Comparison of temporal evolution of computed tomography imaging features in COVID-19 and influenza infections in a multicenter cohort study

Tim Fischer; Yassir El Baz; Giulia Scanferla; Nicole Graf; Frederike Waldeck; Gian-Reto Kleger; Thomas Frauenfelder; Jens Bremerich; Sabine Schmidt Kobbe; Jean-Luc Pagani; Sebastian Schindera; Anna Conen; Simon Wildermuth; Sebastian Leschka; Carol Strahm; Stephan Waelti; Tobias Johannes Dietrich; Werner C Albrich

doi:10.1016/j.ejro.2022.100431

Comparison of temporal evolution of computed tomography imaging features in COVID-19 and influenza infections in a multicenter cohort study

Eur J Radiol Open. 2022:9:100431. doi: 10.1016/j.ejro.2022.100431. Epub 2022 Jun 24.

Authors

Tim Fischer¹, Yassir El Baz¹, Giulia Scanferla², Nicole Graf³, Frederike Waldeck⁴, Gian-Reto Kleger⁵, Thomas Frauenfelder⁶, Jens Bremerich⁷, Sabine Schmidt Kobbe⁸, Jean-Luc Pagani⁹, Sebastian Schindera¹⁰, Anna Conen¹¹, Simon Wildermuth¹, Sebastian Leschka¹, Carol Strahm², Stephan Waelti¹, Tobias Johannes Dietrich¹, Werner C Albrich²

Affiliations

¹ Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
² Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
³ Clinical Trials Unit, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
⁴ Division of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
⁵ Division of Intensive Care, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
⁶ Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
⁷ Department of Radiology, University of Basel Hospital, Basel, Switzerland.
⁸ Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
⁹ Adult Intensive Care Service, University Hospital and University of Lausanne, Lausanne, Switzerland.
¹⁰ Department of Radiology, Cantonal Hospital Aarau, Aarau, Switzerland.
¹¹ Department of Infectious Diseases and Infection Prevention, Cantonal Hospital Aarau, Switzerland.

Abstract

Purpose: To compare temporal evolution of imaging features of coronavirus disease 2019 (COVID-19) and influenza in computed tomography and evaluate their predictive value for distinction.

Methods: In this retrospective, multicenter study 179 CT examinations of 52 COVID-19 and 44 influenza critically ill patients were included. Lung involvement, main pattern (ground glass opacity, crazy paving, consolidation) and additional lung and chest findings were evaluated by two independent observers. Additional findings and clinical data were compared patient-wise. A decision tree analysis was performed to identify imaging features with predictive value in distinguishing both entities.

Results: In contrast to influenza patients, lung involvement remains high in COVID-19 patients > 14 days after the diagnosis. The predominant pattern in COVID-19 evolves from ground glass at the beginning to consolidation in later disease. In influenza there is more consolidation at the beginning and overall less ground glass opacity (p = 0.002). Decision tree analysis yielded the following: Earlier in disease course, pleural effusion is a typical feature of influenza (p = 0.007) whereas ground glass opacities indicate COVID-19 (p = 0.04). In later disease, particularly more lung involvement (p < 0.001), but also less pleural (p = 0.005) and pericardial (p = 0.003) effusion favor COVID-19 over influenza. Regardless of time point, less lung involvement (p < 0.001), tree-in-bud (p = 0.002) and pericardial effusion (p = 0.01) make influenza more likely than COVID-19.

Conclusions: This study identified differences in temporal evolution of imaging features between COVID-19 and influenza. These findings may help to distinguish both diseases in critically ill patients when laboratory findings are delayed or inconclusive.

Keywords: COPD, Chronic obstructive pulmonary disease; COVID-19; COVID-19, Coronavirus disease 2019; CT, Computed tomography; Computed tomography; GGO, Ground glass opacity; HIV, Human immunodeficiency virus; HSCT, Haematopoietic stem cell transplantation; ICC, Intraclass correlation coefficient; ICU, Intensive care unit; IQR, Interquartile range; Influenza; Lung; PCR, Polymerase chain reaction; Pneumonia; SD, Standard deviation; SOT, Solid organ transplantation.