Lung Parenchymal Findings and Their Evaluation in Unenhanced Thin-section Chest CT Performed for COVID-19 Suspicion, Initial Assessment and Follow-up. Literature Review and Analysis.
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Date
2021
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Krūškurvja CT ir viens no galvenajiem klīnisko instrumentu ārstiem, ārstējot 2019. gada koronavīrusa slimību (COVID-19). To var izmantot, lai noteiktu diagnozi un atklātu komplikācijas COVID-19 pacientiem. Tā kā COVID-19 pneimonija ir salīdzinoši jauna slimība, ir svarīgi definēt tās klīniskās izpausmes, lai klīnicisti tās atpazītu un pacienti saņemtu precīzu diagnozi ar pareizu ārstēšanu. Šī literatūras pārskata mērķis ir secināt visbiežāk sastopamos krūškurvja CT atklājumus COVID -19 pneimonija, apkopojot 38 oriģinālu gadījumu pētījumu rezultātus. Turklāt pārskats izceļ visbiežāk sastopamās attēlveidošanas izpausmes, kas konstatētas dažādās slimības stadijās, parādot katram posmam raksturīgās izpausmes. Turklāt rezultāti tiek klasificēti pēc to parādīšanas biežuma, kuras izpausmes ir visizplatītākās, un tāpēc tām ir lielāka ietekme uz diagnozi un prognozi. Tā mērķis ir arī parādīt, kuras izpausmes notiek retāk, bet joprojām ir ievērības cienīgas komplikāciju kontekstā. Šī pētījuma galvenais secinājums ir tāds, ka apstiprinātos gadījumos COVID-19 pneimonijas tipiskās izpausmes ir divpusējas slīpētas stikla opacifikācijas (GGO) perifērās un aizmugures sadalījums, ko papildina plaušu asinsvadu palielināšanās un gaisa bronhogrammas. Pēc tam pārskats parāda, ka COVID-19 agrīnās stadijas pneimonijas pacientiem perifērā izplatībā parasti ir vieni vai vairāki vienpusēji GGO, ar mazāku iesaistīto plaušu segmentu skaitu, salīdzinot ar slimības vēlākajām stadijām. Visbeidzot, pārskatā secināts, ka pīķa laikā un konsolidācijas stadijā konsolidācija ar perifēro-centrālo sadalījumu ir visizplatītākā attēlveidošanas izpausme un ka atveseļojušiem pacientiem bieži tiek novērota plaušu fibroze. Tas arī parāda, ka plaušu iesaistīšanās palielinās, progresējot slimībai, un ka lielākajai daļai pacientu ir progresējoša radiogrāfiskā pasliktināšanās, kam seko pakāpeniska radiogrāfiskā uzlabošanās. Šis pārskats arī norāda, ka noteiktu vēlīnās stadijas pazīmju klātbūtni, piemēram, balto plaušu parādīšanos vai plaušu fibrozi, varētu izmantot, lai novērtētu, vai pacients progresē vai atveseļojas. Secinot no tā, slimības progresēšanas laikā notiek COVID-19 attēlveidošanas izpausmju evolūcija. Lai gan agrīnās stadijas raksturo tīru GGO pārsvars, bieži vien ar vienpusēju perifēro sadalījumu vēlīnās stadijās dominē konsolidācija, kas abās plaušās sadalīta perifēriski centrālā veidā. Lai gan tas nebija šī pārskata mērķis, manuprāt, šis literatūras pārskats arī precizē krūšu kurvja CT lomu klīnicistiem COVID-19 kontekstā. Tas norāda, ka krūšu kurvja CT ir daudz noderīgāka komplikāciju noteikšanā, jo tā nav tik specifiska un jutīga kā reversās transkriptāzes polimerāzes ķēdes reakcija (RT-PCR). Tas ir saistīts ar faktu, ka asimptomātiski pacienti var parādīties bez jebkādām attēlveidošanas patoloģijām.
Chest CT is one of the main clinical tools for clinicians when dealing with coronavirus disease 2019 (COVID-19) pneumonia. It can be used to establish a diagnosis and to detect complications in COVID-19 patients. Since, COVID-19 pneumonia is a relatively new disease it is important to define its clinical manifestations so that clinicians will recognize them and patients will receive an accurate diagnosis with correct treatment.This literature review aims to conclude the most frequent chest CT findings in COVID-19 pneumonia by summarizing the results of 38 original case studies. Furthermore, the review highlights the most frequent imaging manifestations found in different stages of the disease, showing the typical manifestations for each stage. Moreover, results are categorized by their respective frequencies to show, which manifestations are the most prevalent and therefore have greater impact on the diagnosis and prognosis. It also aims to show, which manifestations occur less frequent but are still noteworthy in the context of complications.The main finding of this study is that the typical manifestations of COVID-19 pneumonia in confirmed cases are bilateral ground glass opacifications (GGOs) in peripheral and posterior distribution accompanied by pulmonary vascular enlargement and air bronchograms. Next, the review shows that early stage COVID-19 pneumonia patients typically present with single or multiple unilateral GGOs in peripheral distribution, with a lower number of involved lung segments compared to the later stages of the disease. Lastly, the review concludes, that in the peak and in the consolidation stage, consolidation with peripheral-central distribution is the most frequent imaging manifestation and that in recovering patients, pulmonary fibrosis is frequently observed. Also, it shows, that lung involvement increases as the disease progresses and that most patients have a progressive radiographic deterioration followed by gradual radiographic improvement. This review also indicates, that the presence of certain late stage signs, such as white lung appearance or pulmonary fibrosis, could be used to evaluate whether a patient is progressing or recovering. Concluding from this, as the disease progresses, an evolution of the imaging manifestations of COVID-19 occurs. While early stages are characterized by the predominance of pure GGOs, often with unilateral peripheral distribution the late stages are dominated by consolidation distributed in both lungs in a peripheral-central pattern. Although, it was not the aim of this review, in my opinion, this literature review also clarifies the role of chest CT for clinicians in the context of COVID-19. It indicates, that chest CT is more useful in the detection of complications, because it is not as specific and sensitive as reverse transcriptase polymerase chain reaction (RT-PCR). This is due to the fact, that asymptomatic patients can present without any imaging abnormalities.
Chest CT is one of the main clinical tools for clinicians when dealing with coronavirus disease 2019 (COVID-19) pneumonia. It can be used to establish a diagnosis and to detect complications in COVID-19 patients. Since, COVID-19 pneumonia is a relatively new disease it is important to define its clinical manifestations so that clinicians will recognize them and patients will receive an accurate diagnosis with correct treatment.This literature review aims to conclude the most frequent chest CT findings in COVID-19 pneumonia by summarizing the results of 38 original case studies. Furthermore, the review highlights the most frequent imaging manifestations found in different stages of the disease, showing the typical manifestations for each stage. Moreover, results are categorized by their respective frequencies to show, which manifestations are the most prevalent and therefore have greater impact on the diagnosis and prognosis. It also aims to show, which manifestations occur less frequent but are still noteworthy in the context of complications.The main finding of this study is that the typical manifestations of COVID-19 pneumonia in confirmed cases are bilateral ground glass opacifications (GGOs) in peripheral and posterior distribution accompanied by pulmonary vascular enlargement and air bronchograms. Next, the review shows that early stage COVID-19 pneumonia patients typically present with single or multiple unilateral GGOs in peripheral distribution, with a lower number of involved lung segments compared to the later stages of the disease. Lastly, the review concludes, that in the peak and in the consolidation stage, consolidation with peripheral-central distribution is the most frequent imaging manifestation and that in recovering patients, pulmonary fibrosis is frequently observed. Also, it shows, that lung involvement increases as the disease progresses and that most patients have a progressive radiographic deterioration followed by gradual radiographic improvement. This review also indicates, that the presence of certain late stage signs, such as white lung appearance or pulmonary fibrosis, could be used to evaluate whether a patient is progressing or recovering. Concluding from this, as the disease progresses, an evolution of the imaging manifestations of COVID-19 occurs. While early stages are characterized by the predominance of pure GGOs, often with unilateral peripheral distribution the late stages are dominated by consolidation distributed in both lungs in a peripheral-central pattern. Although, it was not the aim of this review, in my opinion, this literature review also clarifies the role of chest CT for clinicians in the context of COVID-19. It indicates, that chest CT is more useful in the detection of complications, because it is not as specific and sensitive as reverse transcriptase polymerase chain reaction (RT-PCR). This is due to the fact, that asymptomatic patients can present without any imaging abnormalities.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Krūškurvja CT atklājumi COVID-19 pneimonija, Chest CT findings in COVID-19 pneumonia