Computed tomography findings of COVID-19 pneumonia in Intensive Care Unit-patients

Date Icon Publish Date
  • Riccardo Cau
    Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.) di Cagliari, Polo di Monserrato (CA), Italy.
  • Zeno Falaschi
    Department of Radiology, A.O.U. “Maggiore d.c.”, University of Eastern Piedmont, Novara, Italy.
  • Alessio Paschè
    Department of Radiology, A.O.U. “Maggiore d.c.”, University of Eastern Piedmont, Novara, Italy.
  • Pietro Danna
    Department of Radiology, A.O.U. “Maggiore d.c.”, University of Eastern Piedmont, Novara, Italy.
  • Roberto Arioli
    Department of Radiology, A.O.U. “Maggiore d.c.”, University of Eastern Piedmont, Novara, Italy.
  • Chiara D. Arru
    Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.) di Cagliari, Polo di Monserrato (CA), Italy.
  • Domenico Zagaria
    Department of Radiology, A.O.U. “Maggiore d.c.”, University of Eastern Piedmont, Novara, Italy.
  • Stefano Tricca
    Department of Radiology, A.O.U. “Maggiore d.c.”, University of Eastern Piedmont, Novara, Italy.
  • Jasjit S. Suri
    Stroke Monitoring and Diagnosis Division, AtheroPoint™, Roseville, CA, and Global Biomedical Technologies, Inc., Roseville, CA, United States.
  • Mannudeep K. Karla
    Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.
  • Alessandro Carriero
    Department of Radiology, A.O.U. “Maggiore d.c.”, University of Eastern Piedmont, Novara, Italy.
  • Luca Saba
    Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.) di Cagliari, Polo di Monserrato (CA), Italy.


Background: In December 2019, a cluster of unknown etiology pneumonia cases occurred in Wuhan, China leading to identification of the responsible pathogen as SARS-coV-2. Since then, the coronavirus disease 2019 (COVID-19) has spread to the entire world. Computed Tomography (CT) is frequently used to assess severity and complications of COVID-19 pneumonia. The purpose of this study is to compare the CT patterns and clinical characteristics in intensive care unit (ICU) and non-ICU patients with COVID-19 pneumonia.

Design and Methods:
 This retrospective study included 218 consecutive patients (136 males; 82 females; mean age 63±15 years) with laboratory-confirmed SARS-coV-2. Patients were categorized in two different groups: (a) ICU patients and (b) non-ICU inpatients. We assessed the type and extent of pulmonary opacities on chest CT exams and recorded the information on comorbidities and laboratory values for all patients.

 Of the 218 patients, 23 (20 males: 3 females; mean age 60 years) required ICU admission, 195 (118 males: 77 females, mean age 64 years) were admitted to a clinical ward. Compared with non-ICU patients, ICU patients were predominantly males (60% versus 83% p=0.03), had more comorbidities, a positive CRP (p=0.04) and higher LDH values (p=0.008). ICU patients’ chest CT demonstrated higher incidence of consolidation (p=0.03), mixed lesions (p=0.01), bilateral opacities (p<0.01) and overall greater lung involvement by consolidation (p=0.02) and GGO (p=0.001).

: CT imaging features of ICU patients affected by COVID-19 are significantly different compared with non-ICU patients. Identification of CT features could assist in a stratification of the disease severity and supportive treatment.


Lu H, Stratton CW, Tang Y-W. Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. J Med Virol 2020;92:401-2. DOI:

Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel Coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061-9. DOI:

Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506. DOI:

Cau R, Bassareo P, Saba L. Cardiac involvement in COVID-19—Assessment with Echocardiography and cardiac magnetic resonance imaging. SN Compr Clin Med 2020. Online ahead of print. DOI:

Cau R, Bassareo PP, Mannelli L, et al. Imaging in COVID-19-related myocardial injury. Int J Cardiovasc Imaging 2020. Online ahead of print. DOI:

Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020;323:1239-42. DOI:

Saba L, Gerosa C, Fanni D, et al. Molecular pathways triggered by COVID-19 in different organs: ACE2 receptor-expressing cells under attack? A review. Eur Rev Med Pharmacol Sci 2020;24:12609-22.

Corman VM, Landt O, Kaiser M, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill 2020;25:2000045. DOI:

Ng M-Y, Lee EYP, Yang J, et al. Imaging profile of the COVID-19 infection: Radiologic findings and literature review. Radiol Cardiothorac Imaging 2020;2:e200034. DOI:

Huang P, Liu T, Huang L, et al. Use of chest CT in combination with negative RT-PCR assay for the 2019 novel coronavirus but high clinical suspicion. Radiology 2020;295:22-3. DOI:

Xie X, Zhong Z, Zhao W, et al Chest CT for typical coronavirus disease 2019 (COVID-19) pneumonia: Relationship to negative RT-PCR testing. Radiology 2020;296:E41-5. DOI:

Phua J, Weng L, Ling L, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med 2020;8:506-17. DOI:

Carlos WG, Dela Cruz CS, Cao B, et al. Novel Wuhan (2019-nCoV) coronavirus. Am J Respir Crit Care Med 2020;201:P7-8. DOI:

Vandroux D, Allyn J, Ferdynus C, et al. Mortality of critically ill patients with severe influenza starting four years after the 2009 pandemic. Infect Dis (Lond) 2019;51:831-7. DOI:

Gouda W, Yasin R. COVID-19 disease: CT pneumonia analysis prototype by using artificial intelligence, predicting the disease severity. Egypt J Radiol Nucl Med 2020;51:196. DOI:

Lyu P, Liu X, Zhang R, et al. The performance of chest CT in evaluating the clinical severity of COVID-19 pneumonia: Identifying critical cases based on CT characteristics. Invest Radiol 2020;55:412-21. DOI:

Wasilewski PG, Mruk B, Mazur S, et al. COVID-19 severity scoring systems in radiological imaging – a review. Polish J Radiol 2020;85:e361-8. DOI:

Li K, Wu J, Wu F, et al. The clinical and chest CT features associated with severe and critical COVID-19 pneumonia. Invest Radiol 2020;55:327-31. DOI:

Lessmann N, Sánchez CI, Beenen L, et al. Automated assessment of COVID-19 reporting and data system and chest CT severity scores in patients suspected of having COVID-19 using artificial intelligence. Radiology 2021;298:e18-28. DOI:

Ruch Y, Kaeuffer C, Ohana M, et al. CT lung lesions as predictors of early death or ICU admission in COVID-19 patients. Clin Microbiol Infect 2020;26:1417.e5-8. DOI:

Hansell DM, Bankier AA, MacMahon H, et al. Fleischner Society: glossary of terms for thoracic imaging. Radiology 2008;246:697-722. DOI:

Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507-13. DOI:

Jaillon S, Berthenet K, Garlanda C. Sexual dimorphism in innate immunity. Clin Rev Allergy Immunol 2019;56:308-21. DOI:

Bhatraju PK, Ghassemieh BJ, Nichols M, et al. Covid-19 in critically ill patients in the Seattle Region – Case series. N Engl J Med 2020;382:2012-22. DOI:

Grasselli G, Zangrillo A, Zanella A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA 2020;323:1574-81. DOI:

Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20. DOI:

Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: Early experience and forecast during an emergency response. JAMA 2020;323:1545-6. DOI:

Team CDCC-19 R. Preliminary estimates of the prevalence of selected underlying health conditions among patients with coronavirus disease 2019 – United States, February 12-March 28, 2020. MMWR Morb Mortal Wkly Rep 2020;69:382-6. DOI:

Tal-Singer R, Crapo JD. COPD at the time of COVID-19: A COPD foundation perspective. Chronic Obstr Pulm Dis 2020;7:73-5. DOI:

Wang L. C-reactive protein levels in the early stage of COVID-19. Med Mal Infect 2020;50:332-4. DOI:

Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020;8:420-2. DOI:

Ajlan AM, Ahyad RA, Jamjoom LG, et al. Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: Chest CT findings. Am J Roentgenol 2014;203:782-7. DOI:

Wan Y-L, Tsay P-K, Cheung Y-C, et al. A correlation between the severity of lung lesions on radiographs and clinical findings in patients with severe acute respiratory syndrome. Korean J Radiol 2007;8:466-74. DOI:

Hani C, Trieu NH, Saab I, et al. COVID-19 pneumonia: A review of typical CT findings and differential diagnosis. Diagn Interv Imaging 2020;101:263-8. DOI:

Li Y, Xia L. Coronavirus disease 2019 (COVID-19): Role of chest CT in diagnosis and management. Am J Roentgenol 2020;214:1280-6. DOI:

Fang Y, Zhang H, Xie J, et al. Sensitivity of chest CT for COVID-19: Comparison to RT-PCR. Radiology 2020;296:E115-7. DOI:

Engeler CE, Tashjian JH, Trenkner SW, Walsh JW. Ground-glass opacity of the lung parenchyma: a guide to analysis with high-resolution CT. Am J Roentgenol 1993;160:249-51. DOI:

Guan CS, Lv Z Bin, Yan S, et al. Imaging features of coronavirus disease 2019 (COVID-19): Evaluation on thin-section CT. Acad Radiol 2020;27:609-13. DOI:

Ye Z, Zhang Y, Wang Y, et al. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol 2020;30:4381-9. DOI:

Pan F, Ye T, Sun P, et al. Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19). Radiology 2020;295:715-21. DOI:

Pan Y, Guan H, Zhou S, et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol 2020;30:3306-9. DOI:

Wu J, Feng LC, Xian XY, et al. [Novel coronavirus pneumonia (COVID-19) CT distribution and sign features].[Article in Chinese]. Zhonghua Jie He He Hu Xi Za Zhi 2020;43:321-6.

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

Yoon SH, Lee KH, Kim JY, et al. Chest radiographic and CT findings of the 2019 novel coronavirus disease (COVID-19): Analysis of nine patients treated in Korea. Korean J Radiol 2020;21:494-500. DOI:

Sardanelli F, Cozzi A, Monfardini L, et al. Association of mediastinal lymphadenopathy with COVID-19 prognosis. Lancet Infect Dis 2020;20:1230-1. DOI:

Faghihi Langroudi T, Khazaei M. Common imaging patterns of COVID-19 on spiral chest CT scan: a diagnostic approach for pulmonary involvement in ICU patients. J Cell Mol Anesth 2020;5:6-15.

Xiong Y, Sun D, Liu Y, et al. Clinical and high-resolution CT features of the COVID-19 infection: Comparison of the initial and follow-up changes. Invest Radiol 2020;55:332-9. DOI:

Emara DM, Naguib NN, Moustafa MA, et al. Typical and atypical CT chest imaging findings of novel coronavirus 19 (COVID-19) in correlation with clinical data: impact on the need to ICU admission, ventilation and mortality. Egypt J Radiol Nucl Med 2020;51:227. DOI:

Our most popular topics on Journal of Public Health Research

Leave a Reply

Your email address will not be published.