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CT and clinical assessment in asymptomatic and pre-symptomatic patients with early SARS-CoV-2 in outbreak settings

  1. Author:
    Varble, Nicole
    Blain, Maxime
    Kassin, Michael
    Xu, Sheng
    Turkbey, Evrim B
    Amalou, Amel
    Long, Dilara
    Harmon,Stephanie
    Sanford, Thomas
    Yang, Dong
    Xu, Ziyue
    Xu, Daguang
    Flores, Mona
    An, Peng
    Carrafiello, Gianpaolo
    Obinata, Hirofumi
    Mori, Hitoshi
    Tamura, Kaku
    Malayeri, Ashkan A
    Holland, Steven M
    Palmore, Tara
    Sun, Kaiyuan
    Turkbey, Baris
    Wood, Bradford J [ORCID]

  2. Author Address

    Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center and National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA., Philips Research North America, Cambridge, MA, USA., Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA., National Cancer Institute, National Institutes of Health, Bethesda, MD, USA., Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA., State University of New York Upstate Medical University, Syracuse, NY, USA., Nvidia Corporation, Bethesda, MD, USA., Department of Radiology, Xiangyang NO. 1 People 39;s Hospital Affiliated to Hubei University of Medicine, Xiangyang, Hubei, China., Department of Radiology, Fondazione IRCCS C 224; Granda Ospedale Maggiore Policlinico, Milan, Italy., Department of Health Sciences, University of Milano, Milan, Italy., Self-Defense Forces Central Hospital, Tokyo, Japan., National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA., Hospital Epidemiology Service, NIH Clinical Center, Bethesda, MD, USA., Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA., Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center and National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA. bwood@nih.gov., Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA. bwood@nih.gov., National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. bwood@nih.gov., National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA. bwood@nih.gov.,
    1. Year: 2020
    2. Date: Nov 04
    3. Epub Date: 2020 11 04
  2. Journal: European radiology
    1. Pages: 1-12
  4. Type of Article: Article
  5. ISSN: 0938-7994
  1. Abstract:

    Objectives The early infection dynamics of patients with SARS-CoV-2 are not well understood. We aimed to investigate and characterize associations between clinical, laboratory, and imaging features of asymptomatic and pre-symptomatic patients with SARS-CoV-2. Methods Seventy-four patients with RT-PCR-proven SARS-CoV-2 infection were asymptomatic at presentation. All were retrospectively identified from 825 patients with chest CT scans and positive RT-PCR following exposure or travel risks in outbreak settings in Japan and China. CTs were obtained for every patient within a day of admission and were reviewed for infiltrate subtypes and percent with assistance from a deep learning tool. Correlations of clinical, laboratory, and imaging features were analyzed and comparisons were performed using univariate and multivariate logistic regression. Results Forty-eight of 74 (65%) initially asymptomatic patients had CT infiltrates that pre-dated symptom onset by 3.8 days. The most common CT infiltrates were ground glass opacities (45/48; 94%) and consolidation (22/48; 46%). Patient body temperature (p < 0.01), CRP (p < 0.01), and KL-6 (p = 0.02) were associated with the presence of CT infiltrates. Infiltrate volume (p = 0.01), percent lung involvement (p = 0.01), and consolidation (p = 0.043) were associated with subsequent development of symptoms. Conclusions COVID-19 CT infiltrates pre-dated symptoms in two-thirds of patients. Body temperature elevation and laboratory evaluations may identify asymptomatic patients with SARS-CoV-2 CT infiltrates at presentation, and the characteristics of CT infiltrates could help identify asymptomatic SARS-CoV-2 patients who subsequently develop symptoms. The role of chest CT in COVID-19 may be illuminated by a better understanding of CT infiltrates in patients with early disease or SARS-CoV-2 exposure.

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External Sources

  1. View Full Text
  2. DOI: 10.1007/s00330-020-07401-8
  3. PMID: 33146796
  4. PMCID: PMC7610169
  5. View record in Web of Science®
  6. WOS: 000585789100004
  7. PII : 10.1007/s00330-020-07401-8

Library Notes

  1. Fiscal Year: FY2020-2021
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