Similarities and Differences of CT Features between COVID-19 Pneumonia and Heart Failure

  1. Zhaowei Zhu
  2. Jianjun Tang
  3. Xiangping Chai
  4. Zhenfei Fang
  5. Qiming Hu
  6. Xinqun Hu
  7. Danyan Xu
  8. Jia He
  9. Liang Tang
  10. Shi Tai
  11. Yuzhi Wu
  12. Shenghua Zhou

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

Aims: During the COVID-19 epidemic, chest computed tomography (CT) has been highly recommended for screening of patients with suspected COVID-19 because of an unclear contact history, overlapping clinical features, and an overwhelmed health system. However, there has not been a full comparison of CT for diagnosis of heart failure or COVID-19 pneumonia.

Methods: Patients with heart failure ( n =23) or COVID-19 pneumonia ( n =23) and one patient with both diseases were retrospectively enrolled. Clinical information and chest CT images were obtained and analyzed.

Results: There was no difference in ground-glass opacity, consolidation, crazy paving pattern, the lobes affected, and septal thickening between heart failure and COVID-19 pneumonia. However, a less rounded morphology (4% vs. 70%, P=0.00092), more peribronchovascular thickening (70% vs. 35%, P=0.018) and fissural thickening (43% vs. 4%, P=0.002), and less peripheral distribution (30% vs. 87%, P=0.00085) were found in the heart failure group than in the COVID-19 group. Importantly, there were also more patients with upper pulmonary vein enlargement (61% vs. 4%, P=0.00087), subpleural effusion (50% vs. 0%, P=0.00058), and cardiac enlargement (61% vs. 4%, P=0.00075) in the heart failure group than in the COVID-19 group. Besides, more fibrous lesions were found in the COVID-19 group, although there was no statistical difference (22% vs. 4%, P=0.080).

Conclusions: Although there is some overlap of CT features between heart failure and COVID-19, CT is still a useful tool for differentiating COVID-19 pneumonia.

Article activity feed

  1. Version published to 10.15212/cvia.2021.0016
  2. ScreenIT

    SciScore for 10.1101/2020.03.04.20031047: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was reviewed and approved by the Medical Ethical Committee of the Second Xiangya Hospital of Central South University (approval number 2020005), which waived the requirement for patients’ informed consent referring to the CIOMS guideline.
    Consent: This study was reviewed and approved by the Medical Ethical Committee of the Second Xiangya Hospital of Central South University (approval number 2020005), which waived the requirement for patients’ informed consent referring to the CIOMS guideline.
    Randomizationnot detected.
    BlindingIMAGINE INTERPRETATION: Two thoracic radiologists blinded to the clinical data reviewed the CT images independently and resolved discrepancies by consensus.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    STATISTICAL ANALYSIS: Statistical analysis was done with SPSS, version 25.0.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are several limitations of this study. First, this is a retrospective study with limited cases. Most of the patients with COVID-19 enrolled were non-severe cases. Secondly, we mainly focus on the clinical and imaging features at the initial medical contact, while the dynamic changes with appropriate therapy are definitely helpful to differentiate the 2 diseases. In conclusion, during epidemic period, it is essential for doctors to identify the imaging features of COVID-19 and heart failure. Although both diseases can have similar GGO and septal thickening, rounded morphology, peripheral distribution and fibrous lesion were relatively specific in COVID-19. While heart failure usually has more peribronchovascular thickening, fissural thickening, subpleural effusion and cardiac enlargement.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.03.04.20031047v1 on medRxiv