Chinese Medical Sciences Journal ›› 2021, Vol. 36 ›› Issue (2): 85-96.doi: 10.24920/003821
• Original Article • Previous Articles Next Articles
Lan Song1, Zhenchen Zhu1, 2, Ruijie Zhao1, Pengchang Li3, Duxue Tian1, Tiekuan Du4, Yan Xu5, Qiwen Yang3, Wei Cao6, Wei Song1, *(), Zhengyu Jin1, *(
)
Received:
2021-01-11
Published:
2021-06-30
Online:
2021-05-31
Contact:
Wei Song,Zhengyu Jin
E-mail:cjr.songwei@vip.163.com;jinzy@pumch.cn
Lan Song, Zhenchen Zhu, Ruijie Zhao, Pengchang Li, Duxue Tian, Tiekuan Du, Yan Xu, Qiwen Yang, Wei Cao, Wei Song, Zhengyu Jin. Epidemiologic Features, Radiological Findings andClinical Outcomes of 19 Patients with COVID-19in a Single Center in Beijing, China[J].Chinese Medical Sciences Journal, 2021, 36(2): 85-96.
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Figure 1.
Examples of pulmonary lobe segmentation and lesion segmentation. Chest CT images of 40-year-old male (case 17) diagnosed with COVID-19. Right: Original axial unenhanced CT images; Left: Pulmonary lobes and lesion segmentation (corresponding output with deep learning algorithm shows the multifocal subpleurally distributed GGOs in left lower lobe). GGO: ground glass opacity."
Figure 2.
Time course of symptoms, hospital admission, and discharge of patients infected with SARS-CoV-2. The epidemiological and clinical characteristics of the 19 patients with COVID-19. The cases were successively listed according to the date of diagnosis. Date of diagnosis was defined as the origin point; the contact history was reviewed; abnormal blood test and CT image upon admission were listed; and symptom and nucleic acid test were recorded during hospitalization."
Table 1
Summary of clinical features and laboratory results of patients infected with SARS-CoV-2 at initial presentation (n=19) "
Items | Results |
---|---|
Age [mean±SD (range), yrs] | 42±18 (7-68) |
Male [No. (%)] | 11 (57.9) |
Any comorbidity [No. (%)]a | 4 (21.1) |
Signs and symptoms on presentation [No. (%)] | |
Fever | 15 (78.9) |
Dry cough | 11 (57.9) |
Chill | 6 (31.6) |
Fatigue | 4 (21.1) |
Sore throat | 3 (15.8) |
Myalgia | 3 (15.8) |
Rhinorrhea | 3 (15.8) |
Shortness of breath | 2 (10.5) |
Diarrhea | 2 (10.5) |
Expectoration | 1 (5.3) |
Headache | 1 (5.3) |
Asymptomatic and afebrile | 2 (10.5) |
Vital signs at presentation [median (range)] | |
Temperature (℃) | 38 (37.3, 38.0) |
Pulse oximeter O2 saturation (%) | 98 (97, 99) |
Baseline investigations [median (range)] | |
White blood cells [×109/L, mean±SD (range), normal range (3.5-9.5)] | 5.0±1.6 (3.2-10.3) |
Hemoglobin [g/L, mean±SD (range), normal range (120-160)] | 143.2±21.2 (98-196) |
Platelets [×109/L, mean±SD (range), normal range (100-350)] | 212±60 (122-336) |
Neutrophils [×109/L, normal range (2.0-7.5)] | 3.0 (2.0-3.3) |
Lymphocytes [×109/L, normal range (0.8-4.0)] | 1.5 (0.3-3.3) |
C-reactive protein [No. (%) above normal range, normal range (0.0-8.0) mg/L] | 11 (57.9) |
Procalcitonin [No. (%) above normal range, normal range <0.5 ng/ml, n=15] | 1 (6.7) |
LDH [No. (%) above normal range, normal range (0-250) U/L, n=9] | 1 (11.1) |
Creatine kinase [No.(%) above normal range, normal range (24-195) U/L] | 3 (15.8) |
Cardiac troponin I [No. (%) above normal range, normal range (0-0.04) μg/L, n=13] | 1 (7.7) |
NT-proBNP [No. (%) of negative results, normal range (0-125) g/ml, n=12] | 12 (100) |
CK-MB [No. (%) of negative results, normal range (0-3.6) μg/L, n=13] | 13 (100) |
Abnormal chest CT [No. (%)] | 16 (84.2) |
Duration of symptoms [d, median (P25, P75), n=17] | 12 (10, 13.5) |
Days of hospitalization [d, mean±SD (range)] | 20±5 (11-25) |
Table 2
Baseline CT imaging findings in 262 lesions of 19 patients with COVID-19"
CT imaging findings | No. of patients (%) | No. of lesions (%) |
---|---|---|
n | 19 | 262 |
Distribution | ||
Peripheral distribution | 14 (73.7) | 223 (85.1) |
Both peripheral and central distribution | 2 (10.5) | 39 (14.9) |
Peri-bronchial distribution | 14 (73.7) | 170 (64.9) |
Anterior predominant | 1 (5.3) | 65 (24.8) |
Posterior predominant | 15 (78.9) | 197 (75.2) |
Upper lobe distribution | 14 (73.7) | 80 (30.5) |
Middle lobe distribution | 9 (47.4) | 31 (11.8) |
Lower lobe distribution | 14 (73.7) | 151 (57.6) |
Patterns of the lesion | ||
Pure ground glass opacities | 15 (78.9) | 87 (33.2) |
Ground glass opacities with consolidation | 15 (78.9) | 147 (56.1) |
Consolidation | 7 (36.8) | 28 (10.7) |
Other signs surrounding the lesion | ||
Halo-sign | 8 (42.1) | 69 (26.3) |
Reversed halo-sign | 3 (15.8) | 18 (6.9) |
Other signs in the lesion | ||
Interlobular septal thickening | 10 (52.6) | 102 (38.9) |
Crazy paving pattern | 7 (36.8) | 30 (11.5) |
Air bronchogram sign | 15 (78.9) | 89 (34.0) |
Architectural deformation | 6 (31.6) | 36 (13.7) |
Bronchus distortion | 6 (31.6) | 38 (14.5) |
Bronchial wall thickening | 13 (68.4) | 76 (29.0) |
Vascular dilation sign | 16 (84.2) | 105 (40.1) |
Vacuole sign | 7 (36.8) | 38 (14.5) |
Table 3
Lobe of lesion distribution of the pulmonary involvement in each lobe in 19 patients of COVID-19"
Lobe of lesion distribution | No. (%) of 19 patients | Percentage of total 57 involved lobes (%) |
---|---|---|
Left upper lobe | 11 (57.9) | 11 (19.3) |
Left lower lobe | 14 (73.7) | 14 (24.6) |
Right upper lobe | 11 (57.9) | 11 (19.3) |
Right middle lobe | 9 (47.4) | 9 (15.8) |
Right lower lobe | 12 (63.2) | 12 (21.1) |
Table 4
Baseline quantitative CT parameters in the initial CT-positive 16 patients with COVID-19 and 5 family clusters (including 13 patients) [mean±SD (range)]"
Clusters | n | No. of lesions (n) | Total lesion (volume, ml) | Mean CT value (HU) | Pneumonia volume/total lung volume (%) |
---|---|---|---|---|---|
CT positive patients | 16 | 13.8±17.8 (1-53) | 216.7±292.5 (2.7-944.7) | -357.2±166.9 (-583.3--135.4) | 6.4±10.6 (0.1-40) |
Family cluster 1 | 2 | 9.0±1.4 (8-10) | 320.9±335.5 (83.7-558.1) | -534.6±43.8 (-565.6--506.6) | 7.1±5.9 (2.9-11.2) |
Family cluster 2 | 2 | 19.5±13.4 (10-29) | 116.6±145.7 (13.6-219.6) | -394.6±166.9 (-470.7--318.4) | 4.3±5.8 (0.2-8.4) |
Family cluster 3 | 4 | 6.5±4.7 (0-10) | 452.7±457.5 (0-944.7) | -275.0±173.8 (-475.3--164.5) | 15.5±18.0 (0-40) |
Family cluster 4 | 2 | 2.0±2.8 (0-4) | 3.8±5.4 (0-7.6) | -466.4±68.7 (-515.0--417.8) | 0.1±0.1 (0-0.2) |
Family cluster 5 | 3 | 8.0±8.5 (0-17) | 13.4±16.7 (0-32.1) | -238.2±127.6 (-328.4--148.0) | 0.3±0.3 (0-0.6) |
Figure 4.
Thin-slice CT images in three patients with COVID-19. A. 60-year-old woman (case 4). CT image obtained on day 3 after onset of symptoms shows subpleural patchy GGO in the lingual segment of the left upper lobe, with vascular dilation (arrow). B. The same patient on the same day. CT shows subpleural patchy consolidation with scattered vacuole signs (arrow) and bronchial wall thickening (arrowhead) in the dorsal segment of the right lower lobe. C. 68-year-old man (case 5, husband of case 4). CT image obtained on day 19 after onset of symptoms shows multiple patchy GGOs with predominant peri-bronchial distribution and multiple vacuole signs (arrow) in the left upper lobe. D. 31-year-old woman (case 6). CT image obtained on day 4 after onset of symptoms shows subpleural wedge-shaped consolidation with vascular dilation (arrowhead) and fuzzy margin in the right lower lobe."
Figure 5.
Thin-slice CT images in three patients of a family with COVID-19. A. 61-year-old woman (case 10). CT image obtained on day 15 after the date on which she arrived in Beijing shows diffuse subpleural and peri-bronchial confluent GGOs and fibrous cords in both lungs with architecture deformation (arrow) and crazy paving sign (box). B. 64-year-old man (case 18, husband of case 10). CT image obtained on day 15 after the date on which he arrived in Beijing shows diffuse subpleural confluent GGOs and mixed GGOs with consolidations accompanied by crazy paving sign and traction bronchiectasis in both lungs (box). C. Asymptomatic and afebrile 37-year-old woman (case 19, daughter of case 10 and case 18). Her nucleic acid test results of SARS-CoV-2 were negative for 6 times. The seventh nucleic acid test result was positive after 30 days from her first test. CT image obtained on day 14 after contacting with case 10 shows a subpleural patchy consolidations with halo sign (box) in the right lower lobe."
Figure 6.
Thin-slice CT images in two patients with COVID-19. A. Afebrile 39-year-old woman (case 15, wife of case 17). CT image obtained on day 9 after onset of symptoms shows scattered pure GGO nodule (arrow) or part-solid nodule (arrowhead) distributed along the bronchovascular bundle in the bilateral lower lobes. B. 40-year-old man (case 17). CT image obtained on day 5 after onset of symptoms shows subpleural scattered GGOs with crazy paving sign in left lower lobe (box)."
Figure 7.
Thin-slice CT images in three patients with COVID-19. A. 35-year-old man (case 2). CT image obtained on day 10 after onset of symptoms shows large segmental distribution GGO (arrowhead) in the lateral segment of right middle lobe. B. 42-year-old man (case 1). CT image obtained on day 4 after onset of symptoms shows large segmental distribution GGO (arrowhead) in the dorsal segment of left lower lobe. C. 63-year-old woman (case 9). CT image obtained on day 3 after onset of symptoms shows large segmental distribution GGO (arrowhead) in the right middle lobe and multiple subpleural little patchy GGOs (arrow) in the right lower lobe and the left lung."
Figure 8.
Serial CT images in a 62-year-old male with COVID-19. A. The initial CT image obtained on day 3 after onset of symptoms shows round GGO in left lower lobe. B. After 3 days, the first repeat CT shows irregular GGO with heterogeneous density and increasing in extent and density. C, D. Subsequently, lesions absorb gradually with decrease of extent and density (C, 11 days later), and only leaves a small amount of faint GGO on the latest CT scan (D, 16 days later)."
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