Radiologic Abnormalities in Prolonged SARS-CoV-2 Infection: A Systematic Review

Area of Science:

• Radiology
• Infectious Diseases
• Immunology

Background:

• Prolonged SARS-CoV-2 infection, defined as positive PCR for over 21 days with persistent or relapsed symptoms, affects immunocompromised individuals.
• Patients with underlying lymphoma and those treated with anti-CD20 therapy are particularly susceptible to prolonged infections.

Purpose of the Study:

• To systematically review and analyze radiological abnormalities on CT scans in patients with prolonged SARS-CoV-2 infection.
• To characterize the patterns, distribution, and evolution of CT findings over time in this patient cohort.

Main Methods:

• Systematic literature review of 24 patients with prolonged SARS-CoV-2 infection.
• Analysis of CT images based on timing relative to initial PCR positivity.
• Assessment of CT findings, lung involvement severity scores, and presence of lesion migration.

Main Results:

• Most patients presented with typical COVID-19 pneumonia (ground-glass opacities, consolidation) on CT.
• CT severity scores were significantly lower at ≤ 21 days compared to > 21 days (P < 0.001).
• Lesion migration on CT increased significantly from ≤ 21 days (22.7%) to > 21 days (68.2%-87.5%).

Conclusions:

• Prolonged SARS-CoV-2 infection in immunocompromised patients typically manifests as migrating COVID-19 pneumonia.
• The observed radiological changes, particularly migration, evolve over the course of the infection.
• Impaired B-cell immunity is a key factor associated with prolonged SARS-CoV-2 infection and its characteristic CT findings.