Current status quo on COVID-19 including chest imaging

Abstract

With each day the number coronavirus disease 2019 (COVID-19) cases continue to rise rapidly and our imaging knowledge of this disease is expeditiously evolving. The role of chest computed tomography (CT) in the screening or diagnosis of COVID-19 remains the subject of much debate. Despite several months having passed since identifying the disease, and numerous studies related to it, controversy and concern still exists regarding the widespread use of chest CT in the evaluation and management of COVID-19 suspect patients. Several institutes and organizations around the world have released guidelines, recommendations and statements against the use of CT for diagnosing or screening COVID-19 infection and advocating its use only for those cases with a strong clinical suspicion of complication or an alternate diagnosis. However, these guidelines and recommendations are in disagreement with majority of the widely available literature, which strongly favour CT as a pivotal tool in the early diagnosis, management and even follow-up of COVID-19 infection. This article besides comprehensively reviewing the current status quo on COVID-19 disease in general, also writes upon the current consensus statements/recommendations on the use of diagnostic imaging in COVID-19 as well as highlighting the precautions and various disinfection procedures being employed world-wide at the workplace to prevent the spread of infection.

Keywords: COVID-19; SARS-CoV-2; Coronavirus disease; Reverse transcriptase polymerase chain reaction; Viral pneumonia; Computed tomography

Core Tip: As per the recommendations of various national and international organizations, chest imaging [chest radiograph/computed tomography (CT)] is not indicated as a screening tool in asymptomatic coronavirus disease 2019 (COVID-19) patients or in those with mild respiratory features unless the patients are at risk for disease progression. However, these suggestions remain a subject of debate as many studies have shown that especially chest CT can identify lung findings in patients with negative reverse transcriptase polymerase chain reaction or even before the test becomes positive. An added advantage with chest CT is that, based on the lung findings, CT can classify patients into mild, moderate or severe disease category, as patients with more extensive pulmonary disease may benefit from follow-up CTs and potential management options, taking into consideration that the disease has the potential to cause fibrosis. Several chest CT findings typical for COVID-19 have been reported, with the most common one being multifocal ground glass opacities or consolidation usually in a bilateral, peripheral, subpleural, lower lobe and posterior distribution.