THE ESSENTIAL ROLE OF CONVENTIONAL RADIOGRAPHY IN COVID-19; PERSPECTIVE OF A DEVELOPING COUNTRY
Abstract
Background: The Coronavirus disease (COVID-19) pandemic has shaken the world. So far, CT has emerged as main stay of imaging whereas the local data on radiographic features of COVID-19 is sparse. Methods: Prospective study includes 402 chest X rays (CXRs) of 105 patients presenting with symptoms of COVID-19. The nature of abnormality, distribution and lung zone involvement was documented. Following British Society of Thoracic Imaging (BSTI) guidelines, CXRs were grouped into classic/ probable COVID-19, indeterminate, non-COVID-19 and normal categories. The lung involvement was scored according to modified Radiographic Assessment of Lung Edema (RALE) scoring. The follow up radiographs were assessed for disease progression and improvement. Results: Seventy-six males and 29 females with mean age of 50 years were included in our study. 47 out of 105 baseline radiographs were categorized as classic/ probable COVID-19, 26 as indeterminate, 7 as Non-Covid-19 and 25 as normal. 75 patients were positive and 30 were negative on RT-PCR testing. The sensitivity of CXR in diagnosing COVID-19 is 84%. The worsening radiographic features and higher RALE score correlates with longer hospital stay, ICU admissions and mortality. The ground glass opacities and consolidations in peripheral distribution involving bilateral mid and lower zones are the predominant findings of COVID-19 in Pakistani population. Conclusion: Combination of bilateral peripheral ground glass opacities and consolidations are the cardinal feature of COVID-19 on CXRs. The diagnostic categories described by BSTI correlates with PCR results in Pakistani population. The worsening radiographic findings correspond to poor prognosis; hence serial radiographs can be used for assessing disease course.
References
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. China Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382(8):727-33.
WHO. WHO Director-General's opening remarks at the media briefing on COVID-19. [Internet]. [cited 2020 Mar 11]. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19
See the Realtime Pakistan and worldwide COVID- 19 situation! [Internet]. [cited 2020 Aug 10]. Available from: http;//covid.gov.pk
Jajodia A, Ebner L, Heidinger B, Prosch H. Imaging in corona virus disease 2019 (COVID-19)-A Scoping review. Eur J Radiol Open 2020;7:100237.
ACR Recommendations for the Use of Chest Radiography and Computed Tomography (CT) for Suspected COVID-19 Infection. American College of Radiology. [Internet]. [cited 2020 Mar 11]. Available from: https://www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/Recommendations-for-Chest-Radiography-and-CT-for-Suspected-COVID19-Infection
Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X, et al. CT imaging features of 2019 novel Coronavirus (2019-nCoV). Radiology 2020;295(1):202-7.
Song F, Shi N, Shan F, Zhang Z, Shen J, Lu H, et al. Emerging 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology 2020;295(1):210-7.
Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis 2020;20(4):425-34.
Rodrigues JC, Hare SS, Edey A, Devaraj A, Jacob J, Johnstone A, et al. An update on COVID-19 for the radiologist-A British society of Thoracic Imaging statement. Clin Radiol 2020;75(5):323-5.
Chen Y, Liu Q, Guo D. Emerging coronaviruses: genome structure, replication, and pathogenesis. J Med Virol 2020;92(4):418-23.
Giovagnoni A. Facing the COVID-19 emergency: we can and we do. Radiol Med 2020;125(4):337-8.
Jacobi A, Chung M, Bernheim A, Eber C. Portable chest X-ray in coronavirus disease-19 (COVID-19): A pictorial review. Clin Imaging 2020;64:35-42.
Rubin GD, Ryerson CJ, Haramati LB, Sverzellati N, Kanne JP, Raoof S, et al. The role of chest imaging in patient management during the COVID-19 pandemic: a multinational consensus statement from the Fleischner Society. Chest 2020;158(1):106-16.
Ng MY, Lee EY, Yang J, Yang F, Li X, Wang H, et al. Imaging Profile of the COVID-19 Infection: Radiologic Findings and Literature Review. Radiol Cardiothorac Imaging 2020;2(1):e200034.
Yoon SH, Lee KH, Kim JY, Lee YK, Ko H, Kim KH, et al. Chest radiographic and CT findings of the 2019 novel coronavirus disease (COVID-19): analysis of nine patients treated in Korea. Korean J Radiol 2020;21(4):494-500.
Wong HY, Lam HY, Fong AH, Leung ST, Chin TW, Lo CS, et al. Frequency and distribution of chest radiographic findings in COVID-19 positive patients. Radiology 2020;296(2)E72-8.
Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology 2020;295(3):200463.
Toussie D, Voutsinas N, Finkelstein M, Cedillo MA, Manna S, Maron SZ, et al. Clinical and chest radiography features determine patient outcomes in young and middle age adults with COVID-19. Radiology 2020;297(1):E197-206.
Zu ZY, Jiang MD, Xu PP, Chen W, Ni QQ, Lu GM, et al. Coronavirus disease 2019 (COVID-19): a perspective from China. Radiology 2020;296(2):E15-25.
Downloads
Published
How to Cite
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.