Zhiqi Yang1, Xiaofeng Chen1, Ruibin Huang2, Shengkai Li3, Daiying Lin4, Zhijian Yang5, Hongfu Sun6, Guorui Liu7, Jinming Qiu7, Yanyan Tang7, Jianning Xiao4, Yuting Liao8, Xianheng Wu4, Renhua Wu7, Xiangguang Chen9, Zhuozhi Dai10. 1. Department of Radiology, Meizhou People's Hospital, Meizhou, Guangdong, 514031, People's Republic of China. 2. Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China. 3. Department of Radiology, Huizhou Municipal Central Hospital, Huizhou, 516001, Guangdong, China. 4. Department of Radiology, Shantou Central Hospital, Shantou, Guangdong, 515041, People's Republic of China. 5. Department of Radiology, Yongzhou People's Hospital, Yongzhou, Hunan, 425006, People's Republic of China. 6. School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Queensland, 4072, Australia. 7. Department of Radiology, 2nd Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515000, People's Republic of China. 8. GE Healthcare, Guangzhou, 510623, China. 9. Department of Radiology, Meizhou People's Hospital, Meizhou, Guangdong, 514031, People's Republic of China. cxg966504@163.com. 10. Department of Radiology, 2nd Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515000, People's Republic of China. zhuozhi@ualberta.ca.
Abstract
BACKGROUND: To investigate the CT imaging and clinical features of three atypical presentations of coronavirus disease 2019 (COVID-19), namely (1) asymptomatic, (2) CT imaging-negative, and (3) re-detectable positive (RP), during all disease stages. METHODS: A consecutive cohort of 79 COVID-19 patients was retrospectively recruited from five independent institutions. For each presentation type, all patients were classified into atypical vs. typical groups (i.e., asymptomatic vs.symptomatic, CT imaging-negative vs. CT imaging-positive, and RP and non-RP,respectively). The chi-square test, Student's t test, and Kruskal-Wallis H test were performed to compare CT imaging and clinical features of atypical vs. typical patients for all three presentation categories. RESULTS: In our COVID-19 cohort, we found 12.7% asymptomatic patients, 13.9% CT imaging-negative patients, and 8.9% RP patients. The asymptomatic patients had fewer hospitalization days (P=0.043), lower total scores for bilateral lung involvement (P< 0.001), and fewer ground-glass opacities (GGOs) in the peripheral area (P< 0.001) than symptomatic patients. The CT imaging-negative patients were younger (P=0.002), had a higher lymphocyte count (P=0.038), had a higher lymphocyte rate (P=0.008), and had more asymptomatic infections (P=0.002) than the CT imaging-positive patients. The RP patients with moderate COVID-19 had lower total scores of for bilateral lung involvement (P=0.030) and a smaller portion of the left lung affected (P=0.024) than non-RP patients. Compared to their first hospitalization, RP patients had a shorter hospitalization period (P< 0.001) and fewer days from the onset of illness to last RNA negative conversion (P< 0.001) at readmission. CONCLUSIONS: Significant CT imaging and clinical feature differences were found between atypical and typical COVID-19 patients for all three atypical presentation categories investigated in this study, which may help provide complementary information for the effective management of COVID-19.
BACKGROUND: To investigate the CT imaging and clinical features of three atypical presentations of coronavirus disease 2019 (COVID-19), namely (1) asymptomatic, (2) CT imaging-negative, and (3) re-detectable positive (RP), during all disease stages. METHODS: A consecutive cohort of 79 COVID-19patients was retrospectively recruited from five independent institutions. For each presentation type, all patients were classified into atypical vs. typical groups (i.e., asymptomatic vs.symptomatic, CT imaging-negative vs. CT imaging-positive, and RP and non-RP,respectively). The chi-square test, Student's t test, and Kruskal-Wallis H test were performed to compare CT imaging and clinical features of atypical vs. typical patients for all three presentation categories. RESULTS: In our COVID-19 cohort, we found 12.7% asymptomatic patients, 13.9% CT imaging-negative patients, and 8.9% RP patients. The asymptomatic patients had fewer hospitalization days (P=0.043), lower total scores for bilateral lung involvement (P< 0.001), and fewer ground-glass opacities (GGOs) in the peripheral area (P< 0.001) than symptomatic patients. The CT imaging-negative patients were younger (P=0.002), had a higher lymphocyte count (P=0.038), had a higher lymphocyte rate (P=0.008), and had more asymptomatic infections (P=0.002) than the CT imaging-positive patients. The RP patients with moderate COVID-19 had lower total scores of for bilateral lung involvement (P=0.030) and a smaller portion of the left lung affected (P=0.024) than non-RP patients. Compared to their first hospitalization, RP patients had a shorter hospitalization period (P< 0.001) and fewer days from the onset of illness to last RNA negative conversion (P< 0.001) at readmission. CONCLUSIONS: Significant CT imaging and clinical feature differences were found between atypical and typical COVID-19patients for all three atypical presentation categories investigated in this study, which may help provide complementary information for the effective management of COVID-19.