Congruence of radiological scoring systems used in COVID-19 pneumonia and effect of comorbid diseases on radiological features

Radiological appearances in COVID-19

Authors

Keywords:

COVID-19, pneumonia, radiological appearance, scoring systems, comorbid diseases

Abstract

Background/Aim: Several scoring systems have been developed to standardize radiological findings in patients with COVID-19 pneumonia. The most commonly used scoring systems in the radiological examination of COVID-19 are those of the North American Radiology Association (RSNA), British Thoracic Society (BTS), and COVID-19 Reporting and Data System (CO-RADS). However, the compatibility between these radiological scoring systems has not been evaluated before. Therefore, this study evaluated the radiological features of COVID-19 pneumonia and congruence between radiological scoring systems and determined the effect of comorbidities and demographic characteristics on radiological features and thoracic computed tomography (TCT) findings in the context of COVID-19.

Methods: A retrospective cohort study was performed on patients attending our unit with a suspicion of COVID-19 who also had a positive real-time transcriptase-polymerase chain reaction (RT-PCR) test. All TCT images were subjected to the RSNA, BTS, and CO-RADS scoring systems. Demographic data such as age and gender, and comorbid conditions were recorded.

Results: TCT showed peripheral, posterior, and bilateral involvement in 97.7%, 97.7%, and 87.6% of the patients, respectively. The most common TCT finding was ground glass appearance, which was found in 95.5% of the patients. The Charlson Comorbidity Index (CCI) score was found to have an impact on RSNA and BTS criteria (P=0.011 and P=0.014), while age, gender, and the presence of comorbidities such as cardiovascular disease (CVD), diabetes mellitus (DM), and chronic pulmonary disease (CPD) did not have such an effect (P>0.05 for all). On the other hand, CCI scores and the presence of CPD had an association with CO-RADS, but there was no effect of age, gender, DM, and CVD (P=0.915 and P=0.730).

Conclusion: TCT plays an important role in early management, isolation, and follow-up of patients with COVID-19 pneumonia. The radiological scoring systems were found to exhibit good compatibility, but comorbid conditions could have an impact on the assessment. Therefore, we conclude that these radiological assessment criteria are useful in the management and monitoring of such patients.

Downloads

Download data is not yet available.

References

Mehra MR, Desai SS, Kuy S, Henry TD, Patel AN, Mandeep R, et al. Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19. N Engl J Med. 2020 June 18;382:102. doi: 10.1056/NEJMoa2007621 DOI: https://doi.org/10.1056/NEJMoa2007621

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020 Feb 20;382(8):727–33. doi: 10.1056/NEJMoa2001017 DOI: https://doi.org/10.1056/NEJMoa2001017

Huang P, Liu T, Huang L, Liu H, Lei M, Xu W, et al. Use of chest CT in combination with negative RT-PCR assay for the 2019 novel coronavirus but high clinical suspicion. Radiology 2020 Feb 12;295:22–3. doi: 10.1148/radiol.2020200330 DOI: https://doi.org/10.1148/radiol.2020200330

Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J. Chest CT for Typical 2019-nCoV Pneumonia: Relationship to Negative RT-PCR Testing. Radiology 2020 Feb 12;296 (2):41-5. doi: 10.1148/radiol.2020200343 DOI: https://doi.org/10.1148/radiol.2020200343

Kong W, Agarwal PP. Chest Imaging Appearance of COVID-19 Infection. Radiol Cardiothorac Imaging. 2020 Feb 13; 2(1): e200028. doi: 10.1148/ryct.2020200028 DOI: https://doi.org/10.1148/ryct.2020200028

Fang Y, Zhang H, Xie J, Lin M, Ying, L, Pang P, et al. Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radiology. 2021 Feb 19;296 (2):115–7. doi: 10.1148/radiol.2020200432 DOI: https://doi.org/10.1148/radiol.2020200432

Editorial. Emerging understandings of 2019-nCoV. Lancet 2020 Jan 24;395(10221):311. doi: 10.1016/S0140-6736(20)30186-0 DOI: https://doi.org/10.1016/S0140-6736(20)30186-0

Rubin EJ, Baden LR, Morrissey S, Campion EW. Medical Journals and the 2019-nCoV Outbreak. N Engl J Med. 2020 Feb 27;382(9):866. doi: 10.1056/NEJMe2001329 DOI: https://doi.org/10.1056/NEJMe2001329

Simpson S, Kay FU, Abbara S, Bhalla S, Chung M, Jonathan H, et al. Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. J Thorac Imaging. 2020 Apr 28;35(4):219-27. doi: 10.1097/RTI.0000000000000524 DOI: https://doi.org/10.1097/RTI.0000000000000524

Thoracic Imaging in COVID‐19 Infection, Guidance for the Reporting Radiologist British Society of Thoracic Imaging 2021

Prokop M, Van Everdingen W, Van Rees, Vellinga T, Quarles van UffordH, Stöger L, et al. CO-RADS: A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19-Definition and Evaluation. Radiology. 2020 Apr 27;296 (2):97–104. doi: 10.1148/radiol.2020201473 DOI: https://doi.org/10.1148/radiol.2020201473

He Y. Translation: Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (Trial Version 7): National Health Commission, National Administration of Traditional Chinese Medicine. Infect Microbes Dis. 2020 Apr 17;2(2):48–54. doi: 10.1097/IM9.0000000000000022 DOI: https://doi.org/10.1097/IM9.0000000000000022

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 Feb 4;295(1):202–7. doi: 10.1148/radiol.2020200230

Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19) imaging reporting and data system (COVID-RADS) and common lexicon: a proposal based on the imaging data of 37 studies. Eur Radiol. 2020 Apr 28;30(9):4930–42. doi: 10.1007/s00330-020-06863-0 DOI: https://doi.org/10.1007/s00330-020-06863-0

Li K, Wu J, Wu F, Guo, D. Chen L, Fang Z, et al. The Clinical and Chest CT Features Associated with Severe and Critical COVID-19 Pneumonia. Invest Radiol. 2020 Feb 29;55(6):327–31. doi: 10.1097/RLI.0000000000000672 DOI: https://doi.org/10.1097/RLI.0000000000000672

Song F, Shi N, Shan F, Zhang Z, Shen J, Lu H, et al. Emerging 2019 Novel Coronavirus (2019-nCoV) Pneumonia. Radiology. 2020 Feb 6;295(1):210–7. doi: 10.1148/radiol.2020200274 DOI: https://doi.org/10.1148/radiol.2020200274

Pan Y, Guan H, Zhou S, Wang Y, Li Q, Zhu T, et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol. 2020 Feb 13;30(6):3306-9. doi: 10.1007/s00330-020-06731-x DOI: https://doi.org/10.1007/s00330-020-06731-x

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 Feb 4;295(1):202–7. doi: 10.1148/radiol.2020200230 DOI: https://doi.org/10.1148/radiol.2020200230

Kanne JP. Chest CT findings in 2019 novel coronavirus (2019-NCoV) infections from Wuhan, China: Key points for the radiologist. Radiology. 2020 Feb 4;295(1):16-7. doi: 10.1148/radiol.2020200241 DOI: https://doi.org/10.1148/radiol.2020200241

Zhou S, Wang Y, Zhu T, Xia L. CT features of coronavirus disease 2019 (COVID-19) pneumonia in 62 patients in Wuhan, China. Am Roentgen Ray Soc. 2020 Jun;214(6):1287–94. doi: 10.2214/AJR.20.22975 DOI: https://doi.org/10.2214/AJR.20.22975

Zhang J, Wang X, Jia X, Hu K, Chen G, Wei J, et al. Risk factors for disease severity, unimprovement, and mortality in COVID-19 patients in Wuhan, China. Clin Microbiol Infect. 2020 Jun;26 (6):767–72. doi: 10.1016/j.cmi.2020.04.012 DOI: https://doi.org/10.1016/j.cmi.2020.04.012

Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients. J Infect. 2020 Jun;80 (6):14–8. doi: 10.1016/j.jinf.2020.03.005 DOI: https://doi.org/10.1016/j.jinf.2020.03.005

Jaillon S, Berthenet K, Garlanda C. Sexual Dimorphism in Innate Immunity. Clin Rev Allergy Immunol. 2019 Jun;56(3):308–21. DOI 10.1007/s12016-017-8648-x DOI: https://doi.org/10.1007/s12016-017-8648-x

Jain V, Yuan JM. Predictive symptoms and comorbidities for severe COVID-19 and intensive care unit admission: a systematic review and meta-analysis. Int J Public Health. 2020 May 25;65(5):533-46. doi: 10.1007/s00038-020-01390-7 DOI: https://doi.org/10.1007/s00038-020-01390-7

Ejaz H, Alsrhani A, Zafar A, Javed H, Junaid K, Abdalla A, et al. COVID-19 and comorbidities: Deleterious impact on infected patients. J Infect Public Health. 2020 Dec;13(12):1833–9. doi: 10.1016/j.jiph.2020.07.014 DOI: https://doi.org/10.1016/j.jiph.2020.07.014

Gold MS, Sehayek D, Gabrielli S, Zhang X, McCusker C, Ben-Shoshan M. COVID-19 and comorbidities: a systematic review and meta-analysis. Postgrad Med. 2020 Jun 14;132 (8):749-55. doi: 10.1080/00325481.2020.1786964 DOI: https://doi.org/10.1080/00325481.2020.1786964

Kulcsar KA, Coleman CM, Beck SE, Frieman MB. Comorbid diabetes results in immune dysregulation and enhanced disease severity following MERS-CoV infection. JCI Insight. 2019 Oct 17;4(20):e131774. doi: 10.1172/jci.insight.131774. DOI: https://doi.org/10.1172/jci.insight.131774

Maddaloni E, Buzzetti R. Covid-19 and diabetes mellitus: unveiling the interaction of two pandemics. Diabetes Metab Res Rev. 2020 Mar 31;36(7):e33213321. doi: 10.1002/dmrr.3321 DOI: https://doi.org/10.1002/dmrr.3321

Rao S, Lau A, So HC. Exploring Diseases/Traits and Blood Proteins Causally Related to Expression of ACE2, the Putative Receptor of SARS-CoV-2: A Mendelian Randomization Analysis Highlights Tentative Relevance of Diabetes-Related Traits. Diabetes Care. 2020 Jul;43(7):1416–26. doi: 10.2337/dc20-0643 DOI: https://doi.org/10.2337/dc20-0643

Pal R, Bhansali A. COVID-19, diabetes mellitus and ACE2: The conundrum. Diabetes. Res Clin Pract. 2020 Apr 1;162:108132. doi: 10.1016/j.diabres.2020.108132 DOI: https://doi.org/10.1016/j.diabres.2020.108132

Singh AK, Gupta R, Ghosh A, Misra A. Diabetes in COVID-19: Prevalence, pathophysiology, prognosis and practical considerations. Diabetes Metab Syndr Clin Res Rev. 2020 Jul;14(4):303–10. doi: 10.1016/j.dsx.2020.04.004 DOI: https://doi.org/10.1016/j.dsx.2020.04.004

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020 Mar 17;323(11):1061-9. doi: 10.1001/jama.2020.1585 DOI: https://doi.org/10.1001/jama.2020.1585

Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med. 2020 Apr 8;8(4):21. doi: 10.1016/S2213-2600(20)30116-8. DOI: https://doi.org/10.1016/S2213-2600(20)30116-8

Downloads

Published

2023-01-22

Issue

Section

Research Article

How to Cite

1.
Ölmez H, Tosun M, Ünver E, Özer D, Karavas E, Arslan YK. Congruence of radiological scoring systems used in COVID-19 pneumonia and effect of comorbid diseases on radiological features: Radiological appearances in COVID-19. J Surg Med [Internet]. 2023 Jan. 22 [cited 2024 Feb. 25];7(1):101-6. Available from: https://jsurgmed.com/article/view/7675