Observational Study Medicine ®

OPEN

Chest CT of COVID-19 in patients with a negative

first RT-PCR test
Comparison with patients with a positive first RT-PCR test
Zu-Hua Chen, MDa, Yun-Jiang Li, MDa, Xiu-Juan Wang, MDa, Yun-Feng Ye, MDa, Bao-Liang Wu, MDa,
∗
Yan Zhang, MDa, Wei-Ling Xuan, MDa, Jian-Feng Bao, MDb, Xue-Ying Deng, MDc,d,

Abstract
To compare clinical and imaging features between patients with an initial negative reverse-transcription-polymerase chain-reaction
(RT-PCR) test and patients with an initial positive RT-PCR test. CT follow-up analysis in the negative RT-PCR group is also described.
Thirty-three patients with SARS-CoV-2 infection confirmed by RT-PCR, with 216 lesions upon CT, were included. Demographic
information and chest CT imaging features were collected.
The average age in the whole study group was 46.9 ± 11.1 years, with 18 males and 15 females. Patients in the positive RT-PCR
test group were more likely to have a fever than patients in the negative RT-PCR test group (85.7% vs 50%, P < .05). Lesions in the
positive group were more likely to be located in the peripheral area than lesions in the negative group (83.6% vs 68.2%, P < .05).
Regarding the appearance of 216 lesions, ground-glass opacities (GGOs) with consolidation (43.2%) was the most common
appearance in the negative group, followed by pure GGOs (31.8%), while in the positive group, pure GGOs (32%) and GGOs with
interlobular septal thickening (32.8%) were both most frequent, and the difference between them was evident (P < .05). For the
follow-up analysis, the largest short-axis of a lesion was smaller upon follow-up (median size 13.6 mm vs 14 mm), albeit by a smaller
margin. Pure GGOs decreased in frequency, from 31.3% to 21.3%, while consolidation increased in frequency, from 7.5% to 12.5%.
The manifestations of COVID-19 in patients with a first negative RT-PCR test and patients with a positive first RT-PCR test are
different to some extent. The consolidation component may increase after follow-up.
Abbreviations: GGO = ground-glass opacity, MERS-CoV = Middle East respiratory syndrome coronavirus, RT-PCR = reverse-
transcription-polymerase chain-reaction, SARS-CoV = severe acute respiratory syndrome coronavirus.
Keywords: COVID-19, severe acute respiratory syndrome coronavirus 2, tomography, x-ray computed

1. Introduction Hubei Province, China.[1] With the rapid spread of the disease,
there have been nearly 2 million laboratory-confirmed cases and
In 31, December 2019, a cluster of patients diagnosed with
more than 120,000 deaths worldwide, affecting 213 countries,
COVID-19 infected by severe acute respiratory syndrome
areas or territories by 16 April 2020.[2] SARS-CoV-2 is one of the
coronavirus 2 (SARS-CoV-2) was initially reported in Wuhan,
coronaviruses, which are enveloped RNA viruses that are found
Editor: Oliver Schildgen.
broadly, not only in humans but also in other mammals and
birds, and can infect human airway epithelial cells.[1] Similar to
The authors have no funding and conflicts of interest to disclose.
two other highly pathogenic and transmissible viruses, SARS-
All data generated or analyzed during this study are included in this published
article [and its supplementary information files].
CoV and Middle East respiratory syndrome coronavirus (MERS-
a CoV), SARS-CoV-2 is a member of the Coronaviridae family and
Department of Radiology, b Department of Science and Education, The
Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University, can result in severe and even fatal respiratory diseases, such as
c
Department of Radiology, The Cancer Hospital of the University of Chinese acute respiratory distress syndrome, especially in older patients
Academy of Sciences (Zhejiang Cancer Hospital), d Institute of Cancer and Basic with comorbidities.[3,4]
Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China. Patients with COVID-19 present with typical manifestations,
∗
Correspondence: Xue-Ying Deng, Department of Radiology, The Cancer such as single or multiple patchy ground-glass opacities, with or
Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer
without interstitial, interlobular septal thickening, which can be
Hospital), Banshandong Road 1#, Hangzhou, China
(e-mail: [email protected]). accompanied by consolidation, located in the peripheral area,
Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.
without subpleural sparing.[5] The patient with typical chest CT
This is an open access article distributed under the terms of the Creative results usually manifests positive results of real-time reverse-
Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is transcription-polymerase chain-reaction (RT-PCR) for the virus.
permissible to download, share, remix, transform, and buildup the work provided However, in clinical practice, we found that patients could
it is properly cited. The work cannot be used commercially without permission
present negative results in their first or even subsequent RT-PCR
from the journal.
tests, even in patients with typical chest CT results, and the
How to cite this article: Chen ZH, Li YJ, Wang XJ, Ye YF, Wu BL, Zhang Y, Xuan
WL, Bao JF, Deng XY. Chest CT of COVID-19 in patients with a negative first
proportion of patients with negative RT-PCR test results is
RT-PCR test: comparison with patients with a positive first RT-PCR test. high.[6] Therefore, to include these patients and prevent potential
Medicine 2020;99:26(e20837). public risks caused by missed patients, China has added clinical
Received: 23 March 2020 / Received in final form: 22 April 2020 / Accepted: 22 criteria only in Hubei Province, based on chest CT results and
May 2020 clinical discovery, which resulted in exaggeratively increasing the
http://dx.doi.org/10.1097/MD.0000000000020837 number of cases to more than 14,840 overnight, including 13332

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Chen et al. Medicine (2020) 99:26 Medicine

clinically confirmed cases on the first day of its release (February Every lesion was identified by the readers. For example, a lobe
13).[7] Few studies exist in the literature related to CT results in containing a lesion was counted as one lesion, a lobe containing 3
patients with negative RT-PCR test results.[6] Thus, the purpose lesions separately was counted as three lesions, while a diffuse
of our study was to compare the CT imaging features of 12 lesion involving 2 lobes or 3 lobes was counted as 2 lesions or 3
patients with initial negative RT-PCR results with those of 21 lesions, respectively.
patients with initial positive RT-PCR results. Furthermore, we For patients with negative first RT-PCR results, CT was
also performed follow-up research among patients with negative performed after they tested positive after one or more RT-PCR
RT-PCR results, including the largest sample to date. tests. The data were collected as follows: the appearance of each
lesion as mentioned above; the largest short-axis of the lesions;
and the change in the consolidation component and the GGO
2. Materials and methods
component.
This retrospective study was approved by our institutional review
board, while the requirement for informed consent from each 2.4. Statistical analysis
patient was waived.
All data were analyzed using IBM SPSS statistics software
(version 24; IBM company, NY). Continuous variables are
2.1. Patients
expressed as the mean ± the standard deviation or median (25%–
Patients diagnosed with COVID-19 confirmed by RT-PCR from 75%), according to their distribution, and counting variables are
January 24, 2020 to February 6, 2020 were retrospectively presented as frequencies (percentages). The clinical and CT
evaluated. imaging findings were compared between patients with a negative
The inclusion criteria were as follows: (A) patients with a first RT-PCR test and those with a positive first RT-PCR test by
positive RT-PCR test and (B) patients demonstrating pneumonia using Student’s t test or the Mann-Whitney U test for quantitative
in thin-section CT images. Three patients with normal chest CT variables and Fisher exact test or the x2 test for qualitative data. A
imaging results were excluded. Finally, 33 patients were included, paired t-test was used between follow-up patients. A P value
including 12 patients with a negative first RT-PCR test and 21 of < .05 was considered statistically significant.
patients with a positive first RT-PCR test.
3. Results
2.2. Image acquisition
A total of 33 patients with 216 lesions were included, including 21
All patients underwent thin-section high-resolution CT scans. All patients with a positive first RT-PCR test with 128 lesions and 12
CT examinations were performed with GE Revolution Evo CT patients with a negative first RT-PCR test with 88 lesions.
scan (GE Healthcare, Milwaukee, WI) without the use of an Moreover, 11 patients with a negative RT-PCR test had follow-up
intravenous agent. All scans were performed with patients in the chest CT data, including 80 lesions. The median time from the first
supine position during end-inspiration. The CT parameters were negative result to the first positive result was 2 days, and the average
as follows: 120 kV; automatic tube current, 10 to 240 mA; section number of days was 2.7 days, ranging from 1 to 6 days. The median
thickness, 5 mm; interlayer spacing, 5 mm; and scanning time, less number of RT-PCR tests was 2 times, and the average number
than 5 seconds. Reconstruction was performed with a thickness was 2.6 times, ranging from 2 to 6 times. The average time interval
of 1.25 mm. from the onset of symptoms to the performance of lung CT was
3.12 days in all patients, 3.19 days in the positive first RT-PCR test
2.3. Imaging analysis group and 3 days in the negative first RT-PCR test group.

The CT findings were evaluated by 3 radiologists (YJ, XJ, YF) 3.1. Comparison of clinical information between patients
who had ample experience in cardiothoracic radiology. Any with a negative first RT-PCR test and those with a positive
disagreements between them were settled by consensus after
first RT-PCR test
discussion.
For each patient, demographic information, including age, sex, The demographic and clinical information are summarized in
symptoms, comorbidities, contact history (travel to Wuhan, Table 1. The average age of the whole study group was 46.9 ±
exposure to infected patients and unknown reasons) and 11.1 years old, the median age was 46 years old, and males were
laboratory examinations (C-reactive protein, white blood cell slightly more predominant than females. No significant difference
count and lymphocyte count), was collected. The following CT was found in sex or age between the two groups (P > .05).
imaging features were included: the number of lungs and lobes Regarding symptoms, patients in the positive RT-PCR test group
involved; the appearance of each lesion, including pure ground- were more likely to have a fever than patients in the negative RT-
glass opacity (GGO; defined as hazy increased lung attenuation PCR test group (85.7% vs 50%); the difference was significant
with no obscuration of the underlying bronchial or vessels), GGO (P < .05). Other symptoms included cough (n = 19), fatigue (n =
with interstitial or interlobular septal thickening or reticulation, 6), headache (n = 4), chest distress (n = 3), muscle soreness (n = 1),
GGO with consolidation (defined as opacification obscuring the and throat discomfort and pain (n = 6). Regarding contact
underlying vessels), and consolidation; the predominant distri- history, 33.3% of patients in the positive group had been to
bution of lesions, including peripheral (defined as outer one-third Wuhan recently, while none of the patients in the negative group
of the peripheral zone of both lungs), central (adjacent to the had traveled to Wuhan, and most of the patients (83.3%) in the
peripheral area) or both; bronchiectasis; air bronchogram; negative group were exposed to infected patients; the difference
pleural effusion and lymphadenopathy (lymph node size larger between them was significant (P < .05). In terms of comorbidity,
than 10 mm in short-axis dimension). The largest short-axis only 5 patients had comorbidities, such as hypertension, diabetes,
lesion was measured in the vertical pleural direction. and liver cirrhosis. In laboratory examinations, nearly half

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Table 1
Baseline demographic and clinical characteristics of 33 patients with COVID-19.
All subjects (n = 33) Negative (n = 12) Positive (n = 21) P value
Age (yr) 46.9 ± 11.1 47.6 ± 13.4 46.5 ± 9.9 .788
∗
Gender .245
Male 18 (54.5) 8 (66.7) 10 (47.6)
Female 15 (45.5) 4 (33.3) 11 (52.4)
Symptomatic
∗
Fever 24 (72.7) 6 (50) 18 (85.7) .036
Cough 19 (57.6) 7 (58.3) 12 (57.1) .947
Fatigue 6 3 3 –
Headache 4 0 4 –
Chest distress 3 1 2 –
Muscular soreness 1 0 1 –
Throat discomfort and pain 6 2 4 –
∗
Contact history .042
Travel to Wuhan 7 (21.2) 0 (0) 7 (33.3)
Exposure to infected patient 19 (57.6) 10 (83.3) 9 (42.9)
Unknown reasons 7 (21.2) 2 (16.7) 5 (23.8)
Days from symptom onset to admit to hospital 2 (1–4.5) 2 (1–6) 2 (1.5–4.5) .593
Comorbidity –
Hypertension 2 0 2
Diabetes 1 0 1
Liver cirrhosis 1 0 1
Lung cancer 1 1 0
Hashimoto thyroiditis 1 0 1
Laboratory examination
Elevation of C-reaction protein (0–10) mg/L 16 (48.5) 6 (50) 10 (47.6) .895
∗
Normal white blood cell count (4–10) 109/L 31 (93.9) 11 (91.7) 20 (95.2) .602
∗ 9
Lower lymphocyte count (1.1–3.2) 10 /L 15 (45.5) 3 (25) 12 (57.1) .077
∗
Fisher exact test.

(48.5%) of patients had elevated C-reactive protein levels, and largest short axis of the lesion (P > .05). In the negative group, the
93.9% of all patients had normal white blood cell counts. There right superior lobe (26.1%) and right inferior lobe (27.3%) were
was no significant difference between the two groups. the most commonly involved lobes, while the right inferior lobe
For the number of lobes involved in 33 patients, the median (32%) and left inferior lobe were the most frequently involved
number of lobes involved was 3 (P > .05). In the negative group, lobes in the positive group (P < .05). Lesions in the positive group
41.7% of patients had 5 lobes involved, and only 8.3% of were more likely to be located in the peripheral area than lesions
patients had one lobe involved, while in the positive group, a in the negative group (83.6% vs 68.2%), and the difference
similar proportion was seen in each lobe. Nearly 75% of patients between them was significant (P< .05). Regarding the appearance
had bilateral lung involvement. (Table 2) of each lesion, GGO with consolidation (43.2%) was the most
common appearance in the negative group, followed by pure
GGO (31.8%), while in the positive group, pure GGO (32%) and
3.2. Comparison of CT imaging features for each lesion
GGO with interlobular septal thickening (32.8%) were most
between patients with a negative first RT-PCR test and
frequent, and the difference between them was evident (P < .05).
those with a positive first RT-PCR test Bronchiectasis was more common in the positive test group than
The imaging characteristics are summarized in Table 3. There in the negative test group (54.7% vs 17%, P < .05), while air
was no significant difference between the two groups in the bronchogram was more often shown in the negative group
(28.4% vs 9.4%, P < 0.05). (Figs. 1–3)
Table 2
Baseline CT imaging characteristics of 33 patients with COVID-19. 3.3. Follow-up evaluation in patients with a negative first
All subjects Negative Positive RT-PCR test
(n = 33) (n = 12) (n = 21) P value Eighty lesions in the negative group had CT follow-up
Number of lobes involved 3 (2–5) 3 (1–5) 3 (1.5–4.5) .427 information (Table 4). The average time interval between first
One lobe 6 (18.2) 1 (8.3) 5 (23.8) and follow-up CT was 3.6 days, ranging from 2 days to 10 days.
Two lobes 7 (21.2) 3 (25) 4 (19) Forty-three of the lesions (63.8%) improved upon follow-up, and
Three lobes 6 (18.2) 3 (25) 3 (14.3) 29 of them (36.3%) progressed while the remaining lesions
Four lobes 4 (12.1) 0 (0) 4 (19) (10%) remained the same. The largest short-axis of a lesion was
Five lobes 10 (30.3) 5 (41.7) 5 (23.8)
smaller upon follow-up (median size 13.6 mm vs 14 mm), albeit
Number of lung involved .627
by a small margin. For lesions that improved upon follow-up, the
Unilateral lung 8 (24.2) 3 (25) 5 (23.8)
Bilateral lung 25 (75.8) 9 (75) 16 (76.2) average decrease in size was 3.4 ± 4.2 mm, ranging from 0.1 mm
to 24.5 mm. For lesions that worsened upon follow-up, the

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Table 3
CT imaging characteristics of 216 lesions from COVID-19 patients.
All subjects (n = 216) Negative (n = 88) Positive (n = 128) P value
Largest short-axis of lesion (mm) 13.7 (9.5–22.3) 14 (8.8–28.3) 13.7 (9.8–20.7) .472
Involve lung lobes .037
Right superior lobe 40 (18.5) 23 (26.1) 17 (13.3)
Right middle lobe 22 (10.2) 12 (13.6) 10 (7.8)
Right inferior lobe 65 (30.1) 24 (27.3) 41 (32)
Left superior lobe 39 (18.1) 15 (17) 24 (18.8)
Left inferior lobe 50 (23.1) 14 (15.9) 36 (28.1)
Predominant distribution .022
Peripheral area 167 (77.3) 60 (68.2) 107 (83.6)
Central area 24 (11.1) 15 (17) 9 (7)
Both area related 25 (11.6) 13 (14.8) 12 (9.4)
Performance of lesions .020
Pure GGO 69 (31.9) 28 (31.8) 41 (32)
GGO with interlobular septal thickening 57 (26.4) 15 (17) 42 (32.8)
GGO with consolidation 71 (32.9) 38 (43.2) 33 25.8)
Consolidation 19 (8.8) 7 (8) 12 (9.4)
Bronchiectasis 85 (39.4) 15 (17) 70 (54.7) <.001
Air bronchogram 37 (17.1) 25 (28.4) 12 (9.4) <.001
GGO = ground-glass opacities.

Figure 1. A–D. Chest CT images of a 43-year-old female, presenting multiple patchy areas of pure ground-glass opacities (GGOs) (white arrowhead). These
abnormalities are all distributed in the posterior and peripheral parts of both lungs.

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Figure 2. A–D. Chest CT images of a 31-year-old female, presenting multiple patchy areas of pure GGOs and GGOs with interlobular septal thickening in both
lungs. These lesions are mostly located in the peripheral area.

average increase in size was 3.5 ± 3.8 mm, ranging from 0.1 mm 21 patients, and they found that 71% of them had more than two
to 18 mm. The appearance of each lesion also changed lobes involved. This result was similar to that of our study; we
significantly (P < .05). Overall, pure GGOs decreased in found that 30.3% of all patients had five lobes involved. In their
frequency, from 31.3% to 21.3%, while consolidation increased study, 57% of patients presented with GGOs, and 33% of them
in frequency, from 7.5% to 12.5% and from 45% to 47.5%. In presented with GGOs with rounded morphologies, but only 33%
terms of lesions, the consolidation component decreased in 33 of them were found to have a peripheral distribution.[10]
patients (41.3%), increased in 28 patients (35%), and remained However, in our study, we found 77.3% of all lesions were
the same in 19 patients (23.8%). Similarly, the GGO component located in the peripheral area, and 83.6% of lesions in patients
decreased in 46 patients (57.5%), increased in 23 patients with a positive first RT-PCR test were located in that area. A
(28.8%), and remained the same in 11 patients (13.8%). peripheral area distribution was typical in up to 85% of lesions.[5]
(Fig. 4A–D) Pan Yueying et al[11] included 63 patients and found that 44.4%
of them had 5 lobes involved, which was similar to our result.
Song Fengxiang et al[5] included 51 patients with 1324 lesions
4. Discussion
and found that 30% of lesions were pure GGOs, 39% were
Chest CT is of paramount importance in the diagnosis of GGOs with interlobular septal thickening, 18% were GGOs with
COVID-19 caused by SARS-CoV-2 infection. Notwithstanding, consolidation, and 13% were consolidation lesions. In our study,
diagnosis cannot be based upon CT features alone, and RT-PCR we found that GGOs with consolidation (43.2%) and pure
is the gold standard for the diagnosis of SARS-CoV-2 infection.[8] GGOs (31.8%) were the most common lesion appearances in
However, in clinical practice, many patients present with a patients in the negative RT-PCR test group, while pure GGOs
negative first RT-PCR test even though they have typical lung (32%) and GGOs with interlobular septal thickening (32.8%)
manifestations and a highly suspected contact history. Thus, we were most frequent appearances in patients in the positive RT-PCR
aimed to determine the differences in chest CT imaging features test group. Pleural effusions and lymphadenopathy were absent
and clinical characteristics between patients with a negative first in most of the patients, which was similar to our study.[5,10]
RT-PCR test and those with a positive first RT-PCR test. Patients can present diverse chest CT results, and imaging
The greatest strength of our study was that we evaluated each changes in COVID-19 are very rapid, which may be affected by
lesion rather than just patients based on imaging features and we immune status. Lesions can be absorbed after proper treat-
compared features between our 2 groups. Wang Dawei et al[9] ment.[12] In this study, we found that GGOs tended to be
showed that bilateral patchy shadows or GGOs in the lungs were absorbed or transfer to consolidation. In regard to lesions, the
found in all 138 patients. Chung Michael et al[10] included only consolidation component decreased in 41.3% of patients,

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Figure 3. A–D. Chest CT images of an 89-year-old female, presenting multiple patchy and segmental areas of GGOs with interlobular septal thickening, GGOs with
consolidation and consolidation in both lungs. Lesions are located in both the peripheral and the central area. Bronchiectasis and air bronchogram are present.

increased in 35%, and remained the same in 23.8%. The GGO than patients exposed only to infected patients. COVID-19
component decreased in 57.5% of patients, increased in 28.8%, tended to occur in patients in their 40 to 50 seconds, both in our
and remained the same in 13.8%. Pan Feng et al[13] showed that study and in others. A large population study analyzed 425
lung involvement progressed to consolidation up to 2 weeks after patients with confirmed COVID-19; their median age was 59
disease onset, and then lesions were absorbed stage by stage, years, and 56% of them were male, which was similar to our
leaving widespread GGOs and subpleural parenchymal bands. results.[15] Fever and cough were the most common symptoms in
However, Song Fengxiang et al[5] found that the consolidation patients, while fever was even more common in patients in the
component was greater within an interval of > 4 days after positive RT-PCR group. A study including 138 hospitalized
symptom onset. patients found that fever (98.6%), fatigue (69.6%) and dry cough
Epidemiologically speaking, a negative RT-PCR test seemed (59.4%) were common symptoms, and 46.4% of the patients
likely in patients who had not travelled to Wuhan recently, a city had one or more coexisting medical conditions, which was much
considered an outbreak source of SARS-CoV-2 infection, higher than the proportion in our study, possibly because our
possibly related to the Huanan Seafood Wholesale Market.[14] patients were much younger (46 vs 56 years old).[9]
Patients exposed directly to Wuhan may carry higher virus titers Most of our patients had more than one lung lobe involved,
and 75.8% of had bilateral lung involvement, while in patents
with SARS, unifocal involvement was more frequent than
Table 4
multifocal or bilateral involvement.[16] COVID-19 sometimes
Baseline demographic and clinical characteristics of 11 patients
has manifestations similar to those of MERS pneumonia, with
(80 lesions) with a negative first RT-PCR test.
both appearing as subpleural lesions with extensive GGOs and
Negative Follow-up consolidation. A history of close exposure may differentiate
(n = 80) (n = 80) P value
COVID-19 and MERS.[16,17]
Largest short-axis of lesion 14 (8.8–28.3) 13.7 (9.8–20.7) .310 There are several limitations in our study. This was a retrospective
Performance of lesions .007 study with inevitable bias. Only 33 patients were included, and
Pure GGO 25 (31.3) 17 (21.3) the sample was relatively small, although we included a larger
GGO with interlobular septal thickening 13 (16.3) 15 (18.8)
sample of patients with a negative first RT-PCR test than other
GGO with consolidation 36 (45) 38 47.5)
studies.[6] Some detailed patient information, such as treatment
Consolidation 6 (7.5) 10 (12.5)
method and patient outcomes, was unavailable in our study.

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Figure 4. A-B. Baseline chest CT images of a 35-year-old male with a negative first RT-PCR test, presenting multiple patchy areas of pure GGOs and GGOs with
interlobular septal thickening in both lungs. C-D. Two days after baseline chest CT, when he had his first positive RT-PCR test, CT images showed that the
consolidation component had increased (white arrowhead).

In conclusion, the manifestations of COVID-19 in patients [2] Coronavirus disease 2019 (COVID-19) Situation Report. Geneva: World
Health Organization, 16 April, 2020, https://covid19whoint/. Accessed
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16 April 2020.
RT-PCR test were different. Lesions in the positive group were [3] Cui J, Li F, Shi Z-L. Origin and evolution of pathogenic coronaviruses.
more likely to be pure GGOs and GGOs with interlobular septa, Nat Rev Microbiol 2018;17:181–92.
with peripheral distribution, while lesions in the negative group [4] Chen N, Zhou M, Dong X, et al. Epidemiological and clinical
were pure GGOs and GGOs with consolidation. After follow-up, characteristics of 99 cases of 2019 novel coronavirus pneumonia in
Wuhan, China: a descriptive study. Lancet 2020;395:507–13.
the GGO component decreased and the consolidation component [5] Song F, Shi N, Shan F, et al. Emerging coronavirus 2019-nCoV
increased. pneumonia. Radiology 2020;295:210–7.
[6] Xie X, Zhong Z, Zhao W, et al. Chest CT for Typical 2019-nCoV
Pneumonia: Relationship to Negative RT-PCR Testing. Radiology
Author contributions 2020;200343. doi: 10.1148/radiol.2020200343.
[7] Coronavirus disease 2019 (COVID-19) Situation Report - 24. Geneva:
Zu-Hua Chen has finished original manuscript.
World Health Organization, 13 February 2020, https://wwwwhoint/
Yun-Jiang Li coped with data and did statistical analysis. docs/default-source/coronaviruse/situation-reports/20200213-sitrep-24-
Xiu-Juan Wang, Yun-Feng Ye and Bao-Liang Wu have collected covid-19pdf?sfvrsn=9a7406a4_4. Accessed 14 February 2020.
patients data and analysis CT images. [8] China National Health Commission. Diagnosis and treatment of
Yan Zhang and Wei-Ling Xuan have collected clinical data and pneumonitis caused by new coronavirus (trial version 5). Beijing: China
National Health Commission, 2020 http://wwwnhcgovcn/xcs/fkdt/
did follow-up researches. 202002/e84bd30142ab4d8982326326e4db22eashtml. Accessed 5 Feb-
Jian-Feng Bao have verified the final results. ruary 2020.
Xueying Deng designed and managed this study, and modified [9] Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized
final manuscript. patients with 2019 novel coronavirus–infected pneumonia inWuhan,
China. JAMA 2020;323:1061–9.
All authors did literature research.
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