Coronavirus Disease 2019 (COVID-19) CT Findings: A Systematic Review and Meta-analysis

J Am Coll Radiol. 2020 Jun;17(6):701-709. doi: 10.1016/j.jacr.2020.03.006. Epub 2020 Mar 25.


Purpose: To date, considerable knowledge gaps remain regarding the chest CT imaging features of coronavirus disease 2019 (COVID-19). We performed a systematic review and meta-analysis of results from published studies to date to provide a summary of evidence on detection of COVID-19 by chest CT and the expected CT imaging manifestations.

Methods: Studies were identified by searching PubMed database for articles published between December 2019 and February 2020. Pooled CT positive rate of COVID-19 and pooled incidence of CT imaging findings were estimated using a random-effect model.

Results: A total of 13 studies met inclusion criteria. The pooled positive rate of the CT imaging was 89.76% and 90.35% when only including thin-section chest CT. Typical CT signs were ground glass opacities (83.31%), ground glass opacities with mixed consolidation (58.42%), adjacent pleura thickening (52.46%), interlobular septal thickening (48.46%), and air bronchograms (46.46%). Other CT signs included crazy paving pattern (14.81%), pleural effusion (5.88%), bronchiectasis (5.42%), pericardial effusion (4.55%), and lymphadenopathy (3.38%). The most anatomic distributions were bilateral lung infection (78.2%) and peripheral distribution (76.95%). The incidences were highest in the right lower lobe (87.21%), left lower lobe (81.41%), and bilateral lower lobes (65.22%). The right upper lobe (65.22%), right middle lobe (54.95%), and left upper lobe (69.43%) were also commonly involved. The incidence of bilateral upper lobes was 60.87%. A considerable proportion of patients had three or more lobes involved (70.81%).

Conclusions: The detection of COVID-19 chest CT imaging is very high among symptomatic individuals at high risk, especially using thin-section chest CT. The most common CT features in patients affected by COVID-19 included ground glass opacities and consolidation involving the bilateral lungs in a peripheral distribution.

Keywords: COVID-19; CT imaging findings; ground glass opacities; meta-analysis; thin-section chest CT.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Betacoronavirus*
  • COVID-19
  • Coronavirus Infections / diagnostic imaging*
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / pathology
  • Female
  • Humans
  • Male
  • Pandemics / statistics & numerical data*
  • Pneumonia, Viral / diagnostic imaging*
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / pathology
  • Radiography, Thoracic / methods
  • SARS-CoV-2
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed / methods*
  • Tomography, X-Ray Computed / statistics & numerical data