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World J Radiol. Nov 28, 2020; 12(11): 261-271
Published online Nov 28, 2020. doi: 10.4329/wjr.v12.i11.261
Multimodality imaging in COVID-19 patients: A key role from diagnosis to prognosis
Antonello D'Andrea, Juri Radmilovic, Andreina Carbone, Alberto Forni, Ercole Tagliamonte, Lucia Riegler, Biagio Liccardo, Fabio Crescibene, Cesare Sirignano, Giovanna Esposito, Eduardo Bossone
Antonello D'Andrea, Department of Cardiology, Chair of Cardiology–Luigi Vanvitelli University–Monaldi Hospital-Association of Operating Room Nurses Ospedali Dei Colli–Naples, Naples 80131, Italy
Juri Radmilovic, Alberto Forni, Ercole Tagliamonte, Lucia Riegler, Giovanna Esposito, Department of Cardiology and Intensive Coronary Unit, “Umberto I” Hospital, Nocera Inferiore 84014, Salerno, Italy
Andreina Carbone, Biagio Liccardo, Department of Cardiology, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples 80131, Italy
Fabio Crescibene, M. Scarlato COVID Hospital, Scafati Hospital, Scafati 84018, Italy
Cesare Sirignano, Institute of Biostructures and Bioimaging of National Research Council, National research Council, Naples 80145, Italy
Eduardo Bossone, Division of Cardiology, Cardarelli Hospital, Naples 80131, Italy
Author contributions: D’Andrea A designed the research study, performed the medical literature research, analyzed the data and wrote the manuscript; Radmilovic J analyzed the data and wrote the manuscript; Carbone A, Forni A and Tagliamonte E analyzed the data; Riegler L, Liccardo B and Crescibene F performed the research and wrote the paper; Sirignano C, Esposito G and Bossone E analyzed the data; All authors have read and approve the manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with the senior author or any of the other coauthors who contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Antonello D'Andrea, MD, PhD, Chief Doctor, Professor, Department of Cardiology, Chair of Cardiology–Luigi Vanvitelli University–Monaldi Hospital-Association of Operating Room Nurses Ospedali Dei Colli–Naples, Leonardo Bianchi Street, Naples 80131, Italy. antonellodandrea@libero.it
Received: August 31, 2020
Peer-review started: August 31, 2020
First decision: September 15, 2020
Revised: September 30, 2020
Accepted: October 19, 2020
Article in press: October 19, 2020
Published online: November 28, 2020
Processing time: 90 Days and 16.5 Hours
Abstract

The integrated clinical, laboratory and ultrasound approach is essential for the diagnosis, evaluation and monitoring of the patient's therapy in coronavirus disease 2019 pneumonia. The ideal imaging approach in this context is not yet well defined. Chest X-ray is characterized by low sensitivity in identifying earlier lung changes. The "bedside" pulmonary ultrasound has an undeniable series of advantages in the patient at high infectious risk and can provide incremental data in the respiratory intensive care for the serial control of the individual patient as well as for the home delivery of the stabilized subjects. Pulmonary computed tomography shows high sensitivity but should not be routinely performed in all patients, because in the first 48 h it can be absolutely negative and in the late phase the imaging findings may not change the therapeutic approach. Echocardiography should be limited to patients with hemodynamic instability to assess ventricular function and pulmonary pressures.

Keywords: COVID-19; Interstitial pneumonia; Pulmonary computed tomography; Echocardiography; Lung ultrasound; Thromboembolism

Core Tip: Coronavirus disease 2019 (COVID-19) pneumonia needs an integrated clinical, laboratory and ultrasound approach. The "bedside" pulmonary ultrasound has many advantages in the patient at high infectious risk and can provide incremental data in the respiratory intensive care. Chest X-ray is characterized by low sensitivity in identifying earlier lung changes. Pulmonary computed tomography shows high sensitivity but should not be routinely performed in all patients, because in the first 48 h it can be absolutely negative. We discuss the role of imaging approach in the evaluation of patients with COVID-19 pneumonia.