Chest CT for Post-COVID-19 Abnormalities: Nine Takeaways from a Multi-Society Consensus Statement
Developed by 21 thoracic radiologists, the new international consensus statement addresses appropriate indications, scan acquisition and keys to reporting for the use of chest CT imaging in evaluating for residual lung abnormalities from COVID-19.
For patients who have been hospitalized for acute COVID-19 infection, researchers have found that restrictive pulmonary abnormalities may be evident on chest computed tomography (CT) four months after COVID-19 infection in up to 25 percent of this patient population.
Accordingly, thoracic radiologists from the Society of Thoracic Radiology, the European Society of Thoracic Imaging and the Asian Society of Thoracic Imaging have issued an international consensus statement on the use of chest CT for post-COVID-19 evaluations.
Here are nine takeaways from the consensus statement recently published in Radiology.
- Noting a reported 43.5 percent prevalence of residual lung deformities on chest CT a year after COVID-19 infection, the consensus authors recommend chest CT for patients with continued or worsening respiratory symptoms three months after COVID-19 infection and at three to six months after discharge for all patients who were hospitalized with moderate to severe COVID-19.
- Emphasizing accuracy issues with detecting ground-glass opacities, the consensus panelists do not recommend ultra-low-dose CT (< 0.5 mSv) for post-COVID-19 chest CT imaging.
Here one can see baseline axial CT imaging as well as one-month, four-month and one-year follow-up images revealing post-COVID-10 residual abnormalities in a 69-year-old man with a history of smoking and myocardial infarction. (Images courtesy of Radiology.)
3. Pointing out that fibrotic remodeling of small airways and vascular injury can lead to abnormalities with small airways and subsequent dyspnea after COVID-19, the consensus authors recommend expiratory CT scanning to evaluate patients for the common finding of air trapping.
4. While honeycombing is indicative of fibrosis, the consensus panelists maintained that honeycombing is rare in patients with prior COVID-19 and suggested that honeycombing in these patients may suggest pre-existing fibrosing lung disease.
5. For this patient population, the consensus authors said “fibrosis” should be reserved for describing “persistently present” traction bronchiectasis, honeycombing and/or architectural distortion with volume loss.
6. The consensus authors suggest the use of standard CT radiation dosing when patients have had respiratory changes, particularly acute changes.
7. When one suspects pre-existing interstitial lung disease (ILD), the consensus panelists emphasize differentiating between abnormalities that may be associated with prior COVID-19 infection and abnormalities that may reflect an ongoing ILD in the radiology report.
8. When structural abnormalities on CT cannot fully explain a patient’s respiratory symptoms, the consensus authors suggest employing contrast-enhanced CT pulmonary angiography.
9. For typical initial workup and follow-up chest CT exams in post-COVID-19 evaluations, the consensus panelists emphasize coverage of the entire lung parenchyma and unenhanced, full inspiratory volumetric scanning with the patient in the supine position. For image reconstruction, the consensus authors emphasize thin-section images of < 1.5 mm with continuous or overlapping sections.
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