Clinico-Radiological Evaluation and Correlation of CT Chest Images with Progress of Disease in COVID-19 Patients.

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Clinico-Radiological Evaluation and Correlation of CT Chest Images with Progress of Disease in COVID-19 Patients.

J Assoc Physicians India. 2020 Jul;68(7):34-42

Authors: Bhandari S, Rankawat G, Bagarhatta M, Singh A, Singh A, Gupta V, Sharma S, Sharma R

Purpose: The present study was undertaken to investigate and quantify the severity of COVID-19 infection on high-resolution chest computed tomography (CT) and to determine its relationship with clinical parameters. This study also aimed to see CT changes with clinical recovery or progression of disease.
Materials and methods: In an attempt to provide extensive information pertaining to clinical and radiological characteristics of COVID-19, the present study was undertaken in 80 hospitalized patients. The patients were COVID-19 confirmed positive by genomic analysis through RT-PCR at tertiary care center in Jaipur. Initially all patients were evaluated for their clinical parameters and then correlated with HRCT chest after hospitalization. CT findings correlated with duration of disease to assess progress or recovery.
Results: A total of 80 patients of laboratory confirmed COVID-19 test by RT-PCR at SMS Hospitals, Jaipur were assessed. Among the confirmed cases, most of patients were young adults in the fifth and sixth decade of age group with mean age of 50.40 years. There was a male preponderance (59% male and 41% female). Out of total analyzed patients, 39 patients (48.75%) were symptomatic, among them fever (79.47%), cough (74.35%), shortness of breath (36%) and sore throat (17.94%) were the most common presenting clinical manifestations. A few patients (12.82%) also had other symptoms like headache, chest pain, pain abdomen, altered sensorium etc. 54% patients had some underlying co morbid disease in sample population. The most prevalent comorbidities were Diabetes mellitus (56%), Hypertension (48.83%), COPD/K-chest (12%), CAD (9.32%) and others (11.62%) like hypothyroidism, anemia, CVA etc. The lung pathological changes were evaluated by HRCT imaging and by assigning CT severity score. We found Typical COVID findings in 50% patients, Indeterminate in 11%, Atypical in 11% and 28% patients had Negative CT chest for COVID. The clinical status of patients correlated with the CT severity score, with mild cases showing score <15/25 in 45.83% patients and severe cases showing CT severity score >15/25 in 87.50% patients. The CT features varied with duration and course of disease. Proportional GGO was higher (59.37%) in early phase and it was lower (12.5%) in later stage of disease.
Conclusion: The varied spectra of COVID-19 presentation included fever, cough, shortness of breath, sore throat etc. Diabetes mellitus, hypertension, COPD/K-Chest and CAD were found as major comorbid conditions. Symptomatic presentation of COVID-19 was observed to be higher in patients with co morbid disease, especially if multiple. HRCT chest in COVID-19 patients had a major diagnostic and prognostic importance as positive CT findings were more prominent in symptomatic patients and co-morbid patients. Clinical symptoms of patients directly correlated with CT severity index. CT imaging was found to be useful in predicting clinical recovery of patients or progression of disease.

PMID: 32602679 [PubMed - as supplied by publisher]

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