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. 2020 Mar 30;2(2):e200075.
doi: 10.1148/ryct.2020200075. eCollection 2020 Apr.

Serial Quantitative Chest CT Assessment of COVID-19: A Deep Learning Approach

Lu Huang  1 , Rui Han  1 , Tao Ai  1 , Pengxin Yu  1 , Han Kang  1 , Qian Tao  1 , Liming Xia  1
Affiliations

Serial Quantitative Chest CT Assessment of COVID-19: A Deep Learning Approach

Lu Huang et al. Radiol Cardiothorac Imaging. .

Abstract

Purpose: To quantitatively evaluate lung burden changes in patients with coronavirus disease 2019 (COVID-19) by using serial CT scan by an automated deep learning method.

Materials and methods: Patients with COVID-19, who underwent chest CT between January 1 and February 3, 2020, were retrospectively evaluated. The patients were divided into mild, moderate, severe, and critical types, according to their baseline clinical, laboratory, and CT findings. CT lung opacification percentages of the whole lung and five lobes were automatically quantified by a commercial deep learning software and compared with those at follow-up CT scans. Longitudinal changes of the CT quantitative parameter were also compared among the four clinical types.

Results: A total of 126 patients with COVID-19 (mean age, 52 years ± 15 [standard deviation]; 53.2% males) were evaluated, including six mild, 94 moderate, 20 severe, and six critical cases. CT-derived opacification percentage was significantly different among clinical groups at baseline, gradually progressing from mild to critical type (all P < .01). Overall, the whole-lung opacification percentage significantly increased from baseline CT to first follow-up CT (median [interquartile range]: 3.6% [0.5%, 12.1%] vs 8.7% [2.7%, 21.2%]; P < .01). No significant progression of the opacification percentages was noted from the first follow-up to second follow-up CT (8.7% [2.7%, 21.2%] vs 6.0% [1.9%, 24.3%]; P = .655).

Conclusion: The quantification of lung opacification in COVID-19 measured at chest CT by using a commercially available deep learning-based tool was significantly different among groups with different clinical severity. This approach could potentially eliminate the subjectivity in the initial assessment and follow-up of pulmonary findings in COVID-19.Supplemental material is available for this article.© RSNA, 2020.

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Conflict of interest statement

Disclosures of Conflicts of Interest: L.H. disclosed no relevant relationships. R.H. disclosed no relevant relationships. T.A. disclosed no relevant relationships. P.Y. disclosed no relevant relationships. H.K. disclosed no relevant relationships. Q.T. disclosed no relevant relationships. L.X. disclosed no relevant relationships.

Figures

Flowchart shows the patient selection process. IgM = immunoglobulin M.
Figure 1:
Flowchart shows the patient selection process. IgM = immunoglobulin M.
Scatterplots with the distribution of lung opacification percentage according to days since initial symptoms. (a) The dynamic change in lung opacification percentage of whole lung (curve fitting equation: y = 2.956 × x3 − 0.03065 × x2 − 0.004374 × x −1.106, in which x is time from the onset of initial symptoms, y is lung opacification percentage of whole lung; R2 = 0.161, P < .001). (b) The distribution of percentage of lung opacification at quantitative CT in different clinical types according to days since initial symptoms at baseline CT.
Figure 2a:
Scatterplots with the distribution of lung opacification percentage according to days since initial symptoms. (a) The dynamic change in lung opacification percentage of whole lung (curve fitting equation: y = 2.956 × x3 − 0.03065 × x2 − 0.004374 × x −1.106, in which x is time from the onset of initial symptoms, y is lung opacification percentage of whole lung; R2 = 0.161, P < .001). (b) The distribution of percentage of lung opacification at quantitative CT in different clinical types according to days since initial symptoms at baseline CT.
Scatterplots with the distribution of lung opacification percentage according to days since initial symptoms. (a) The dynamic change in lung opacification percentage of whole lung (curve fitting equation: y = 2.956 × x3 − 0.03065 × x2 − 0.004374 × x −1.106, in which x is time from the onset of initial symptoms, y is lung opacification percentage of whole lung; R2 = 0.161, P < .001). (b) The distribution of percentage of lung opacification at quantitative CT in different clinical types according to days since initial symptoms at baseline CT.
Figure 2b:
Scatterplots with the distribution of lung opacification percentage according to days since initial symptoms. (a) The dynamic change in lung opacification percentage of whole lung (curve fitting equation: y = 2.956 × x3 − 0.03065 × x2 − 0.004374 × x −1.106, in which x is time from the onset of initial symptoms, y is lung opacification percentage of whole lung; R2 = 0.161, P < .001). (b) The distribution of percentage of lung opacification at quantitative CT in different clinical types according to days since initial symptoms at baseline CT.
A 29-year-old male patient with mild COVID-19, axial chest CT images at baseline and follow-up. (a) Baseline: negative CT; (b) first follow-up: ground-glass opacity is observed in the left lower lobe (opacification percentage of the left lower lobe: 0.24%); (c) second follow-up: increased size and new ground-glass opacity (opacification percentage of the left lower lobe: 2.55%).
Figure 3a:
A 29-year-old male patient with mild COVID-19, axial chest CT images at baseline and follow-up. (a) Baseline: negative CT; (b) first follow-up: ground-glass opacity is observed in the left lower lobe (opacification percentage of the left lower lobe: 0.24%); (c) second follow-up: increased size and new ground-glass opacity (opacification percentage of the left lower lobe: 2.55%).
A 29-year-old male patient with mild COVID-19, axial chest CT images at baseline and follow-up. (a) Baseline: negative CT; (b) first follow-up: ground-glass opacity is observed in the left lower lobe (opacification percentage of the left lower lobe: 0.24%); (c) second follow-up: increased size and new ground-glass opacity (opacification percentage of the left lower lobe: 2.55%).
Figure 3b:
A 29-year-old male patient with mild COVID-19, axial chest CT images at baseline and follow-up. (a) Baseline: negative CT; (b) first follow-up: ground-glass opacity is observed in the left lower lobe (opacification percentage of the left lower lobe: 0.24%); (c) second follow-up: increased size and new ground-glass opacity (opacification percentage of the left lower lobe: 2.55%).
A 29-year-old male patient with mild COVID-19, axial chest CT images at baseline and follow-up. (a) Baseline: negative CT; (b) first follow-up: ground-glass opacity is observed in the left lower lobe (opacification percentage of the left lower lobe: 0.24%); (c) second follow-up: increased size and new ground-glass opacity (opacification percentage of the left lower lobe: 2.55%).
Figure 3c:
A 29-year-old male patient with mild COVID-19, axial chest CT images at baseline and follow-up. (a) Baseline: negative CT; (b) first follow-up: ground-glass opacity is observed in the left lower lobe (opacification percentage of the left lower lobe: 0.24%); (c) second follow-up: increased size and new ground-glass opacity (opacification percentage of the left lower lobe: 2.55%).
A 41-year-old man with moderate COVID-19, axial chest CT images at baseline and follow-up. (a) Baseline: ground-glass opacity is found in the right lower lobe (opacification percentage of the right lower lobe: 1.33%); (b) first follow-up: increased patchy ground-glass opacity with new consolidation in the right lower lobe (opacification percentage of the right lower lobe: 12.56%); (c) second follow-up: ground-glass opacity is partially absorbed and development of perilobular pattern (opacification percentage of the right lower lobe: 9.28%).
Figure 4a:
A 41-year-old man with moderate COVID-19, axial chest CT images at baseline and follow-up. (a) Baseline: ground-glass opacity is found in the right lower lobe (opacification percentage of the right lower lobe: 1.33%); (b) first follow-up: increased patchy ground-glass opacity with new consolidation in the right lower lobe (opacification percentage of the right lower lobe: 12.56%); (c) second follow-up: ground-glass opacity is partially absorbed and development of perilobular pattern (opacification percentage of the right lower lobe: 9.28%).
A 41-year-old man with moderate COVID-19, axial chest CT images at baseline and follow-up. (a) Baseline: ground-glass opacity is found in the right lower lobe (opacification percentage of the right lower lobe: 1.33%); (b) first follow-up: increased patchy ground-glass opacity with new consolidation in the right lower lobe (opacification percentage of the right lower lobe: 12.56%); (c) second follow-up: ground-glass opacity is partially absorbed and development of perilobular pattern (opacification percentage of the right lower lobe: 9.28%).
Figure 4b:
A 41-year-old man with moderate COVID-19, axial chest CT images at baseline and follow-up. (a) Baseline: ground-glass opacity is found in the right lower lobe (opacification percentage of the right lower lobe: 1.33%); (b) first follow-up: increased patchy ground-glass opacity with new consolidation in the right lower lobe (opacification percentage of the right lower lobe: 12.56%); (c) second follow-up: ground-glass opacity is partially absorbed and development of perilobular pattern (opacification percentage of the right lower lobe: 9.28%).
A 41-year-old man with moderate COVID-19, axial chest CT images at baseline and follow-up. (a) Baseline: ground-glass opacity is found in the right lower lobe (opacification percentage of the right lower lobe: 1.33%); (b) first follow-up: increased patchy ground-glass opacity with new consolidation in the right lower lobe (opacification percentage of the right lower lobe: 12.56%); (c) second follow-up: ground-glass opacity is partially absorbed and development of perilobular pattern (opacification percentage of the right lower lobe: 9.28%).
Figure 4c:
A 41-year-old man with moderate COVID-19, axial chest CT images at baseline and follow-up. (a) Baseline: ground-glass opacity is found in the right lower lobe (opacification percentage of the right lower lobe: 1.33%); (b) first follow-up: increased patchy ground-glass opacity with new consolidation in the right lower lobe (opacification percentage of the right lower lobe: 12.56%); (c) second follow-up: ground-glass opacity is partially absorbed and development of perilobular pattern (opacification percentage of the right lower lobe: 9.28%).
A 56-year-old man with severe COVID-19, axial chest CT images at baseline and follow-up. (a) Baseline: multiple ground-glass opacities are observed in the right and left upper lobes (opacification percentages of right and left lobes: 19.78% and 17.79%, respectively); (b) first follow-up: multiple patchy ground-glass opacities are increased bilaterally (opacification percentages of right and left lobes: 30.39% and 29.72%, respectively); (c) second follow-up: ground-glass opacity is absorbed, with development of consolidation and perilobular pattern (opacification percentages of right and left lobes: 24.21% and 19.73%, respectively).
Figure 5a:
A 56-year-old man with severe COVID-19, axial chest CT images at baseline and follow-up. (a) Baseline: multiple ground-glass opacities are observed in the right and left upper lobes (opacification percentages of right and left lobes: 19.78% and 17.79%, respectively); (b) first follow-up: multiple patchy ground-glass opacities are increased bilaterally (opacification percentages of right and left lobes: 30.39% and 29.72%, respectively); (c) second follow-up: ground-glass opacity is absorbed, with development of consolidation and perilobular pattern (opacification percentages of right and left lobes: 24.21% and 19.73%, respectively).
A 56-year-old man with severe COVID-19, axial chest CT images at baseline and follow-up. (a) Baseline: multiple ground-glass opacities are observed in the right and left upper lobes (opacification percentages of right and left lobes: 19.78% and 17.79%, respectively); (b) first follow-up: multiple patchy ground-glass opacities are increased bilaterally (opacification percentages of right and left lobes: 30.39% and 29.72%, respectively); (c) second follow-up: ground-glass opacity is absorbed, with development of consolidation and perilobular pattern (opacification percentages of right and left lobes: 24.21% and 19.73%, respectively).
Figure 5b:
A 56-year-old man with severe COVID-19, axial chest CT images at baseline and follow-up. (a) Baseline: multiple ground-glass opacities are observed in the right and left upper lobes (opacification percentages of right and left lobes: 19.78% and 17.79%, respectively); (b) first follow-up: multiple patchy ground-glass opacities are increased bilaterally (opacification percentages of right and left lobes: 30.39% and 29.72%, respectively); (c) second follow-up: ground-glass opacity is absorbed, with development of consolidation and perilobular pattern (opacification percentages of right and left lobes: 24.21% and 19.73%, respectively).
A 56-year-old man with severe COVID-19, axial chest CT images at baseline and follow-up. (a) Baseline: multiple ground-glass opacities are observed in the right and left upper lobes (opacification percentages of right and left lobes: 19.78% and 17.79%, respectively); (b) first follow-up: multiple patchy ground-glass opacities are increased bilaterally (opacification percentages of right and left lobes: 30.39% and 29.72%, respectively); (c) second follow-up: ground-glass opacity is absorbed, with development of consolidation and perilobular pattern (opacification percentages of right and left lobes: 24.21% and 19.73%, respectively).
Figure 5c:
A 56-year-old man with severe COVID-19, axial chest CT images at baseline and follow-up. (a) Baseline: multiple ground-glass opacities are observed in the right and left upper lobes (opacification percentages of right and left lobes: 19.78% and 17.79%, respectively); (b) first follow-up: multiple patchy ground-glass opacities are increased bilaterally (opacification percentages of right and left lobes: 30.39% and 29.72%, respectively); (c) second follow-up: ground-glass opacity is absorbed, with development of consolidation and perilobular pattern (opacification percentages of right and left lobes: 24.21% and 19.73%, respectively).
A 53-year-old man with critical COVID-19, axial chest CT images at baseline and follow-up. (a) Baseline: multiple ground-glass opacities are observed in the right and left upper lobes (opacification percentages of right and left lobes: 53.55% and 45.89%, respectively); (b) first follow-up: multiple patchy ground-glass opacities are increased bilaterally, with development of consolidation (opacification percentages of right and left lobes: 59.36% and 67.77%, respectively).
Figure 6a:
A 53-year-old man with critical COVID-19, axial chest CT images at baseline and follow-up. (a) Baseline: multiple ground-glass opacities are observed in the right and left upper lobes (opacification percentages of right and left lobes: 53.55% and 45.89%, respectively); (b) first follow-up: multiple patchy ground-glass opacities are increased bilaterally, with development of consolidation (opacification percentages of right and left lobes: 59.36% and 67.77%, respectively).
A 53-year-old man with critical COVID-19, axial chest CT images at baseline and follow-up. (a) Baseline: multiple ground-glass opacities are observed in the right and left upper lobes (opacification percentages of right and left lobes: 53.55% and 45.89%, respectively); (b) first follow-up: multiple patchy ground-glass opacities are increased bilaterally, with development of consolidation (opacification percentages of right and left lobes: 59.36% and 67.77%, respectively).
Figure 6b:
A 53-year-old man with critical COVID-19, axial chest CT images at baseline and follow-up. (a) Baseline: multiple ground-glass opacities are observed in the right and left upper lobes (opacification percentages of right and left lobes: 53.55% and 45.89%, respectively); (b) first follow-up: multiple patchy ground-glass opacities are increased bilaterally, with development of consolidation (opacification percentages of right and left lobes: 59.36% and 67.77%, respectively).
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