Findings of Serial Computed Tomography Imaging in Patients with Coronavirus Disease-19


  • Masoomeh Raoufi Department of Radiology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Shahram Kahkouee National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Jamileh Bahri Department of Radiology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Neda Khalili School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Network of Immunity In Infection, Malignancy and Autoimmunity, Universal Scientific Education and Research Network, Tehran, Iran
  • Farzaneh Robatjazi Department of Radiology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Nastaran Khalili School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Network of Immunity In Infection, Malignancy and Autoimmunity, Universal Scientific Education and Research Network, Tehran, Iran



COVID-19, coronavirus disease-2019, computed tomography, organizing pneumonia, serial imaging


AIM: We investigated the serial changes of chest computed tomography (CT) in patients with coronavirus disease-2019 (COVID-19) presenting with viral-induced lung damage on follow-up CT.

METHODS: We evaluated 66 patients with confirmed COVID-19, who had undergone at least two chest CTs from February 24 to April 21, 2020. Nine patients also had a third CT. All patients demonstrated viral-induced lung damage (organizing pneumonia-like pattern) on second CT. The involvement pattern of each lobe and the extent of infiltration (based on CT score) were assessed on serial CTs to determine changes throughout the disease course. Patients’ demographic and clinical data and final outcome were also recorded.

RESULTS: Mean age (standard deviation [SD]) of patients was 56.04 (15.2) years old; 51.5% were male. About 93.9% of patients had survived. Mean (SD) interval between the first and second CT and second and third CT was 7.6 (5.9) and 16.8 (8.3) days, respectively. The extent of total lung involvement was significantly higher in the second CT compared with the first CT (p < 0.001) and also increased non-significantly in the third CT (p = 0.29). The right lower lobe persistently had the highest CT score through the disease course.

CONCLUSION: Evaluation of serial CT imaging can reveal information regarding the stage of COVID-19, thus providing help for appropriate treatment planning.


Download data is not yet available.


Metrics Loading ...

Plum Analytics Artifact Widget Block


Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): A systematic review of imaging findings in 919 patients. Am J Roentgenol. 2020;215(1):87-93. PMid:32174129

Ng MY, Lee EY, Yang J, Yang F, Li X, Wang H, et al. Imaging profile of the COVID-19 infection: Radiologic findings and literature review. Radiol Cardiothorac Imaging. 2020;2(1):e200034.

Long C, Xu H, Shen Q, Zhang X, Fan B, Wang C, et al. Diagnosis of the Coronavirus disease (COVID-19): rRT-PCR or CT? Eur J Radiol. 2020;126:108961. PMid:32229322

Zhang P, Li J, Liu H, Han N, Ju J, Kou Y, et al. Long-term bone and lung consequences associated with hospital-acquired severe acute respiratory syndrome: A 15-year follow-up from a prospective cohort study. Bone Res. 2020;8:8. PMid:32128276

Walsh SL, Hansell DM. Diffuse interstitial lung disease: Overlaps and uncertainties. Eur Radiol. 2010;20(8):1859-67. PMid:20204644

Lai R, Feng X, Gu Y, Lai HW, Liu F, Tian Y, et al. Pathological changes of lungs in patients with severity acute respiratory syndrome. J Zhonghua Bing Li Xue Za Zhi. 2004;33(4):354-7. PMid:15363323

Ajlan AM, Ahyad RA, Jamjoom LG, Alharthy A, Madani TA. Middle East respiratory syndrome coronavirus (MERS-CoV) infection: Chest CT findings. Am J Roentgenol. 2014;203(4):782- 7. PMid:24918624

Gómez-Gómez A, Martínez-Martínez R, Gotway MB. Organizing pneumonia associated with swine-origin influenza A H1N1 2009 viral infection. Am J Roentgenol. 2011;196(1):W103-4. PMid:21178022

Wu Y, Xie Y, Wang X. Longitudinal CT findings in COVID-19 pneumonia: Case presenting organizing pneumonia pattern. Radiol Cardiothorac Imaging. 2020;2(1):e200031.

Poggiali E, Dacrema A, Bastoni D, Tinelli V, Demichele E, Ramos PM, et al. Can lung US help critical care clinicians in the early diagnosis of novel coronavirus (COVID-19) pneumonia? Radiology. 2020;295(3):E6. PMid:32167853

Maldonado F, Daniels CE, Hoffman EA, Eunhee SY, Ryu JH. Focal organizing pneumonia on surgical lung biopsy: Causes, clinicoradiologic features, and outcomes. Chest. 2007;132(5):1579-83. PMid:17890462

Travis WD, Costabel U, Hansell DM, King TE Jr., Lynch DA, Nicholson AG, et al. An official American thoracic society/ European respiratory society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med. 2013;188(6):733-48. PMid:24032382

Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner society: Glossary of terms for thoracic imaging. Radiology. 2008;246(3):697-722. PMid:18195376

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9. PMid:32031570

Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT findings in coronavirus disease-19 (COVID- 19): Relationship to duration of infection. Radiology. 2020;295(3):200463.

Ujita M, Renzoni EA, Veeraraghavan S, Wells AU, Hansell DM. Organizing pneumonia: Perilobular pattern at thin-section CT. Radiology. 2004;232(3):757-61. PMid:15229349

Kligerman SJ, Franks TJ, Galvin JR. From the radiologic pathology archives: Organization and fibrosis as a response to lung injury in diffuse alveolar damage, organizing pneumonia, and acute fibrinous and organizing pneumonia. Radiographics. 2013;33(7):1951-75. PMid:24224590

Kim H. Outbreak of novel coronavirus (COVID-19): What is the role of radiologists? Eur Radiol. 2020;30(6):3266-7. PMid:32072255

Salehi S, Reddy S, Gholamrezanezhad A. Long-term pulmonary consequences of coronavirus disease 2019 (COVID-19): What we know and what to expect. J Thorac Imaging. 2020;35(4):W87- 9. PMid:32404798

Song F, Shi N, Shan F, Zhang Z, Shen J, Lu H, et al. Emerging 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology. 2020;295(1):210-7. PMid:32027573

Xie L, Liu Y, Xiao Y, Tian Q, Fan B, Zhao H, et al. Follow-up study on pulmonary function and lung radiographic changes in rehabilitating severe acute respiratory syndrome patients after discharge. Chest. 2005;127(6):2119-24. PMid:15947329

Wu X, Dong D, Ma D. Thin-section computed tomography manifestations during convalescence and long-term follow-up of patients with severe acute respiratory syndrome (SARS). Med Sci Monit. 2016;22:2793-9. msm.896985 PMid:27501327

Liu D, Zhang W, Pan F, Li L, Yang L, Zheng D, et al. The pulmonary sequalae in discharged patients with COVID-19: A short-term observational study. Respir Res. 2020;21(1):125. PMid:32448391

Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19). Radiology. 2020;295(3):715-21. PMid:32053470

Duan YN, Qin J. Pre-and posttreatment chest CT findings: 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology. 2020;295(1):21. PMid:32049602

Antonio GE, Wong KT, Hui DS, Wu A, Lee N, Yuen EH, et al. Thin-section CT in patients with severe acute respiratory syndrome following hospital discharge: Preliminary experience. Radiology. 2003;228(3):810-5.

Ong KC, Ng AW, Lee LS, Kaw G, Kwek SK, Leow MK, et al. 1-year pulmonary function and health status in survivors of severe acute respiratory syndrome. Chest. 2005;128(3):1393- 400. PMid:16162734

Drakopanagiotakis F, Paschalaki K, Abu-Hijleh M, Aswad B, Karagianidis N, Kastanakis E, et al. Cryptogenic and secondary organizing pneumonia: Clinical presentation, radiographic findings, treatment response, and prognosis. Chest. 2011;139(4):893-900. PMid:20724743

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet. 2020;395(10229):1054-62. PMid:32171076

Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: An observational cohort study. Lancet Infect Dis. 2020;20(6):689-96.

Fadini GP, Morieri ML, Longato E, Avogaro A. Prevalence and impact of diabetes among people infected with SARS-CoV-2. J Endocrinol Invest. 2020;43(6):867-9. PMid:32222956

Wang X, Wang S, Sun L, Qin G. Prevalence of diabetes mellitus in 2019 novel coronavirus: A meta-analysis. Diabetes Res Clin Pract. 2020;164:108200. PMid:32407746

Zhu L, She ZG, Cheng X, Qin JJ, Zhang XJ, Cai J, et al. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing Type 2 diabetes. Cell Metabolism. 2020;31(6):1068-77.e3.

Kligerman SJ, Groshong S, Brown KK, Lynch DA. Nonspecific interstitial pneumonia: Radiologic, clinical, and pathologic considerations. Radiographics. 2009;29(1):73-87.

Lee JW, Lee KS, Lee HY, Chung MP, Yi CA, Kim TS, et al. Cryptogenic organizing pneumonia: Serial high-resolution CT findings in 22 patients. AJR Am J Roentgenol. 2010;195(4):916- 22. PMid:20858818

Ooi GC, Khong PL, Müller NL, Yiu WC, Zhou LJ, Ho JC, et al. Severe acute respiratory syndrome: Temporal lung changes at thin-section CT in 30 patients. Radiology. 2004;230(3):836-44. PMid:14990845

Randomised Evaluation of COVID-19 Therapy (RECOVERY). Available from: NCT04381936. [Last accessed on 2020 Jun 18].




How to Cite

Raoufi M, Kahkouee S, Bahri J, Khalili N, Robatjazi F, Khalili N. Findings of Serial Computed Tomography Imaging in Patients with Coronavirus Disease-19. Open Access Maced J Med Sci [Internet]. 2020 Dec. 25 [cited 2022 Aug. 15];8(T1):627-33. Available from: