Key Considerations for Radiologists When Diagnosing the Novel Coronavirus Disease (COVID-19)

Dear Editor,

We have read the publication titled “Chest Radiographic and CT Findings of the 2019 Novel Coronavirus Disease (COVID-19): Analysis of Nine Patients Treated in Korea” with great interest (1). The study suggested that the typical computed tomography (CT) features of COVID-19 pneumonia were ill-defined pure ground-glass opacities (GGO) or mixed GGO and consolidation. The statistical analysis revealed that there was a significant difference in the distribution of lesions (p < 0.05) (1). We would like to share our opinion regarding diagnosing COVID-19 using radiological findings. Firstly, even though there are some typical radiological features of COVID-19 pneumonia, these features are not specific signs for different kinds of virus-related pneumonia or COVID-19 infection stages (2,3). CT is a useful tool for the surveillance of pneumonic lesions and is more likely to detect early and/or mild lesions in the virus lifecycle (2,4). Therefore, CT examinations play an important role in detecting or monitoring pulmonary parenchyma in patients suspected with COVID-19 pneumonia. Secondly, not all patients with COVID-19 have abnormal CT features (5). The real-time reverse transcriptase-polymerase chain reaction amplification of the viral DNA is considered the “gold standard”. Therefore, a CT examination and nuclear acid test should be used together for detecting COVID-19. Thirdly, fever and cough have been the most frequent initial symptoms (3), and radiologists should pay attention to these chief symptoms. Lastly, the history of exposure to other patients with COVID-19 or the epidemic area is critical to know. In conclusion, radiologists should make a comprehensive analysis when diagnosing COVID-19 infection that is beyond just assessing the radiological features.