Coronavirus Disease 2019 (COVID-19) Pneumonia: Early Stage Chest CT Imaging Features and Clinical Relevance

Background: Early diagnostic of COVID-19 pneumonia remains a dilemma. We aimed to investigate the importance of early stage chest CT imaging features in the early diagnosis of COVID-19 pneumonia. Methods: This retrospective investigation included 91 patients (49 males and 42 females, aged 18-87 years) confirmed with COVID-19 infection and presented as early stage CT images between January 21, 2020 to February 10, 2020. The early stage CT imaging features were evaluated. Findings: 66 of 91 (72.5%) COVID-19 patients had a history of exposure to Wuhan or infected patient. The most common symptoms were fever (69/91, 75.8%) and dry cough (60/91, 65.9%). A total of 996 lesions were found in 91 enrolled patients. The early stage CT features included the following: The lesions were mainly bilateral (955/966, 95.9%) and peripheral distribution (607/996, 60.9%), and distributed along the bronchial and vascular bundles (517/996, 51.9%). The most common lesions were small patchy/strip shaped (678/996, 68.1%) pure ground glass opacities (639/996, 64.2%). Furthermore, early stage CT imaging also presents some characteristic signs, including vascular thickening sign in 35/91 (38.5%) patients, crazy paving sign in 56/91 (61.5%) patients, air bronchogram sign in 42/91 (46.2%) patients, and nodule with halo sign in 15 (16.5%) patients. Interpretation: Multiple small patchy/strip shaped GGO in bilateral and subpleural lungs are the characteristic features of early stage CT of COVID-19 pneumonia, which combined with clinical and laboratory data can help rapid diagnosis and guide early clinical management for COVID-19 pneumonia patients. Funding Statement: National Natural Science Foundation of China (81803778). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Our institutional review board approved the study and did not require additional informed consent for reviewing the patients’ medical records and images.