Chest computed tomography in COVID-19 pneumonia: a retrospective study of 155 patients at a university hospital in Rio de Janeiro, Brazil

Abstract Objective: To define diagnostic criteria for coronavirus disease 2019 (COVID-19) on computed tomography (CT); to study the correlation between CT and polymerase chain reaction (PCR) testing for infection with severe acute respiratory syndrome coronavirus 2; and to determine whether the extent of parenchymal involvement and the need for mechanical ventilation are associated with the CT findings and clinical characteristics of patients with COVID-19. Materials and Methods: This was a retrospective study of 155 patients with COVID-19 treated between March and May 2020. We attempted to determine whether the CT findings correlated with age and clinical variables, as well as whether the need for mechanical ventilation correlated with the extent of the pulmonary involvement. Results: On average, the patients with COVID-19 were older than were those without (mean age, 54.8 years vs. 45.5 years; p = 0.031). The most common CT finding (seen in 88.6%) was ground-glass opacity, which correlated significantly with a diagnosis of COVID-19 (p = 0.0001). The CT findings that correlated most strongly with the need for mechanical ventilation were parenchymal bands (p = 0.013), bronchial ectasia (p = 0.046), and peribronchovascular consolidations (p = 0.012). The presence of one or more comorbidities correlated significantly with more extensive parenchymal involvement (p = 0.023). For the diagnosis of COVID-19, CT had a sensitivity of 84.3%, a specificity of 36.7%, and an accuracy of 73.5% (p = 0.012 vs. PCR). Conclusion: The patterns of CT findings are useful for the diagnosis of COVID-19 and the evaluation of disease severity criteria. The presence of any comorbidity is associated with greater severity of COVID-19.

摘要 研究目的：制定新型冠状病毒肺炎（coronavirus disease 2019, COVID-19）的计算机断层扫描（computed tomography, CT）诊断标准；探究严重急性呼吸综合征冠状病毒2（severe acute respiratory syndrome coronavirus 2）感染的CT表现与聚合酶链反应（polymerase chain reaction, PCR）检测结果的相关性；明确肺实质受累范围与机械通气（mechanical ventilation）需求是否与COVID-19患者的CT征象及临床特征相关。材料与方法：本研究为回顾性研究，纳入2020年3月至5月收治的155例COVID-19患者，旨在明确CT征象与患者年龄、临床变量的相关性，以及机械通气需求是否与肺实质受累程度相关。结果：COVID-19患者的平均年龄高于非患者（平均年龄：54.8岁 vs 45.5岁；p=0.031）。最常见的CT征象为磨玻璃影（ground-glass opacity），检出率达88.6%，其与COVID-19诊断显著相关（p=0.0001）。与机械通气需求相关性最强的CT征象为肺实质条索影（p=0.013）、支气管扩张（p=0.046）及支气管血管周围实变（p=0.012）。合并1种或多种合并症与更广泛的肺实质受累显著相关（p=0.023）。以PCR检测为参照标准，CT诊断COVID-19的灵敏度为84.3%、特异度为36.7%、准确度为73.5%（与PCR相比p=0.012）。结论：CT征象模式有助于COVID-19的诊断及疾病严重程度评估，合并任意基础疾病均与COVID-19更高的严重程度相关。