholar. This is global public health problem, we should pay more attention to current situation of COVID-19 infection. However, the progress of the disease after the treatment and discharge of the patient was rarely reported, and it is unclear whether there is a residual focus or fibrosis. Here we reported forty-nine patients (27 males, 22 females; mean age: 41 years, range: 25–70 years) who were performed follow CT to evaluate the progression of COVID-19 pneumonia. The average CT follow-up time is 30.5 days (range, 24 to 38 days) after the initial hospital admission and 15.8 days after discharge (range, 7–25 days). The CT features were evaluated by two experienced radiologists in consensus, the CT characteristics include ground-glass opacities, interstitial thickening, and consolidation, and fibrosis (parenchymal band, traction bronchiectasis, and irregular interfaces). The demographics, length of stay (LOS) in hospital, and rate of intensive care unit (ICU) were also analyzed to evaluate the progression. The results suggested that 89.8% (44/49) of patients had a typical transition from early stage to advanced stage and advanced stage to dissipating stage (Fig. 1), 42.9% (21/49) of patients with the evidence fibrosis in follow CT examination whereas 57.1% (28/49) of patients without the definite fibrosis. The age of patients with fibrosis in follow CT was older than that of those who without fibrosis (mean age, 45.4 vs. 33.8 years, P < 0.05), the LOS of patients with fibrosis was longer than that of patients without fibrosis (19.1 vs. 15.0 days, P < 0.05), and percentage of patients with fibrosis in ICU was higher than that of those who without fibrosis (19.0% vs. 3.6%, P = 0.08). That is to say, Patients with fibrosis in follow CT were older, with longer LOS, higher rate of ICU admission than that of those who without fibrosis. Ground-glass opacities and consolidation were observed in the follow CT. However, in the early stage, the manifestations of single or multiple ground-glass opacities were observed and distributed along the bronchovascular or subpleural in the pulmonary parenchyma, higher density consolidations were presented in the advanced stage, and ground-glass opacities and consolidations were absorbed in dissipating stage. Previous study had suggested that the CT findings were various at different stages of COVID-19 infection4.Pan F. Ye T. Sun P. et al.Time course of lung changes on chest ct during recovery from 2019 novel coronavirus (COVID-19) pneumonia.Radiology. 2020; 200370https://doi.org/10.1148/radiol.2020200370Crossref PubMed Scopus (1847) Google Scholar,5.Shi H. Han X. Jiang N. et al.Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study.Lancet Infect Dis. 2020; https://doi.org/10.1016/S1473-3099(20)30086-4Abstract Full Text Full Text PDF Scopus (2553) Google Scholar. Particularly, more ground-glass opacities and less consolidation were the principal manifestation in the CT images (CT scans before onset of symptoms or CT scans done ≤ 1 week after onset of symptom). Ground-glass opacities were decreased with increasing the stages of COVID-19 pneumonia. However, the consolidation or ground-glass opacities mixed consolidation increased, and reticular was demonstrated in the later stages (scan > 1 week after symptom onset)5.Shi H. Han X. Jiang N. et al.Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study.Lancet Infect Dis. 2020; https://doi.org/10.1016/S1473-3099(20)30086-4Abstract Full Text Full Text PDF Scopus (2553) Google Scholar. In our present study, the evolution of CT manifestations was familiar to the previous literature. In conclusion, the patients with COVID-19 pneumonia had a typical transition from early stage to advanced stage and advanced stage to dissipating stage. The manifestations of single or multiple ground-glass opacities were observed and distributed along the bronchovascular or subpleural in the pulmonary parenchyma in the early stage, higher density consolidations were presented in the advanced stage, and ground-glass opacities and consolidations were absorbed in dissipating stage. However, the patients with fibrosis in follow CT were older, with longer LOS, higher rate of ICU admission than that of those who without fibrosis.