Dynamic changes in chest CT findings of patients with coronavirus disease 2019 (COVID-19) in different disease stages: a multicenter study

Background: To investigate the dynamic changes in high-resolution computed tomography (HRCT) findings of coronavirus disease 2019 (COVID-19) patients with different severities in different disease stages. Methods: We retrospectively collected the clinical and imaging data of 96 patients in Yunnan Province, China, who were diagnosed with COVID-19 between January 22 and March 15, 2020. Based on disease severity, the COVID-19 patients were classified into four types: mild (n=15), moderate (n=59), severe (n=19), and critical (n=3). Based on hospital stay and number of computed tomography (CT) scans, the clinical/disease course was divided into four stages, including stage 1 (days 0-4), stage 2 (days 5-9), stage 3 (days 10-14), and stage 4 (days 15-19). The HRCT findings, CT value, and lesion volume were analyzed for each stage and compared among the four stages of COVID-19 patients. Results: CT findings were negative over the four stages for all mild COVID-19 patients. More lesions were found in the peripheral lung fields than in peripheral + central fields (P<0.05), and the number of negative patients in stage 4 were more than those in stages 1-3 (P<0.05). The left and right lower lobe were the most frequently affected lobes (P<0.05). In moderate patients, round ground glass opacities (GGOs) decreased from stage 1 to stage 4; partial consolidation peaked in stage 2 and then decreased in stages 3-4; fibrous stripes and subpleural lines increased from stage 1 and peaked in stage 4. Partial consolidation and consolidation were more common in severe patients than in moderate patients over the disease course (P<0.05). Critical patients showed significant partial consolidation and consolidation; The CT value, lesion volume and lesion volume percentage significantly decreased from stages 1-2 to stage 4 (all P<0.05). Conclusions: The dynamic changes in lung HRCT images are clinically related to the disease course of COVID-19.