Chest X-ray in new Coronavirus Disease 2019 (COVID-19) infection: findings and correlation with clinical outcome

• Published in: Radiologia medica 2020-08, Vol.125 (8), p.730-737
• Main Authors: Cozzi, Diletta, Albanesi, Marco, Cavigli, Edoardo, Moroni, Chiara, Bindi, Alessandra, Luvarà, Silvia, Lucarini, Silvia, Busoni, Simone, Mazzoni, Lorenzo Nicola, Miele, Vittorio
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Betacoronavirus; Chest; Chest Radiology; Clinical outcomes; Confidence intervals; Consolidation; Coronavirus Infections - diagnostic imaging; Coronaviruses; COVID-19; Diagnostic Radiology; Emergency medical services; Emergency Service, Hospital; Epidemiology; Female; Humans; Imaging; Infections; Interventional Radiology; Italy; Male; Males; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Nodules; Pandemics; Pneumonia, Viral - diagnostic imaging; Radiography; Radiography, Thoracic; Radiology; Retrospective Studies; Reverse Transcriptase Polymerase Chain Reaction; SARS-CoV-2; Sensitivity; Sensitivity and Specificity; Severe acute respiratory syndrome coronavirus 2; Ultrasound; Viral diseases
• ISSN: 0033-8362; 1826-6983
• DOI: 10.1007/s11547-020-01232-9

Aim The purpose of this study is to describe the main chest radiological features (CXR) of COVID-19 and correlate them with clinical outcome. Materials and methods This is a retrospective study involving patients with clinical-epidemiological suspect of COVID-19 infection, who performed CXRs at the emergency department (ED) of our University Hospital from March 1 to March 31, 2020. All patients performed RT-PCR nasopharyngeal and throat swab, CXR at the ED and clinical-epidemiological data. RT-PCR results were considered the reference standard. The final outcome was expressed as discharged or hospitalized patients into a medicine department or intensive care unit (ICU). Results Patients that had a RT-PCR positive for COVID-19 infection were 234 in total: 153 males (65.4%) and 81 females (34.6%), with a mean age of 66.04 years (range 18–97 years). Thirteen CXRs were negative for radiological thoracic involvement (5.6%). The following alterations were more commonly observed: 135 patients with lung consolidations (57.7%), 147 (62.8%) with GGO, 55 (23.5%) with nodules and 156 (66.6%) with reticular–nodular opacities. Patients with consolidations and GGO coexistent in the same radiography were 35.5% of total. Peripheral (57.7%) and lower zone distribution (58.5%) were the most common predominance. Moreover, bilateral involvement (69.2%) was most frequent than unilateral one. Baseline CXR sensitivity in our experience is about 67.1%. The most affected patients were especially males in the age group 60–79 years old (45.95%, of which 71.57% males). RALE score was slightly higher in male than in female patients. ANOVA with Games-Howell post hoc showed significant differences of RALE scores for group 1 vs 3 ( p