COVID-19 Diagnostic Imaging Recommendations

Cynthia Czawlytko, MD; Rydhwana Hossain, MD; Charles S White, MD

Appl Radiol. 2020;49(3):10/15/2020

Abstract and Introduction

Introduction

COVID-19, the infectious disease caused by SARS-CoV-2, has had an immense global impact since its emergence from Wuhan, China in late 2019, and its declaration by the World Health Organization as a pandemic in March 2020. As a result, the scientific community has found itself in a race against time to control the spread of the disease with efforts aimed at early disease recognition and isolation of affected patients. Medical imaging has emerged as a useful tool in this race.

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Abstract and Introduction
Clinical Presentation
Chest Radiography
Chest CT
Lung Ultrasound
Society Recommendations
Physician Resources and Future Implications
Conclusion
References

Table 1. Non-pulmonary Organ Systems Affected by COVID-19
	Complications	Symptoms
Cardiovascular	Myocardial injury, demand ischemia, heart failure, myocarditis, pulmonary embolism, deep vein thrombosis	Chest pain, shortness of breath, hemoptysis
Neurological	Acute cerebrovascular disease, acute hemorrhagic necrotizing encephalopathy	Central nervous system (CNS) -headache, dizziness, impaired consciousness, ataxia, acute cerebrovascular disease, and epilepsy). Peripheral nervous system (PNS) symptoms (hypogeusia, hyposmia, and neuralgia), and skeletal muscular symptoms
Abdominal	Alkalosis, hyperkalemia, acute renal injury, abnormal liver function tests	Nausea, vomiting, diarrhea, abdominal pain
Hematological	Lymphocytopenia, leukocytosis, thrombocytosis, disseminated intravascular coagulation, hemophagocytic lymphohistocytosis
Musculoskeletal	Rhabdomyolysis	Myalgia

Table 2. Proposed Reporting Language for CT Findings Related to COVID-19*
Routine screening CT for diagnosis or exclusion of COVID-19 is currently not recommended by most professional organizations or the US Centers for Disease Control and Prevention.
COVID-19 Pneumonia Imaging Classification	Rationale	CT Findings Language	Suggested Reporting
Typical appearance	Commonly reported imaging features of greater specificity for COVID-19 pneumonia.	• Peripheral, bilateral, GGO with or without consolidation or visible intralobular lines ("crazy-paving").	"Commonly reported imaging features of (COVID-19) pneumonia are present.
		• Multifocal GGO of rounded morphology with or without consolidation or visible intra-lobular lines ("crazy-paving").	Other processes such as influenza pneumonia and organizing pneumonia, as can be seen with drug toxicity and connective tissue disease, can cause a similar imaging pattern."
		• Reverse halo sign or other findings of organizing pneumonia (seen later in the disease).
Indeterminate appearance	Nonspecific imaging features of COVID-19 pneumonia.	• Absence of typical features AND presence of Multifocal, diffuse, perihilar, or unilateral GGO with or without consolidation lacking a specific distribution and are non-rounded or non-peripheral.	"Imaging features can be seen with (COVID-19) pneumonia, though are nonspecific and can occur with a variety of infectious and noninfectious processes."
Indeterminate appearance	Nonspecific imaging features of COVID-19 pneumonia.	• Few very small GGO with a non-rounded and non-peripheral distribution.
Atypical appearance	Uncommonly or not reported features of COVID-19 pneumonia.	• Absence of typical or indeterminate features AND presence of Isolated lobar or segmental consolidation without GGO.	"Imaging features are atypical or uncommonly reported for (COVID-19) pneumonia. Alternative diagnoses should be considered."
		• Discrete small nodules. (centrilobular, "tree-in-bud").
		• Lung cavitation
		Smooth interlobular septal thickening with pleural effusion.
Negative for pneumonia	No features of pneumonia	No CT features to suggest pneumonia.	"No CT findings present to indicate pneumonia. (Note: CT may be negative in the early stages of COVID-19.)."

*Used with permission from Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19- https://pubs.rsna.org/doi/pdf/10.1148/ryct.2020200152

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