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Id Subject Object Predicate Lexical cue
T1 0-66 Sentence denotes The role of imaging in 2019 novel coronavirus pneumonia (COVID-19)
T2 68-76 Sentence denotes Abstract
T3 77-246 Sentence denotes Almost the entire world, not only China, is currently experiencing the outbreak of a novel coronavirus that causes respiratory disease, severe pneumonia, and even death.
T4 247-334 Sentence denotes The outbreak began in Wuhan, China, in December of 2019 and is currently still ongoing.
T5 335-552 Sentence denotes This novel coronavirus is highly contagious and has resulted in a continuously increasing number of infections and deaths that have already surpassed the SARS-CoV outbreak that occurred in China between 2002 and 2003.
T6 553-624 Sentence denotes It is now officially a pandemic, announced by WHO on the 11th of March.
T7 625-889 Sentence denotes Currently, the 2019 novel coronavirus (SARS-CoV-2) can be identified by virus isolation or viral nucleic acid detection; however, false negatives associated with the nucleic acid detection provide a clinical challenge and thus make the imaging examination crucial.
T8 890-1009 Sentence denotes Imaging exams have been a main clinical diagnostic criteria for the 2019 novel coronavirus disease (COVID-19) in China.
T9 1010-1354 Sentence denotes Imaging features of multiple patchy areas of ground glass opacity and consolidation predominately in the periphery of the lungs are characteristic manifestations on chest CT and extremely helpful in the early detection and diagnosis of this disease, which aids prompt diagnosis and the eventual control of this emerging global health emergency.
T10 1355-1365 Sentence denotes Key Points
T11 1366-1537 Sentence denotes • In December 2019, China, an outbreak of pneumonia caused by a novel, highly contagious coronavirus raised grave concerns and posed a huge threat to global public health.
T12 1538-1829 Sentence denotes • Among the infected patients, characteristic findings on CT imaging include multiple, patchy, ground-glass opacity, crazy-paving pattern, and consolidation shadows, mainly distributed in the peripheral and subpleural areas of both lungs, which are very helpful for the frontline clinicians.
T13 1830-2105 Sentence denotes • Imaging examination has become the indispensable means not only in the early detection and diagnosis but also in monitoring the clinical course, evaluating the disease severity, and may be presented as an important warning signal preceding the negative RT-PCR test results.
T14 2107-2140 Sentence denotes Electronic supplementary material
T15 2141-2277 Sentence denotes The online version of this article (10.1007/s00330-020-06827-4) contains supplementary material, which is available to authorized users.
T16 2279-2291 Sentence denotes Introduction
T17 2292-2440 Sentence denotes In December of 2019, the city of Wuhan, located in the Hubei province of China, became the epicenter of an outbreak of a pneumonia of unknown cause.
T18 2441-2528 Sentence denotes This pneumonia was later confirmed to be secondary to infection by a novel coronavirus.
T19 2529-2847 Sentence denotes This virus was originally called the 2019 novel coronavirus (2019-nCoV), but on February 11, 2020, the disease was named COVID-19 by the World Health Organization (WHO), and the virus was named “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2) by the International Committee on Taxonomy of Viruses (ICTV).
T20 2848-2974 Sentence denotes It is believed that the COVID-19 outbreak has a zoonotic origin and began in the Huanan wet seafood wholesale market in Wuhan.
T21 2975-3065 Sentence denotes SARS-CoV-2 has proven to be extremely contagious and spreads easily from person to person.
T22 3066-3227 Sentence denotes Cases of COVID-19 have now spread beyond Wuhan to many other provinces in China as well as other countries, which has raised international attention and concern.
T23 3228-3380 Sentence denotes As of March 12, 2020, more than 81,000 human infections with SARS-CoV-2 and at least 3100 deaths related to COVID-19 have been confirmed in China alone.
T24 3381-3502 Sentence denotes Although the epidemic situation in China has been relatively under control, the situation outside China is getting worse.
T25 3503-3765 Sentence denotes So far, the COVID-19 viral disease that has swept into at least 114 countries with more than 60,000 cases diagnosed and more than 4000 people killed is now officially a pandemic, as WHO Director-General Tedros Adhanom Ghebreyesus announced in Geneva on March 11.
T26 3766-3922 Sentence denotes At first, COVID-19 appeared in a few clusters and was more likely to affect persons with advanced age or other comorbidities, but it is now more widespread.
T27 3923-4058 Sentence denotes Infection can result in severe pneumonia and even fatal respiratory diseases such as acute respiratory distress syndrome (ARDS) [1, 2].
T28 4059-4241 Sentence denotes The main clinical presentation includes fever, dry cough, fatigue, and malaise and/or non-specific upper respiratory tract infection symptoms that may not be particularly noticeable.
T29 4242-4394 Sentence denotes As previously reported [1], patients with severe illness can develop dyspnea and some even developed ARDS and required ICU admission and oxygen therapy.
T30 4395-4522 Sentence denotes Laboratory findings of patients infected with SARS-CoV-2 include lymphopenia, elevated CRP, and erythrocyte sedimentation rate.
T31 4523-4670 Sentence denotes Genetic sequencing of SARS-CoV-2 has enabled the rapid development of point-of-care real-time RT-PCR diagnostic tests specific for COVID-19 [3, 4].
T32 4671-4787 Sentence denotes Novel coronavirus nucleic acids are detected in throat swabs, sputum, lower respiratory tract secretions, and blood.
T33 4788-4955 Sentence denotes At present, the diagnosis of COVID-19 is primarily based on the patient’s epidemiological history, clinical symptoms, chest imaging findings, and etiological evidence.
T34 4956-5054 Sentence denotes Viral nucleic acid testing is an important diagnostic criterion; however, it has some limitations.
T35 5055-5298 Sentence denotes False negatives from viral nucleic acid testing arise from the uneven quantity of detection technology, disease characteristics (asymptomatic patients), and status of epidemic prevention and control, as well as errors in clinical sampling [5].
T36 5299-5458 Sentence denotes COVID-19 is highly contagious; thus, early detection and diagnosis are of paramount importance to isolate suspected cases and contacts to control the outbreak.
T37 5459-5639 Sentence denotes The challenges in identification of pathogens by viral nucleic acid testing have made some frontline clinicians propose CT as a diagnostic method for identifying COVID-19 patients.
T38 5640-5762 Sentence denotes This review aims to briefly introduce the novel coronavirus pneumonia and highlight the value of imaging in its diagnosis.
T39 5764-5789 Sentence denotes Etiology and epidemiology
T40 5790-5894 Sentence denotes Coronaviruses typically result in respiratory and enteric infections and affect both animals and humans.
T41 5895-6279 Sentence denotes Six coronavirus species are known to cause human infection, two of which typically can cause severe respiratory illness and fatalities: SARS-CoV (severe acute respiratory syndrome coronavirus) which had an outbreak in Guangdong, China, between 2002 and 2003 and MERS-CoV (Middle East respiratory syndrome coronavirus) which had an outbreak in 2012 outbreaks in the Middle East [6, 7].
T42 6280-6381 Sentence denotes By January 7, 2020, Chinese scientists had isolated the novel coronavirus from patients in Wuhan [3].
T43 6382-6619 Sentence denotes It has been reported [8] that SARS-CoV-2 was more similar to two bat-derived coronavirus strains (bat-SL-CoVZC45 and bat-SL-CoVZXC21) than to known human-infecting coronaviruses, including the virus that caused the SARS outbreak of 2003.
T44 6620-6829 Sentence denotes Molecular modeling has shown structural similarity between the receptor-binding domains of SARS-CoV and SARS-CoV-2, which suggests that SARS-CoV-2 may use angiotensin-converting enzyme 2 (ACE 2) as a receptor.
T45 6830-6943 Sentence denotes The differences of the etiological characteristics among SARS-COV, MERS-COV, and SARS-CoV-2 are shown in Table 1.
T46 6944-7017 Sentence denotes Table 1 Etiological characteristics of SARS-COV, MERS-COV, and SARS-CoV-2
T47 7018-7078 Sentence denotes Virus Genus Intermediate host Reservoir host Receptor Origin
T48 7079-7105 Sentence denotes SARS-COV-2 β-coronavirus ?
T49 7106-7127 Sentence denotes Bat ACE2 Wuhan, China
T50 7128-7182 Sentence denotes SARS-COV β-coronavirus Civet Bat ACE2 Guangzhou, China
T51 7183-7242 Sentence denotes MERS-COV β-coronavirus Dromedary Bat CD26/DPP4 Saudi Arabia
T52 7243-7435 Sentence denotes On December 31, 2019, the Health Commission of Hubei province in China announced that 27 patients were afflicted with this mysterious disease, which was subsequently discovered to be COVID-19.
T53 7436-7554 Sentence denotes The outbreak is believed to zoonotic in origin and likely started at the Huanan wet seafood wholesale market in Wuhan.
T54 7555-7666 Sentence denotes SARS-CoV-2 is highly contagious and the basic reproductive number of the virus was estimated to be 2·2 [9, 10].
T55 7667-7745 Sentence denotes COVID-19 has spread beyond Wuhan to other cities in China and other countries.
T56 7746-7868 Sentence denotes In recent days, there is a significant growth trend in other countries, especially in South Korea, Japan, Italy, and Iran.
T57 7869-7950 Sentence denotes The current global situation as of March 13 2020, of COVID-19 is shown in Fig. 1.
T58 7951-8138 Sentence denotes Fig. 1 Countries, territories, and areas with reported confirmed cases of COVID-19, as of March 13, 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
T59 8139-8300 Sentence denotes In the available reports, the bat is the most possible host of the SARS-CoV-2 and another animal may act as an intermediate host between bats and humans [8, 11].
T60 8301-8386 Sentence denotes To this point, the main infection sources were the patients infected with SARS-CoV-2.
T61 8387-8483 Sentence denotes COVID-19 mainly spread via human-to-human transmission through respiratory droplets and contact.
T62 8484-8643 Sentence denotes The human population in general is susceptible, while the elderly as well as people with underlying diseases show more serious conditions after infection [12].
T63 8644-8832 Sentence denotes Although most people were reported to have a good prognosis of COVID-19, it is unknown whether there are potential impacts on the patients in the future and the sequelae are not available.
T64 8833-8994 Sentence denotes In the case of the SARS outbreak, significant impact on pulmonary function, functional capacity, and quality of life was found during patient follow-up [13, 14].
T65 8995-9124 Sentence denotes The additional and detailed information about “Etiology and Epidemiology” is provided in Electronic Supplementary Material (ESM).
T66 9126-9142 Sentence denotes Imaging features
T67 9143-9369 Sentence denotes According to current diagnostic criteria, identification of the viral pathogen via nucleic acid detection (usually from swab test) is considered as the gold standard and formative assessment for the diagnosis of COVID-19 [12].
T68 9370-9715 Sentence denotes However, due to various problems of virus detection in the clinical setting such as a shortage of supply test kits, irregular sampling of samples, laboratory error, insufficient viral material in the specimen, improper extraction of nucleic acid from clinical materials, and contaminatory and technical problems, there have been false negatives.
T69 9716-9902 Sentence denotes Health care workers on the front line have found the diagnostic value of imaging to be increasingly valuable, which has translated over into clinical diagnosis of COVID-19 patients [12].
T70 9903-10174 Sentence denotes In the clinical work of this epidemic, the radiologists play a crucial role in the rapid identification and early diagnosis of a suspected patient—this can be of great benefit not only to the patient but also to the larger public health surveillance and response systems.
T71 10176-10192 Sentence denotes Chest radiograph
T72 10193-10352 Sentence denotes Chest radiograph of COVID-19 is not routinely recommended in clinical practice currently because they are insensitive to detecting COVID-19 in the early stage.
T73 10353-10631 Sentence denotes However, chest radiography may have some utility, with the potential to serve as a screening tool on the frontlines in medical settings with limited resources or in cases where the patient’s physical condition does not allow for transport to the radiology department CT scanner.
T74 10632-10758 Sentence denotes As the disease progresses beyond the early stage, chest radiography can detect multiple patchy opacities throughout the lungs.
T75 10759-10859 Sentence denotes These opacities eventually become confluent and severe cases may appear as a “whited out lung” [15].
T76 10860-11032 Sentence denotes In more advanced cases, in addition to the ground glass opacity and consolidation, even pleural fluid (in a severe case) has been reported on the chest radiographs [2, 16].
T77 11033-11154 Sentence denotes Progressive opacities and consolidation have been observed on chest radiographs over the time course of the illness [17].
T78 11155-11318 Sentence denotes In the first case of COVID-19 reported in the USA, there were no obvious abnormalities on the chest radiograph during the early stages after the onset of symptoms.
T79 11319-11425 Sentence denotes However, on day 9 of the illness, an increased area left basilar opacity was visible on chest radiography.
T80 11426-11546 Sentence denotes Then, stable streaky opacities in the lung bases were visible, and the opacities have steadily increased over time [18].
T81 11548-11573 Sentence denotes Chest computed tomography
T82 11574-11811 Sentence denotes Computed tomography (CT) imaging is strongly recommended because it is very sensitive to detecting early disease, assessing the nature and extent of lesions, and discovering subtle changes that are often not visible on chest radiography.
T83 11812-11969 Sentence denotes The imaging features of lesions are always described with the following factors: distribution, quantity, shape, pattern, density, and concomitant signs [19].
T84 11970-12239 Sentence denotes The typical chest CT imaging characteristics of COVID-19 include multiple, peripheral, bilateral, patchy, sub-segmental, or segmental ground glass opacities and areas of consolidation, which are mostly distributed along the bronchovascular bundles and subpleural space.
T85 12240-12370 Sentence denotes The presence of associated interlobular septal thickening in the areas of ground glass opacity can give a crazy paving appearance.
T86 12371-12468 Sentence denotes Air bronchograms with the areas of consolidation and bronchial wall thickening are often present.
T87 12469-12588 Sentence denotes More rarely, there is a thickening of the adjacent pleura or interlobar pleura, and a small amount of pleural effusion.
T88 12589-12644 Sentence denotes There is no obvious lymphadenopathy [15] (Tables 2, 3).
T89 12645-12937 Sentence denotes The imaging features mentioned above are consistent with the findings from 81 patients in a recently reported article, in which the predominant pattern of abnormality observed was bilateral, peripheral, ill-defined, and ground glass opacification, mainly involving the right lower lobes [20].
T90 12938-13178 Sentence denotes Furthermore, in the currently available reports, the most common chest CT findings in COVID-19 patients are the peripheral areas of ground glass opacity/consolidation (without subpleural sparing) which are bilateral in distribution [21–23].
T91 13179-13311 Sentence denotes In one study, of 21 patients, most had more than two lobes affected (15 of 21, 71%) with bilateral involvement (16 of 21, 76%) [24].
T92 13312-13650 Sentence denotes Another study showed that the most common patterns of COVID-19 on thin-section CT images are pure ground glass opacity, ground glass opacity with intra- and/or interlobular septal thickening, and ground glass opacity with consolidation and consolidation, with prominent distribution in the posterior and peripheral part of the lungs [25].
T93 13651-13805 Sentence denotes In a large research cohort study, chest CT findings showed a bilateral distribution of patchy ground glass opacity and consolidation in 138 patients [26].
T94 13806-13883 Sentence denotes Typical chest radiograph and chest CT of COVID-19 are shown in Figs. 2 and 3.
T95 13884-13938 Sentence denotes Table 2 The typical features on CT imaging of COVID-19
T96 13939-13992 Sentence denotes Parameter Characteristic manifestations on CT imaging
T97 13993-14080 Sentence denotes Density Ground glass opacity and consolidation, possible interlobular septal thickening
T98 14081-14122 Sentence denotes Shape Patchy, sub-segmental, or segmental
T99 14123-14216 Sentence denotes Distribution Mid and lower lungs along the bronchovascular bundles with bilateral involvement
T100 14217-14280 Sentence denotes Location Peripheral and subpleural areas of the lung parenchyma
T101 14281-14389 Sentence denotes Concomitant signs (variable) Air bronchogram, a small amount of pleural effusion, no obvious lymphadenopathy
T102 14390-14440 Sentence denotes Table 3 Frequency of chest CT findings in COVID-19
T103 14441-14465 Sentence denotes CT signs Frequency Stage
T104 14466-14497 Sentence denotes Ground glass opacity ++++ E/A/S
T105 14498-14545 Sentence denotes Consolidation without ground glass opacity ++ S
T106 14546-14592 Sentence denotes Ground glass opacity and crazy paving ++ E/A/S
T107 14593-14642 Sentence denotes Ground glass opacity with consolidation +++ E/A/S
T108 14643-14676 Sentence denotes Patchy ground glass opacity +++ E
T109 14677-14712 Sentence denotes Bilateral distribution ++++ E/A/S/D
T110 14713-14742 Sentence denotes Peripheral distribution +++ E
T111 14743-14767 Sentence denotes Air bronchogram ++ E/A/S
T112 14768-14788 Sentence denotes Pleural effusion + S
T113 14789-14811 Sentence denotes Strip-like opacity + D
T114 14812-14986 Sentence denotes The appearance frequency of each CT characteristic is described in order from low to high as (+~++++); E, A, S, and D stand for stage early, advanced, severe, and dissipation
T115 14987-15118 Sentence denotes Fig. 2 Chest radiograph (a) in a 61-year-old man shows bilateral patchy, somewhat nodular opacities in the mid to lower lungs [16].
T116 15119-15275 Sentence denotes Unenhanced computed tomography (CT) images (b) in a 33-year-old woman., Images show multiple ground glass opacities in the periphery of the bilateral lungs.
T117 15276-15438 Sentence denotes The bilateral, peripheral patterns of opacities without subpleural sparing are common and characteristic CT findings of the 2019 novel coronavirus pneumonia [22].
T118 15439-15685 Sentence denotes Chest CT image of a 71-year-old male (c) shows consolidation in the peripheral right upper lobe and a patchy area of ground glass opacity with some associated consolidation intra- and interlobular septal thickening within the left upper lobe [25]
T119 15686-15725 Sentence denotes Fig. 3 Typical CT findings of COVID-19.
T120 15726-15889 Sentence denotes Chest CT (a) in a 75-year-old male show multiple patchy areas of pure ground glass opacity (GGO) and GGO with reticular and/or interlobular septal thickening [25].
T121 15890-16050 Sentence denotes Chest CT image of a 38-year-old male (b) shows multiple patches, grid-like lobule, and thickening of interlobular septa, typical “paving stone-like” signs [19].
T122 16051-16206 Sentence denotes An axial CT image obtained in 65-year-old female (c) shows bilateral ground glass and consolidative opacities with a striking peripheral distribution [23].
T123 16207-16403 Sentence denotes CT image of a 65-year-old male (d) shows large consolidation in the right middle lobe, patchy consolidation in the posterior and basal segment of right lower lobe, with air bronchogram inside [19]
T124 16404-16630 Sentence denotes In “Expert Recommendations from the Chinese Medical Association Radiology Branch,” chest CT manifestations of COVID-19 are divided into three stages: early, advanced, and severe, based on the extent of lesion involvement [15].
T125 16631-16833 Sentence denotes This current clinical guideline recommends dividing COVID-19 into four stages according to the time of onset and the response of body to the virus with additional dissipation stage (Fig. 4).Early stage:
T126 16834-17007 Sentence denotes Chest CT shows single or multiple scattered patchy or conglomerate ground glass opacities, predominantly in the middle and lower lungs and along the bronchovascular bundles.
T127 17008-17100 Sentence denotes These ground glass lesions are often located in peripheral and subpleural areas of the lung.
T128 17101-17230 Sentence denotes Intra- and interlobular septal thickening sometimes present in the areas of ground glass opacity can give a crazy paving pattern.
T129 17231-17417 Sentence denotes The pathological process during this stage is dilatation and congestion of the alveolar septal capillary, exudation of fluid in alveolar cavity, and interlobular interstitial edema [19].
T130 17418-17730 Sentence denotes One patient had normal chest CT at initial presentation; however, 3 days later the disease progressed and developed a solitary rounded ground glass lesion in the right lower lobe, indicating this pattern may represent the very first radiologically visible manifestation in patients infected with SARS-CoV-2 [24].
T131 17731-17746 Sentence denotes Advanced stage:
T132 17747-17850 Sentence denotes At this stage, chest CTs will show new lesions that are similar to the earlier lesions described above.
T133 17851-17978 Sentence denotes In addition, findings from the early stage of disease increase in density and extent, coexisting with the new areas of disease.
T134 17979-18076 Sentence denotes As areas of consolidation grow, air bronchograms are often present in the areas of consolidation.
T135 18077-18236 Sentence denotes A previous case report described a patient who had evolved into a mixed pattern of ground glass opacities and consolidation by 15 after onset of symptoms [27].
T136 18237-18399 Sentence denotes The pathological features in this stage are the accumulation of a cell-rich exudate in the alveolar cavity, vascular expansion, and exudation in the interstitium.
T137 18400-18505 Sentence denotes The fibrous exudation connects each alveolus through the interalveolar space to form a fusion state [19].
T138 18506-18519 Sentence denotes Severe stage:
T139 18520-18724 Sentence denotes As the disease further progresses, chest CT shows diffuse consolidation of the lungs of varying density secondary to the fibrous exudate into the alveolar cavity, air bronchograms, and bronchial dilation.
T140 18725-18798 Sentence denotes Non-consolidated areas of the lung appear as patchy ground glass opacity.
T141 18799-18953 Sentence denotes When most of the lungs are involved, the lungs appear as a “whited out lung.” The pleura is thickened and there can be a small amount of pleural effusion.
T142 18954-18972 Sentence denotes Dissipation stage:
T143 18973-19129 Sentence denotes Images show gradual resolution of the ground glass opacity and consolidation in the lungs with some residual curvilinear opacities compatible with fibrosis.
T144 19130-19186 Sentence denotes Fig. 4 CT manifestations of different stages of COVID-19
T145 19187-19355 Sentence denotes After isolation and treatment, a majority of patients infected by COVID-19 stabilize and gradually recover and on imaging the areas of disease decrease correspondingly.
T146 19356-19600 Sentence denotes However, in a small number of patients with underlying disease or advanced age, the disease progresses during the treatment with the scope of the lesions in the lungs expanding and increasing density, eventually appearing as “whited out lungs.”
T147 19602-19629 Sentence denotes Role of imaging in COVID-19
T148 19630-19838 Sentence denotes On the frontlines of fighting the COVID-19 epidemic, chest imaging (particularly chest CT) now has an irreplaceable role in the early diagnosis of COVID-19 as well as monitoring the disease’s clinical course.
T149 19839-19986 Sentence denotes COVID-19 has characteristic manifestations in the lung that are readily detected on chest CT as described in some recent publications [15, 24, 25].
T150 19987-20181 Sentence denotes In several prior reports, chest CT showed progression of disease that corresponded with worsening clinical symptoms and also disease resolution as the patients clinically recovered [21, 22, 27].
T151 20182-20361 Sentence denotes In a recent report [20], the predominant pattern of abnormality in COVID-19 observed on the basis of the interval between symptom onset and the first CT scan has some differences.
T152 20362-20634 Sentence denotes Lesions quickly evolved from focal unilateral to diffuse bilateral ground glass opacities that progressed to or co-existed with consolidations within 1–3 weeks, indicating the change through clinical course which was also reflected on the number of involved lung segments.
T153 20635-20942 Sentence denotes In a prior study of 51 patients, the absolute number of lung findings increased with the time from symptom onset and lesions with consolidations including ground glass opacities with consolidation and pure consolidation showed mildly positive correlation with the time between symptom onset and the CT [25].
T154 20943-21098 Sentence denotes Another report demonstrated mild or moderate progression of disease as manifested by increasing extent and density of lung opacities during follow-up [24].
T155 21099-21305 Sentence denotes In the context of typical clinical presentation and exposure history, some patients may present with negative results of RT-PCR for COVID-19 but have characteristic imaging features of COVID-19 on chest CT.
T156 21306-21430 Sentence denotes Subsequently, these patients whose labs were initially negative for COVID-19 did test positive later with repeat swab tests.
T157 21431-21597 Sentence denotes Thus, in patients at high risk for COVID-19, chest CT evidence of viral pneumonia may precede negative RT-PCR test results and present as an important warning signal.
T158 21598-21762 Sentence denotes A combination of repeated swab tests and CT scanning may be helpful for individuals with high clinical suspicion of COVID-19 but negative RT-PCR screening [28, 29].
T159 21763-21821 Sentence denotes Chest CT has a high sensitivity for diagnosis of COVID-19.
T160 21822-22053 Sentence denotes In a report of 51 patients with chest CT and RT-PCR assay performed within 3 days, the sensitivity of chest CT was greater than that of RT-PCR for COVID-19 at initial patient presentation (98% vs 71%, respectively, p < 0.001) [30].
T161 22054-22158 Sentence denotes In another study of 1014 patients, 59% had positive RT-PCR results, and 88% had positive chest CT scans.
T162 22159-22251 Sentence denotes The sensitivity of chest CT in suggesting COVID-19 was 97% based on positive RT-PCR results.
T163 22252-22394 Sentence denotes Between 60% and 93% of cases had initial positive CT consistent with COVID-19 prior (or parallel) to the initial positive RT-PCR results [31].
T164 22395-22447 Sentence denotes In addition, chest CT can evaluate disease severity.
T165 22448-22637 Sentence denotes In terms of the percentage of pneumonia lesions in the entire lung volume, the difference between the earlier stage patients and the severe stage patients is statistically significant [32].
T166 22638-22903 Sentence denotes In an initial prospective analysis of the clinical features of 41 patients, chest CT images of ICU patients on admission showed bilateral multiple lobular and subsegmental areas of consolidation, and overall had more imaging abnormalities than non-ICU patients [1].
T167 22904-23032 Sentence denotes Older patients may have more systemic symptoms, more extensive lung involvement, and worse prognosis than younger patients [33].
T168 23033-23244 Sentence denotes Thus, the typical CT findings of COVID-19 can not only help early screening suspected cases, but can also monitor the clinical progression and may predict severe complications such as acute respiratory diseases.
T169 23245-23405 Sentence denotes With high sensitivity for COVID-19, chest CT would play a very important role in the diagnosis and treatment of COVID-19 in the high-risk regions and countries.
T170 23406-23585 Sentence denotes In some extreme situations in very high-risk areas (Wuhan, China), CT was the one of main diagnostic criteria for this disease due to the relatively high false negative of RT-PCR.
T171 23586-23707 Sentence denotes For some low-risk regions and countries, positive predictive value of CT alone or adding CT to RT-PCR should be adjusted.
T172 23708-23763 Sentence denotes The proposition of CT could be tempered to some degree.
T173 23764-23900 Sentence denotes Therefore, to be more accurate, the role of chest CT in COVID-19 should be assessed based on the prevalence of the disease in each area.
T174 23902-23924 Sentence denotes Differential diagnosis
T175 23925-24169 Sentence denotes The CT appearance of COVID-19 shares some similarities with other diseases that cause viral pneumonia, including influenza viruses, parainfluenza virus, adenovirus, respiratory syncytial virus, rhinovirus, human metapneumovirus, etc. (Table 4).
T176 24170-24424 Sentence denotes In particular, those within the same viridae (SARS and MERS) have great similarities in imaging findings because they belong to the same coronaviridae family, and thus need to be excluded through clinical manifestations and laboratory pathogen detection.
T177 24425-24592 Sentence denotes Imaging in MERS pneumonia can also show ground glass lesions in the subpleural and basal parts with consolidation, and fibrosis changes can be left after healing [34].
T178 24593-24801 Sentence denotes In the pneumonia patients infected by respiratory syncytial virus, chest CT mainly manifested as small centrilobular nodules and areas of consolidation which are often asymmetrically distributed in the lungs.
T179 24802-24958 Sentence denotes Adenovirus pneumonia shows bilateral multifocal ground glass opacities with patchy consolidations on CT images and may show lobar or segmental distribution.
T180 24959-25130 Sentence denotes Human parainfluenza virus pneumonia may show centrilobular nodules with bronchial wall thickening that differentiates it from the imaging appearances of the other viruses.
T181 25131-25310 Sentence denotes Radiographs in patients with influenza pneumonia show bilateral patchy areas of ground glass opacity with or without focal areas of consolidation, usually in the lower lobes [34].
T182 25311-25519 Sentence denotes In a report on H1N1 influenza infection, in addition to the most common findings of ground glass opacity, interlobular septal thickening, and centrilobular nodules were the second most frequent findings [35].
T183 25520-25729 Sentence denotes Rapidly progressive ground glass opacities and consolidations with air bronchograms and interlobular septal thickening, with right lower lobe predominance, are the main imaging findings in H7N9 pneumonia [36].
T184 25730-25955 Sentence denotes Viruses are a common cause of respiratory infection and recognition of viral pneumonia patterns may help in the differentiation among viral pathogens, while the definite diagnosis is achieved by laboratory detection of virus.
T185 25956-26015 Sentence denotes Table 4 Differential diagnosis of different viral pneumonia
T186 26016-26045 Sentence denotes Virus Imaging characteristics
T187 26046-26210 Sentence denotes MERS-COV Ground glass lesions in the subpleural and basal portions of the lung parenchyma with areas of consolidation; fibrotic changes can be present after healing
T188 26211-26295 Sentence denotes H1N1 Ground glass opacity, interlobular septal thickening, and centrilobular nodules
T189 26296-26396 Sentence denotes H7N9 Ground glass opacity and consolidation with air bronchograms and interlobular septal thickening
T190 26397-26536 Sentence denotes Human parainfluenza virus Centrilobular nodules with bronchial wall thickening, findings which differentiate it from other viral infections
T191 26537-26672 Sentence denotes Respiratory syncytial virus Small centrilobular nodules and areas of parenchymal consolidation; asymmetrically distributed in the lungs
T192 26673-26800 Sentence denotes Adenovirus pneumonia Bilateral multifocal ground glass opacities, patchy consolidation in a lobar and/or segmental distribution
T193 26801-26926 Sentence denotes In addition, COVID-19 also needs to be distinguished from mycoplasma pneumonia, chlamydia pneumonia, and bacterial pneumonia.
T194 26927-27097 Sentence denotes Other diseases that need to be identified are vasculitis, acute interstitial pneumonia, connective tissue-related lung disease, and cryptogenic organizing pneumonia [15].
T195 27099-27110 Sentence denotes Conclusions
T196 27111-27367 Sentence denotes The COVID-19 initially began in China; however, it is extremely contagious and has spread beyond China to many other countries, raising concerns and posing not only a huge threat to global public health but also a huge economic burden and panic to society.
T197 27368-27463 Sentence denotes Early disease recognition can prompt early patient isolation and early diagnosis and treatment.
T198 27464-27780 Sentence denotes In the current situation, imaging of COVID-19, particularly with chest CT, has a very high value because it shows characteristic manifestations and has enabled frontline clinicians to have primary diagnosis in their first contact with suspected patients, even in the presence of initially false negative lab results.
T199 27781-27972 Sentence denotes Earlier diagnosis with the aid of imaging allows for early containment and response to this communicable disease as well as overcoming the outbreak as soon as possible through a joint effort.
T200 27974-28007 Sentence denotes Electronic supplementary material
T201 28009-28027 Sentence denotes ESM 1 (DOCX 39 kb)
T202 28029-28045 Sentence denotes Publisher’s note
T203 28046-28164 Sentence denotes Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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T207 28486-28830 Sentence denotes This study was funded by Construction of Key Laboratory (Cultivation) of Chinese Academy of Medical Sciences(2019PT310025), National Foreign Expert Talent Project (G20190001630), Education Reform Project of Peking Union Medical College (10023201900204), and Clinical and Translational Fund of Chinese Academy of Medical Sciences (2019XK320063).
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T210 28877-28935 Sentence denotes The scientific guarantor of this publication is Minjie Lu.
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