Role of Chest Imaging in Diagnosis and Management of COVID-19
DISCOVERIES REPORTS (ISSN 2393249X), 2021, volume 4

Access FULL text of the manuscript here:

GO BACK to 2021, VOLUME 4

CITATION: Waleed MS, Bhatt KP, Fatima FN, Mathew A, Domingo PIM, Patel MH, Singh BM. Role of Chest Imaging in Diagnosis and Management of COVID-19. Discoveries Reports, 2021; 4: e20. DOI: 10.15190/drep.2021.5  Submitted: Mar. 31, 2021; Revised: May 08, 2021; Accepted: May 08, 2021; Published: June 30, 2021; 

Role of Chest Imaging in Diagnosis and Management of COVID-19 

Madeeha Subhan Waleed (1,*), Kinal Paresh Bhatt (2), Farwah N. Fatima (3), Anoopa Mathew (4), Paz Ines M. Domingo (5), Mehrie H. Patel (6), Bishnu M. Singh (7)

(1) Ayub Medical College, 22040, Abbottabad, Pakistan
(2) Larkin Health System, 33143, South Miami, FL, USA
(3) Lahore Medical and Dental College,53400, Lahore, Pakistan
(4) K.S. Hegde Medical Academy, 575018, Mangaluru, Karnataka, India
(5) University of the East Ramon Magsaysay Memorial Medical Center, 1113, Quezon City, Philippines
(6) Pramukhswami Medical College, 388325, Gujarat, India
(7) Hetauda City Hospital, 44107, Hetauda, Nepal

* Corresponding author: Madeeha Subhan Waleed MBBS, Ayub Medical College, 22040, Abbottabad, Pakistan; Email:; Phone:00923335634888.


The COVID-19 pandemic is a serious global health threat. The standard gold test for detecting COVID -19 is a real-time reverse transcription-polymerase chain reaction (RT-PCR) of viral nucleic acid. There are different specific and nonspecific diagnostic tests available for COVID-19. The use of imaging in COVID-19 is considered a specific diagnostic test and is stratified based on the severity of the disease. Chest radiographs of COVID-19 patients are usually insensitive to detecting COVID-19 in the early stage. They may have some utility, with the potential to serve as a screening tool on the frontlines in medical settings with limited resources. CT (computerized tomography) scans have greater sensitivity and are used in disease staging. They are a good indicator of the infection in patients with negative viral testing or chest X-ray results, when clinical findings are still serious concerns for COVID-19. However, meticulous equipment decontamination is required to reduce any chance of viral contamination and spread across patients and facility staff. It is salient to utilize the advantages of different imaging modalities in the wrestle against COVID-19. The mounting prevalence of COVID-19 in the community demands for an accurate and sensitive test for COVID-19. This review article sheds light on the limited role of different imaging modalities in diagnosing and managing COVID-19.


1.  Cui J, Li F, Shi ZL. Origin and evolution of pathogenic coronaviruses. Nat Rev Microbiol. 2019 Mar;17(3):181-192.
2. Karia R, Gupta I, Khandait H, Yadav A, Yadav A. COVID-19 and its Modes of Transmission. SN Compr Clin Med. 2020;1-4.
3. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020 Mar 26;382(13):1199-1207.
4. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. Journal of Autoimmunity 2020; 109:102433.
5. Ahluwalia AS, Qarni T, Narula N, Sadiq W, Chalhoub MN. Bilateral pneumothorax as possible atypical presentation of coronavirus disease 2019 (COVID-19) Respir Med Case Rep. 2020;31:101217.
6. Clark, A., Jit, M., Warren-Gash, C., Guthrie, B., Wang, H. H. X et al. Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modeling study. The Lancet Global Health. 2020;8: e1003–e1017.
7. Waleed MS, Sadiq W, Azmat M. Understanding the Mosaic of COVID-19: A Review of the Ongoing Crisis. Cureus. 2020 Mar 22;12(3):e7366.
8. Pan Y, Yu X, Du X, Li Q, Li X, Qin T et al. Epidemiological and clinical characteristics of 26 asymptomatic SARS-CoV-2 carriers. The Journal of Infectious Diseases. 2020; 221(12).
9. Corman VM, Landt O, Kaiser M, Molenkamp R, Meijer A, Chu DK et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Eurosurveillance. 2020; 25(3):2000045.
10. Lassaunière R, Frische A, Harboe ZB, Nielsen AC, Fomsgaard A, Krogfelt KA et al. Evaluation of nine commercial SARS-CoV-2 immunoassays. Medrxiv. 2020 Jan 1.
11. Guo L, Ren L, Yang S, Xiao M, Chang D, Yang F et al. Profiling early humoral response diagnose novel coronavirus disease (COVID-19). Clinical Infectious Diseases. 2020 March 21.
12. Centers for Disease Control and Prevention Overview of testing for SARS-CoV-2. [cited 2020 Oct 30].
13. Chen Z, Zhang Z, Zhai X, Li Y, Lin L, Zhao H et al. Rapid and Sensitive Detection of anti-SARS-CoV-2 IgG, Using Lanthanide-Doped Nanoparticles-Based Lateral Flow Immunoassay. Analytical chemistry. 2020 Apr 23;92(10):7226-31.
14. Pan Y, Li X, Yang G, Fan J, Tang Y, Zhao J et al. Serological immunochromatographic approach in diagnosis with SARS-CoV-2 infected COVID-19 patients. Journal of Infection. 2020; 81(1):E28-E32.
15. Li Z, Yi Y, Luo X, Xiong N, Liu Y, Li S et al. Development and clinical application of a rapid IgM‐IgG combined antibody test for SARS‐CoV‐2 infection diagnosis. Journal of Medical Virology. 2020 February 27.
16. Sutandy FR, Qian J, Chen CS, Zhu H. Overview of protein microarrays. Current protocols in protein science. 2013 Apr;72(1):27-1.
17. Chen Z, Dodig-Crnković T, Schwenk JM, Tao SC. Current applications of antibody microarrays. Clinical proteomics. 2018;15(1):7.
18. Oliveira BA, Oliveira LC, Sabino EC, Okay TS. SARS-CoV-2 and the COVID-19 disease: a mini-review on diagnostic methods. Revista does Instituto de Medicina Tropical de Sao Paulo. 2020;62.
19. Zhao W, Zhong Z, Xie X, Yu Q, Liu J. Relation between chest CT findings and clinical conditions of coronavirus disease (COVID-19) pneumonia: a multicenter study. American Journal of Roentgenology. 2020;214(5):1072-7.
20. Rousan LA, Elobeid E, Karrar M, Khader Y. Chest x-ray findings and temporal lung changes in patients with COVID-19 pneumonia. BMC Pulmonary Medicine. 2020 Dec;20(1):1-9.
21. Lagunas‐Rangel FA. Neutrophil‐to‐lymphocyte ratio and lymphocyte‐to‐C‐reactive protein ratio in patients with severe coronavirus disease 2019 (COVID‐19): A meta‐analysis. Journal of Medical Virology. 2020 April 3.
22. Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223):470–473.
23. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020 Feb 15;395(10223):507-513.
24. Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J. Chest CT for Typical Coronavirus Disease 2019 (COVID-19) Pneumonia: Relationship to Negative RT-PCR Testing. Radiology. 2020 Aug;296(2):E41-E45. doi: 10.1148/radiol.2020200343.
25. Huang P, Liu T, Huang L, Liu H, Lei M, Xu W et al. Use of Chest CT in Combination with Negative RT-PCR Assay for the 2019 Novel Coronavirus but High Clinical Suspicion. Radiology. 2020 Apr;295(1):22-23.
26. Chinese Medical Association Radiology Branch Radiological diagnosis of new coronavirus pneumonia: expert recommendations from the Chinese Medical Association Radiology Branch (first edition) Chin J Radiol. 2020;54(00): E001–E001.
27. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J et al China Novel Coronavirus Investigating and Research Team. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020 Feb 20;382(8):727-733.
28. Phan LT, Nguyen TV, Luong QC, Nguyen TV, Nguyen HT, Le HQ et al. Importation and Human-to-Human Transmission of a Novel Coronavirus in Vietnam. N Engl J Med. 2020;382(9):872-874.
29. Zuo H. Contribution of CT features in the diagnosis of COVID-19. Vassilakopoulos TI, ed. Can Respir J. 2020; 2020: 1-16.
30. Zhou A, Wang Y, Zhu T, Xia L. CT Features of Coronavirus Disease 2019 (COVID-19) Pneumonia in 62 Patients in Wuhan, China. AJR Am J Roentgenol. 2020 Jun;214(6):1287-1294
31. National Health Commission of the People’s Republic of China The diagnostic and treatment protocol of COVID-19. China. 2020.
32. Giovagnoni A. Facing the COVID-19 emergency: we can and we do. Radiol Med. 2020 Apr;125(4):337-338.
33. Neri E, Miele V, Coppola F, Grassi R. Use of CT and artificial intelligence in suspected or COVID-19 positive patients Statement of the Italian Society of Medical and Interventional Radiology. Radiol Med. 2020:1-4.
34. ACR recommendations for the use of chest radiography and computed tomography (CT) for suspected COVID-19 infection. American College of Radiology.
35. Hui J.Y.-H., Hon TY, Yang MK, Cho DH, Luk WH, Chan RY et al. High-resolution computed tomography is useful for early diagnosis of severe acute respiratory syndrome-associated coronavirus pneumonia in patients with normal chest radiographs. J Comput Assist Tomogr. 2004 Jan-Feb;28(1):1-9.
36. Wei J, Xu H, Xiong J, Shen Q, Fan B, Ye C et al. 2019 Novel Coronavirus (COVID-19) Pneumonia: Serial Computed Tomography Findings. Korean J Radiol. 2020 Apr;21(4):501-504.
37. Xu Y-H., Dong JH, An WM, Lv XY, Yin XP, Zhang JZ et al. Clinical and computed tomographic imaging features of novel coronavirus pneumonia caused by SARS-CoV-2. J Infect. 2020 Apr;80(4):394-400.
38. Miao C, Jin M, Miao L, Yang X, Huang P, Xiong H et al. Early chest computed tomography to diagnose COVID-19 from suspected patients: A multicenter retrospective study. Am J Emerg Med. 2020 Apr 19:S0735-6757(20)30281-3.
39. Zhao W, Zhong Z, Xie X, Yu Q, Liu J. Relation Between Chest CT Findings and Clinical Conditions of Coronavirus Disease (COVID-19) Pneumonia: A Multicenter Study. AJR Am J Roentgenol. 2020 May;214(5):1072-1077.
40. Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P et al. Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radiology. 2020 Aug;296(2):E115-E117.
41. Sun Z, Zhang N, Li Y, Xu X. A systematic review of chest imaging findings in COVID-19. Quant Imaging Med Surg. 2020 May;10(5):1058-1079.
42. Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana JP et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis. 2020;34:101623.
43. Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus Disease 2019 (COVID-19): A systematic review of imaging findings in 919 patients. American Journal of Roentgenology. 2020; 215: 87-93.
44. Borges do Nascimento IJ, Cacic N, Abdulazeem HM, von Groote TC, Jayarajah U, Weerasekara I, Esfahani Ma et al Novel Coronavirus Infection (COVID-19) in Humans: A Scoping Review and Meta-Analysis. J Clin Med. 2020 Mar 30;9(4):941.
45. Rubin GD, Ryerson CJ, Haramati LB, Sverzellati N, Kanne JP, Raoof S, Schluger NW et al The Role of Chest Imaging in Patient Management During the COVID-19 Pandemic: A Multinational Consensus Statement From the Fleischner Society. Chest. 2020 Jul;158(1):106-116.
46. Aljondi R, Alghamdi S. Diagnostic Value of Imaging Modalities for COVID-19: Scoping Review. J Med Internet Res. 2020 Aug 19;22(8):e19673.
47. Yang W, Sirajuddin A, Zhang X et al. The role of imaging in 2019 novel coronavirus pneumonia (COVID-19). Eur Radiol 2020;30:4874–4882.
48. Salameh JP, Leeflang MM, Hooft L, Islam N, McGrath TA, van der Pol CB, Frank RA et al Cochrane COVID-19 Diagnostic Test Accuracy Group, McInnes MD. Thoracic imaging tests for the diagnosis of COVID-19. Cochrane Database Syst Rev. 2020 Sep 30;9:CD013639. Update in: Cochrane Database Syst Rev. 2020 Nov 26;11:CD013639.
49. Altmayer S, Zanon Z, Pacini GS, Watte G, et al. comparison of the computed tomography findings in COVID-19 and other viral pneumonia in immunocompetent adults: a systematic review and meta-analysis. Eur Radiol. 2020 June 27: 1–12.
50. Cleverley J, Piper J, Jones MM. The role of chest radiography in confirming covid-19 pneumonia. BMJ. 2020 Jul 16;370:m2426.
51. Wong HYF, Lam HYS, Fong AH-T, et al. Frequency and distribution of chest radiographic findings in covid-19 positive patients. Radiology 2020; 295(2).
52. Rubin GD, Ryerson CJ, Haramati LB, et al. The role of chest imaging in patient management during the COVID-19 pandemic: a multinational consensus statement from the Fleischner Society. Radiology 2020; 296:172-80.
53. Fu L, Wang B, Yuan T, Chen X, Ao Y, Fitzpatrick T et al Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis. J Infect. 2020 Jun;80(6):656-665.
54. Yoon SH, Lee KH, Kim JY, et al. Chest radiographic and CT findings of the 2019 novel coronavirus disease (COVID-19): analysis of nine patients treated in Korea. Korean J Radiol 2020; 21: 494-500.
55. Chen T, Wu D, Chen H, et al. Clinical characteristics of 113 deceased patients with coronavirus disease in 2019: a retrospective study. BMJ 2020; 368:m1091.
56. Ng M-Y, Lee EYP, Yang J, Yang F, Li X, Wang H et al Imaging Profile of the COVID-19 Infection: Radiologic Findings and Literature Review. Radiol Cardiothorac Imaging. 2020 Feb 13;2(1):e200034.
57. Jacobi A, Chung M, Bernheim A, Eber C. Portable chest X-ray in coronavirus disease-19(COVID-19): A pictorial review. Clin Imaging 2020;64:35-42.
58. Kooraki S, Hosseiny M, Myers L, Gholamrezanezhad A. Coronavirus (COVID-19) Outbreak: What the Department of Radiology Should Know. J Am Coll Radiol. 2020 Apr;17(4):447-451.
59. Qu J, Yang W, Yang Y, Qin L, Yan F. Infection Control for CT Equipment and Radiographers' Personal Protection During the Coronavirus Disease (COVID-19) Outbreak in China. AJR Am J Roentgenol. 2020 Oct;215(4):940-944.
60. Zhao Y, Xiang C, Wang S, Peng C, Zou Q, Hu J. Radiology department strategies to protect radiologic technologists against COVID19: Experience from Wuhan. Eur J Radiol. 2020 Jun;127:108996.
61. Bhatt K, Lathiya M, Godhani N, Motisariya G, Sanchez-Gonzalez M. COVID-19 pandemic in Dengue endemic areas: A case report. Open J Clin Med Case Rep. 2020; 1700.