International Journal of Engineering Technology and Basic Sciences

Volume: 01, Issue No: 01, August 2021

www.ijetbs.com
Surya Research Publishers

The value of HRCT Chest in Diagnosis of COVID 19

and its Correlation with RT-PCR
Dr. AyeshaKamran1 | Dr. FatimaAbid2 | Dr. Kamran Khan3

1Assistant Professor Radiology DHQ Sargodha

2Assistant professor physiologyDepartment, SMCJSMU, MBBS, MPhil, MBA, CMed
3Assistant professor histopathology Pak international medical college Peshawar

To Cite this Article

Dr. Ayesha Kamran, Dr. Fatima Abid, Dr. Kamran Khan, “The value of HRCT Chest in Diagnosis of COVID 19 and its
Correlation with RT-PCR”, International Journal of Engineering Technology and Basic Sciences, Vol. 01, Issue 01, August
2021, pp.-006-010.

ABSTRACT
Objective: The objective of the study is to link pulmonary participation CT findings in COVID-19 positive
patients with clinical findings and the impact of the CT Score in the results of patients' predictions.
StudyDesign:Single-centeredretrospectiveanalysis
Place and Duration of Study: The study was performed between June and November 2020. Research was
conducted in Sargodha District Headquarters Teaching Hospital.
Methodology: 138 COVID-19 patients were recorded for chest CT analysis and clinical evaluation from June
to November 2020 who were positive for reverse transcriptase polymerase chain reaction. Based on the
spectrum of lobular participation, quantitative CT scores were taken into account. Clinical results linked the
data.
Results:106 (76.8%) of patients were males and 32 (23.18%) were women. Of the 138 positive individuals, 51
(36.9%) were classified as severe and 87 (63.04%) were classified as light. 89 (64.4 percent) individuals have
normal chest CT, whereas 49 (35.5 percent) have parenchymal abnormalities. Among patients with abnordic
CT results, multilobar (88.2 percent) with a predominant peripheral and post-distribution is often found in
39/51 (76.5 percent). Ground glass opacity is the main anomaly in all 48 (97.9%) instances. Pure ground
glass opacity is seen in 13 (27.08 percent) while mixed consolidated ground glass opacity is reported in 17.
(35.4 percent ).
Conclusion: Chest CT results have a possible function in the prediction of good patient consequences of
COVID-19. Diagnostic process can be helpful since CT results are associated with disease severeity and
clinical symptoms.

KEYWORDS: COVID-19, High–resolution computed tomography, Chest X-ray (CXR) and RT-PCR

Copyright © 2021International Journal of Engineering Technology and Basic Sciences

All rights reserved.

nations of the world1. More than one million

I. INTRODUCTION coronavirus fatalities have been caused, which
The recent explosion of the new SARS-CoV-2 indicate an alarming number2. Because of
coronavirus in Wuhan, in the province of Hubei in environmental, socio-economic and ecological
China has turned pandemic. WHO Emergency variables, epidemics of human illnesses have been
Committee proclaimed a global health emergency diversified since the 1980s. Coronaviruses were
in response to emergencies in China and other not thought to be very pathological before the
development of severe acute respiratory syndrome

6International Journal of Engineering Technology and Basic Sciences

 Dr. Ayesha Kamran, Dr. Fatima Abid, Dr. Kamran Khan: The value of HRCT Chest in Diagnosis of COVID 19 and its
Correlation with RT-PCR
in 2003 in China and Saudi Arabia in 2012.3 and mediastine lymph node enlargement.
The literature focuses on high resolution Ground-glass attenuation was described as a vast
compute tomography (HRCT), a kind of CT rise in lung opacity with bronchial and vascular
(computed tomography) since it is more delicate periphery preservation. The consolidation of the
than chest x-rays. CT was the initial line of arteries and the airway walls is characterised as an
research for COVID-19 in China4. The reason why even rise in parenchymal pulmonary attenuation.
this method is used for patients with COVID-19 is In areas not adjacent to areas of soil glass
that HRCT is highly sensitive5. The sensitivity of attenuation and/or consolidation, bronchial wall
simultaneous pharyngeal and nasal swabs is not thickening was identified. Air bronchograms were
sufficient, depending on the manner of specimen characterised as a pattern of air-filled bronchi on a
collection and the technical individuality of the high-matrix airless lung backdrop. Interlobular
test. COVID-19 patients should not be diagnosed septal thickening was determined by the thickness
promptly for pharyngeal and nasal swab and visibility of a septum compared to normal
specimens because to lengthy TAT for viral testing circumstances. Mediastinal lymphadenopathy was
coupled with a faint RT-PCR sensitivity (real-time assessed when the lymph node's minimum
reverse-transcriptase polymerase chain reaction). diameter was more than 10 mm. The anomalies
Chest diagnostic imaging, together with clinical were unilateral or bilateral. The distribution was
symptoms, epidemiological history and laboratory ranked as peripheral, centro-globe, peripheral and
testing, has a key significance in the diagnosis and centro-globe, focal, multifocal and diffuse. Focal
gravity evaluation of COVID-19. was defined as a single anomaly, multifocal, and
Chest CT imaging has shown that it is responsive diffuse as a broad involvement of most of one lung
to certain of COVID-19 symptoms than chest capacity. The upper and lower lung distributions
radiography (CR). The objective of this study was to were categorised as dominating. Chest CT was
evaluate the possible usefulness of chest CT in divided in four categories (typical CT pattern,
early identification of COVID-19 and to investigate probable CT pattern, inconsistent and negative CT
its relevance in the management of the patient patterns for pneumonia) and afterwards into CT
population in Pakistan. negative (inconsistent CT pattern and pneumonia
negative) and CT positive (typical and potential CT
II. METHODOLOGY pneumonia pattern) for COVID-19. This
In this investigation, symptomatic 352 categorization enabled doctors and
individuals (females, men; mean age 58 ± 12 years) anesthesiologists quickly assign patients to a lung
were assessed from June to October 2020 with parenchyma involvement unit.
clinically suspected COVID-19. The DHQ Teaching Statistical analyses have been carried out using
Hospital Sargodha Ethical Committee authorised SPSS (v. 25). Mean values of continuous variables
the study and fully completed informed approval as standard deviation were expressed (SD). For
forms for applicants. The study eliminated patients single comparisons, Mann-Whitney test was
with negative RT-PCR results. Of 352 patients with employed, whereas Kruskal-Wallis test was used
RT-PCR, 138 had SARS-Cov-2 positive findings for many comparisons. Percentages of
and so had Chest CT imaging. Chest CT exams demographic properties were stated and then
were done in a special COVID-19 dedicated CT compared with the exact test of Fisher. An
scan room of our Emergency Radiology Unit with a important statistical p-value was <0.05.
64-slice scanning system (Siemens SOMATOM
Sensation, Siemens Medical Solutions, Forchheim) III. RESULTS
All data were rebuilt with a slice thickness of 1.0 Of 138 positive individuals, 51 (36.9%) were
mm to get high-resolution pictures. The severity of classified as severe while 87 (63.04%) were
the illness was assessed according to the classified as light. 106 (76.8%) of patients were
standards established by the Center of Disease males and 32 (23.18%) were women. The average
Control (CDC). age was 45. Compared with moderate patients,
Nine findings of CTs were seen as ground glass median age 55 years vs. 40 years was older in
opacities (GGOs), consolidation, GGO and patients with severe conditions. They had more
consolidation mixed, single or multiple solid fundamental comorbidities such as cardiovascular
nodules surrounded with ground glass (halo sign), disease (8[5.7%] vs. 0), malignancy (5[3.6%] vs.
wall thickening bronchial, air bronchogram, 2[1.4%]), diabetes (13[9.4%] vs. 4[2.8%]), and high
interlobular septal thickening, pleural effusion, blood pressure; (6[4.3 percent ] vs 12[8.6 percent ]).

7International Journal of Engineering Technology and Basic Sciences

 Dr. Ayesha Kamran, Dr. Fatima Abid, Dr. Kamran Khan: The value of HRCT Chest in Diagnosis of COVID 19 and its
Correlation with RT-PCR
Most of the patients had an epidemic background. implication. Twenty-eight (57.1 per cent) patients
exhibited 5 lobe involvement, whereas 9(18.3 per
Table 1: Demographic Characteristics of COVID-19 cent) showed single lobe involvement and two lobe
Patients. (Significantp-value<0.05) involvement. In 49 (100 percent) patients, 24 (48.9
percent) were posteriorly distributed, whereas 26
Characteristi All Severe Mild p-valu (53.06 percent) were post- and pre-distributed. But
cs patient cases Cases e none of the patients exhibited anterior distribution
s (n= (n= 87) on their own.
(n=138) 51) There was no purely central distribution in any of
Living or 82 29 53 0.020 the cases. In 47 (95%) patients peripheral
traveling (59.4%) (56.8 (60.9%) 3 distribution was detected, 14 (8.16%) of which had
from %) peripheral and central distributions, while 33
epidemic (67.3%) had peripheral distribution. In 48 (97.9
area percent) individuals, the main anomaly, Ground
Contact with 34 13 21 0.409 Glass Opacity (GGO) was found. GGO mixed
positive (24.6%) (25.4 (24.13 consolidation has been found in 17(35.41%),
patients %) %) 19(39.5%) individuals with intralobular and
No contact 18 8 10 0.125 interlobular septal thickening, and 13 (27.08%)
history (13.04 (15.6 (11.4%) patients with pure GGO.
%) %)
Comorbiditie 54 21 33 0.003 Table 2: Chest CT findings
s (39.13 (41.7 (37.9%)
%) %) CT findings of Lung No. of %
Hypertensio 18 6 12 … abnormalities patients
n (13.04 (11.7 (13.7%) Absent 89 64.4%
%) %) Present 49 35.5%
Malignancy 6 2 3 … Lung Involvement
(4.34%) (3.9%) (3.44%) Right lung 5 10.2%
Smoking 14 5 9 … Left lung 7 14.2%
history (10.1%) (9.8%) (10.3%) Bilateral 35 71.4%
Cardiovascul 8 (5.79) 8 0 … Lobular involvement
ar disease (15.6 Left upper lobe 39 79.5%
%) Left middle lobe 41 83.6%
Left lower lobe 28 57.14%
Right lower lobe 43 87.7%
Right middle lobe 36 73.46%
Right upper lobe 46 93.87
1 lobe 5 10.2%
2 lobes 4 8.16%
3 lobes 1 1.6%
4 lobes 11 22.4%
5 lobes 28 57.1%
Opacity location
Central 0 0
Peripheral 33 67.3%
Figure1: Percentages of COVID-19 patients with in
Central and 14 8.16%
different age groups
peripheral
Chest CT observations: Lung parenchyma
Significant difference was witnessed while
abnormalities were detected in 49 (35.5%)
comparing clinical findings and CT score (<0.002).
individuals whereas normal chest RT outcomes
Incritical category the CT mark was higher
were seen in 89 (64.4%). 35 (71.4%) of 49 patients
significantly while making multiple comparisons
with abnormal CT results had bilateral pulmonary
(meanvalue ± SD: 23.6 ± 3, 15-24) as compared

8International Journal of Engineering Technology and Basic Sciences

 Dr. Ayesha Kamran, Dr. Fatima Abid, Dr. Kamran Khan: The value of HRCT Chest in Diagnosis of COVID 19 and its
Correlation with RT-PCR
tomild category (7.6± 5; range 1-18) (p<0.002). In with clinical symptoms in COVID-19. The
severecategory CT score was significantly higher percentage of critical cases reported in the research
(20.4 ± 2.9; range 15-30) than in mild cases (9.3 ± was 10,2%, 59% common and 30,5% mild14.
4; range0-15) (p<0.002). Between critical Caruso D et al. noted that in symptomatic
andseverecategoriesnosignificant value havebeen individuals 96.6% of pulmonary results were found
observed(p=0.7921). on CT. The main symptoms were fever (61%), while
56% were coughed and 33% had duspnea15. A
IV. DISCUSSION research found a 100% CT positive rate in which
The existence of bilateral GGOs is termed 2/3 of dyspnea 10 percent and fever 86 percent
COVID-19 whether or not the regions of showed moderate symptoms 16. The symptomatic
consolidation are present as shown by this study7. COVID-19 individuals in the community were
It was found that the presence of GGOs reflected verified by the CT findings compared with data
the link between the imagery and interstitial from other nations. CT scans are only conducted in
thickening of the acute phase diffuse alveolar positive patients of RT-PCR, but not in all
injury in the early stages8. In the late development symptomatic patients, and this is why our nation
of illness, activation of T and B virus mediated cells has a low incidence of CT. Comorbid diseases have
causes autoimmune responses, generating strong been related with an increased severity rate17.
inflammatory cytokines9. Due to the variety of Patients who had lung parenchymal abnormalities
conditions, including subclinical forms and on chest CT also had multilobar and bilateral
asymptomatic diseases coupled with clinical pulmonary opacific distribution. Our results are
course of ARDS, it is unexpected. consistent with the location and kind of pulmonary
Ferritin is a crucial modulator of immunological opacity seen in COVID-19 patients. The
disorder and adds a great deal to cytokine tempests predominant abnormality was pure GGO (13) and
that may cause the severity of the disease. An rise GGO (17) with mixed consolidation. The results are
in ferritin levels might induce serious Covid-198 consistent with several research reported in Review
problems. One research revealed a higher 18 by Salehi et al.
proportion of serum ferritin in very severe
COVID-199 individuals. Another study showed a V. CONCLUSION
strong link between increasing ferritin levels and CT results can help anticipate the transitory
mortality. They noted that, within 16 days of result of positive COVID-19 patients. In minimally
hospitalisation, the median ferritin level surpassed symptomatic RT-PCR patients, a substantial
9 normal range, increasing the risk of death10. proportion (64.4%) of normal chest CTs were seen
No accessible prognostic biomarkers are as positive COVID-19. The same CT characteristics
available to identify individuals who need have been found in CT positive patients, as
immediate medical care or to estimate the death numerous investigations in bilateral and
rate10. Correlation of progression of disease CT multilobar dispersion with peripheral and
prediction and clinical results may be useful to post-predilection have documented with most of
clinically assisting patients in early treatment, GGOs. This study highly suggests chest CT for
however COVID-19 therapy is based instead on COVID-19 positive individuals who are shown to be
empirical judgments. The assumption was verified beneficial in avoiding people with low illness
by the use of Pan et al. lobular-centered validated probability.
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