Coronavirus disease 2019 (COVID-19) in Italy: features on chest computed tomography using a structured report system

Roberto Grassi, Roberta Fusco, Maria Paola Belfiore, Alessandro Montanelli, Gianluigi Patelli, Fabrizio Urraro, Antonella Petrillo, Vincenza Granata, Palmino Sacco, Maria Antonietta Mazzei, Beatrice Feragalli, Alfonso Reginelli, Salvatore Cappabianca

Research output: Contribution to journalArticlepeer-review


To assess the use of a structured report in the Chest Computed Tomography (CT) reporting of patients with suspicious viral pneumonia by COVID-19 and the evaluation of the main CT patterns. This study included 134 patients (43 women and 91 men; 68.8 years of mean age, range 29-93 years) with suspicious COVID-19 viral infection evaluated by reverse transcription real-time fluorescence polymerase chain reaction (RT-PCR) test. All patients underwent CT examinations at the time of admission. CT images were reviewed by two radiologists who identified COVID-19 CT patterns using a structured reports. Temporal difference mean value between RT-PCRs and CT scan was 0.18 days ± 2.0 days. CT findings were positive for viral pneumonia in 94.0% patients while COVID-19 was diagnosed at RT-PCR in 77.6% patients. Time mean value to complete the structured report by radiologist was 8.5 min ± 2.4 min. The disease on chest CT predominantly affected multiple lobes and the main CT feature was ground glass opacity (GGO) with or without consolidation (96.8%). GGO was predominantly bilateral (89.3%), peripheral (80.3%), multifocal/patching (70.5%). Consolidation disease was predominantly bilateral (83.9%) with prevalent peripheral (87.1%) and segmental (47.3%) distribution. Additional CT signs were the crazy-paving pattern in 75.4% of patients, the septal thickening in 37.3% of patients, the air bronchogram sign in 39.7% and the "reversed halo" sign in 23.8%. Less frequent characteristics at CT regard discrete pulmonary nodules, increased trunk diameter of the pulmonary artery, pleural effusion and pericardium effusion (7.9%, 6.3%, 14.3% and 16.7%, respectively). Barotrauma sign was absent in all the patients. High percentage (54.8%) of the patients had mediastinal lymphadenopathy. Using a Chest CT structured report, with a standardized language, we identified that the cardinal hallmarks of COVID-19 infection were bilateral, peripheral and multifocal/patching GGO and bilateral consolidation with peripheral and segmental distribution.

Original languageEnglish
Pages (from-to)17236
JournalSci. Rep.
Issue number1
Publication statusPublished - Oct 14 2020


  • Adult
  • Aged
  • Aged, 80 and over
  • Betacoronavirus/genetics
  • COVID-19
  • Coronavirus Infections/diagnosis
  • Electronic Health Records
  • Female
  • Humans
  • Italy
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral/diagnosis
  • RNA, Viral/metabolism
  • Real-Time Polymerase Chain Reaction
  • Retrospective Studies
  • SARS-CoV-2
  • Thorax/diagnostic imaging
  • Tomography, X-Ray Computed

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