|
 
 |
| REVIEW ARTICLE |
|
| Year : 2022 | Volume
: 12
| Issue : 1 | Page : 1-7 |
|
COVID-19 and MERS: Are their chest X-ray and computed tomography scanning signs related?
Mohammad Ghaderian1, Mahboobe Kiani1, Sogand Shahbazi-Gahrouei2, Daryoush Shahbazi-Gahrouei1, Abdolkarim Ghadimi Moghadam3, Masoud Haghani4
1 Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Management, Faculty of Humanities Najafabad Branch, Islamic Azad University, Isfahan, Iran
3 Pediatric Infectious Ward, Yasuj University of Medical Sciences, Yasuj, Iran
4 Department of Radiology, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| Date of Submission | 30-Dec-2020 |
| Date of Decision | 02-Jan-2021 |
| Date of Acceptance | 24-May-2021 |
| Date of Web Publication | 28-Dec-2021 |
Correspondence Address:
Daryoush Shahbazi-Gahrouei
Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan
Iran
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jmss.JMSS_84_20
Background: COVID-19 is a respiratory infection brought about by SARS-COV-2. Most of the patients contaminated by this pathogen are afflicted by respiratory syndrome with multiple stages ranging from mild upper respiratory involvement to severe dyspnea and acute respiratory distress syndrome cases. Keeping in mind the high sensitivity of computed tomography (CT) scan in detecting abnormalities, it became the number one modality in COVID-19 diagnosis. A wide diversity of CT features can be found in COVID-19 cases, which can be observed before the onset of clinical signs. The review article is aimed to highlight recent discrepancies in CT-scan and chest X-ray (CXR) characteristics between COVID-19 and Middle East Respiratory Syndrome (MERS). Method: This review study was performed in the literature from the beginning of COVID-19 until the middle of April 2021. For this reason, all relevant works through scientific citation websites such as Google Scholar, PubMed, and Web of Science have been investigated in the mentioned period. Results: COVID-19 was more reproductive than MERS, while MERS was significantly higher in terms of mortality rate (COVID-19: 2.3% and MERS: 34.4%). Signs of ground-glass opacity (GGO), peripheral consolidation, and GGO accompanying with consolidation are the same signs CXR in both MERS and COVID-19. Indeed, fever, cough, headache, and sore throat are the most symptoms in all studied patients. Conclusion: Both COVID-19 and MERS have the same imaging signs. The most similar chest CT findings are GGO, peripheral consolidation, and GGO superimposed by consolidation in both studied diseases, and no statistical differences were seen among the mean number of chest CT-scans in MERS and COVID-19 cases.
Keywords: Chest X-ray, computed tomography scan, COVID-19, Middle East Respiratory Syndrome-CoV, SARS-coronavirus-2
How to cite this article:
Ghaderian M, Kiani M, Shahbazi-Gahrouei S, Shahbazi-Gahrouei D, Ghadimi Moghadam A, Haghani M. COVID-19 and MERS: Are their chest X-ray and computed tomography scanning signs related?. J Med Signals Sens 2022;12:1-7 |
How to cite this URL:
Ghaderian M, Kiani M, Shahbazi-Gahrouei S, Shahbazi-Gahrouei D, Ghadimi Moghadam A, Haghani M. COVID-19 and MERS: Are their chest X-ray and computed tomography scanning signs related?. J Med Signals Sens [serial online] 2022 [cited 2023 Mar 23];12:1-7. Available from: https://www.jmssjournal.net/text.asp?2022/12/1/1/334143 |
| Introduction | |  |
COVID-19 is a viral infection caused by SARS-CoV-2.[1] Its origin is yet to be found, but it was first seen in Wuhan city of China.[2],[3] The basic reproductive number of this virus is relatively high due to its human-human transmission.[4],[5] Emerging the novel coronavirus causes a pandemic throughout the world.[6] The number of infected cases ramping up staggeringly, and by the time of authoring this essay, more than 220 countries and 150 million people have been contaminated by COVID-19, and a rising number of more than 3 million cases have been died so far due to this virus.[7] MERS-CoV is other type of coronavirus, which was originated in Saudi Arabia, and as of July 2019, 2458 cases of MERS were tested positive in 28 countries and 848 patients were died.[8]
COVID-19 is a clinical manifestation of SARS-COVID-2 infection. In the majority of cases, it will lead to respiratory syndrome with several stages from mild upper respiratory tract illness to severe cases of acute respiratory distress syndrome (ARDS) and pneumonia.[9],[10] SARS-COVID-2 and MERS both belong to the β-coronavirus genus, but SARS-COVID-2 seems to have milder symptoms.[11] The most significant clinical sign after 1 week of COVID-19 onset is fever and cough, followed by a sore throat. Other symptoms are expectoration headache, nausea, diarrhea, and vomiting which in severe cases will lead to dyspnea, hypoxia, and ARDS.
Considering the initial involvement of the respiratory tract in COVID-19 and MERS, the first line in diagnosis is a computed tomography (CT scan) followed by a chest X-ray (CXR) with less diagnostic value.[12] Especially with Reverse Transcription Polymerase Chain Reaction (RT-PCR) being less sensitive in terms of confirming COVID-19, CT scan is of great importance in COVID-19 and MERS diagnosis.[13] A vast diversity of CT scan and CXR features is found in COVID-19 and MERS cases that can even be found before clinical symptoms onset.[14],[15] Many studies describe the CT scan manifestation of COVID-19 and MERS in different stages of the disease.[15] The main primary characteristics for both COVID-19 and MERS include bilateral ground-glass opacity (GGO) both in the lateral and posterior segments of lung lobes with diffuse distribution, consolidative opacity, and interstitial septal thickening in the initial phases of the disease. Some less frequent presentations are pleural effusion, pericardial effusion, cavitation, lymphadenopathy, and pneumothorax.[13] In advanced stages of the disease, a progressive sign of ARDS may be presented, which would be an indication for the use of mechanical ventilation for the patient.[15],[16],[17] These radiologic signs are the same in both disease cases but with a little difference in distribution.[11],[18]
A better understanding of the similarities and differences of the clinical and chest CT presentation of these two viral diseases will help the clinicians to better diagnosis. Thus, more efficient patient management and a higher chance of treatment and recovery. The aim of this review article is to investigate recent discrepancies in clinical and CT characteristics between COVID-19 and MERS.
| Materials and Methods | | |
This review study was performed in the literature from the beginning of COVID-19 until the mid of April 2021. A shorter review article regarding to this topic was published in the Persian language previously.[19] For this reason, all related works through citation scientific websites such as Google Scholar, PubMed, and Web of Science have been investigated in the mentioned period, and more than 40 studies have been found using the keywords including COVID-19, MERS-CoV, CT-Scan, and CXR. Non-English language published papers as well as studies relevant to SARS were excluded from this study. Then, radiological and CT-scan findings were extracted and categorized in [Table 1],[Table 2],[Table 3],[Table 4]. | Table 3: Radiological presentations in Middle East respiratory syndrome-coronavirus cases
Click here to view |
Statistical analysis
Meta-analyses were performed by using SPSS version 26.0 (Chicago, IL, USA) software. Due to the limited number of MERS cases and the abnormality of pertained data, Mann–Whitney test and Kolmogorov–Smirnov test were used to analyze the data. According to a 95% confidence interval, statistical significance was set at P < 0.05.
| Results | | |
A preview of data collected from studies reviewed in this literature is provided in [Table 1],[Table 2],[Table 3],[Table 4]. CT scan was the primary diagnostic modality in all published papers, and a CXR was used occasionally. The sample size was varied and was notably small in MERS studies due to its restricted affected region.
Clinical features
According to acquired collected data, both MERS and COVID-19 had the same quarantine period of 1–14 days.[19],[38] Both spread through respiratory tracts and contaminated surfaces.[38],[39] COVID-19 had more transition rate compared to MERS. Considering the World Health Organization report, the infection transmission rate (reproduction number) for COVID-19 roughly around 2–2.5 patients, which was less than MERS (>1).[27] Lui et al. had remarked that the reproduction number of COVID-19 was averagely considered to be 3.28 patients.[4] Mutations are one of the critical parameters which contribute to more reproduction value.[40] However, low doses of X-ray radiation can stimulate anti-infection immune factors that will disrupt the cycle of virus dispersing.[41] COVID-19 had several prevalent clinical symptoms such as cough, fever followed by dyspnea and myalgia, which were also common in MERS in most cases.[8] There were less common clinical presentations such as chest pain, headache, nausea, and vertigo.[42] The severity of symptoms varied, but overall, MERS cases had gone through more severe symptoms due to its high mortality rate.[11] The average time between being exposed to SARS-COVID-2 and the onset of symptoms was approximately 10 days.[43] This interval shrunk a bit in MERS cases, and the average time was about 4-10 days.[44] Based on the recent study on a large population of 44672 cases diagnosed with COVID-19 conducted by the Chinese Center for Disease Control and Prevention, MERS had a such higher mortality rate (around 30%), largely exceeding the COVID-19 with a 3.1% mortality rate. These numbers increased to a 14% death toll when it came to only hospitalized patients with diagnosed COVID-19.[11]
Some risk factors such as underlying comorbidities are related to short-term mortality rate of both MERS and COVID-19.[26],[38] Cases with diagnosed MERS had a wide range of clinical features from asymptomatic to diffuse alveolar damages, which in severe cases will cause ARDS making patients to need of a ventilator.[32] Multiorgan failure was another symptom of MERS that led to acute kidney injury (AKI), which was seldom seen in COVID-19 cases. Another explanation for AKI was related to direct cytopathic effects of the virus on glomeruli and tubule cells in the kidney. On the other hand, both MERS and COVID-19 had neurological defect like cerebra vascular disease and cerebral hemorrhage like interparenchymal hemorrhage, intercranial hemorrhage, epidural hemorrhage, subdural hemorrhage, and subarachnoid hemorrhage that would lead to ischemic or hemorrhagic strokes.[17]
Computed tomography-scan features
In terms of CT presentations, 485 COVID-19 patients and 150 MERS cases were participated in the included papers. Lack of MERS cases was predictable because of the limited region affected by the virus and the studies surveying before mentioned disease. After manual screening and extracting abnormal chest CT-Scans and CXR, the CT scan and radiological patterns and manifestations were extracted from the entry articles. In COVID-19, CT symptoms initiation is 7 ± 4 days after disease onset, and its peak signs were in the 10th day, while in the MERS population, the initiation time was lower. Primary lung lobal involvement in the COVID-19 population has peripheral multi-lesion distribution and relatively localized inflammation in subpleural and parabronchus in the dorsal segment of the right lower lobe, basal segment, and the lateral segment of the same lobe. In contrast, MERS affected the upper airway tract followed by lower respiratory tract involvement in advanced stages.[45] Based on accumulated data, GGO with mean = 67.92 and standard deviation (SD) = 28.32 accompanied by mixed GGO and consolidation (mean = 39.4, SD = 14.9) and peripheral consolidations (mean = 27.7, SD = 19.84), which is known as hyperdense patterns in bronchial tracks and blood vessel borders. These were orderly the most common radiological manifestations in COVID-19 cases [Table 1]. Other reported patterns were fibrous lesions (mean = 31.96, SD = 15.61), lymphadenopathy, pleural effusion (mean = 10.47, SD = 8.52), pericardial effusion, septal thickening, vascular thickening, and air bronchogram sign (mean = 41.17, SD = 11.5). In a study conducted by Lu et al.,[22] a total of 91 patients diagnosed with COVID-19 were examined, and GGO was observed in 76 of them that calculated as 76.9% of the studied population. They reported GGO co-exist with consolidation applied to 37 patients forming 40.7% of the community. Indeed, they conducted crazy paving pattern is seen in 56 patients, which is 6.5% of all patients. Septal thickening was also notable by appearing in 59 patients (64.8%), same as air bronchogram sign (46.2%) and vascular thickening (38.5%).[22] Another peculiar study conducted by Yang et al.[26] was performed on 144 cases and 2375 lobes. According to this study, 26% of lung lobes were affected by GGO mixed with consolidation, which occurs in severe stages of the disease. The formation of opacities was mostly in the shape of patchy GGO (39.35%). They conducted 6.6% of opacities were formed in an oval shape. Furthermore, 74 individuals had a fibrous lesion in the follow-up chest scans, which consist of 48% of the population[26] [Table 1] and [Table 2].
Moreover, in chest CT scan of MERS cases, GGO is the most prevalent findings with mean = 67.92, SD = 28.3 followed by peripheral consolidation (mean = 38, SD = 32.24). Other symptoms including mixed GGO and consolidation (mean = 39.1, SD = 29.56), air bronchogram (mean = 19.45, SD = 12.1), fibrous (mean = 34.15, SD = 20.69), multicentric cavitation, interlobular thickening, pleural effusion (mean = 50.98, SD = 14.28), pneumothorax, and irregular lines. Das et al.[34] had performed a study on 15 patients and a total of 281 lesions. They argued that 86.6% of cases had GGO and 40% had a mixture of GGO and consolidation. Interlobular thickening, which mainly involved bilateral and peripheral lobes was seen in six patients (40%). Pleural effusion, which is a late-stage symptom was presented in nine individuals (60%)[35] [Table 3]. Fully described details of all studies are provided in the presented tables.
Lung involvement distribution
Based on the studies included in this review in confirmed patients of COVID-19, peripheral involvement was the most prominent presentation by 75.65%.(posterior involvement had higher percentage but due to the lack of studies cannot be referred to). Only one review study reported multilobar involvement in 108 severe cases out of 137 population.[15] This may suggest that multilobar involvement is less common in mild stages of the disease and frequent in critical patients.[15] Among six articles determining lung lobar involvement, 75.65% of patients had peripheral involvement and 64.57% had bilateral involvement and 23.58% had central lobe involvement. These numbers indicated that in the majority of cases, peripheral and bilateral involvement was a symptom of early stages of the disease.
In MERS cases, lung involvement is somewhat the same as COVID-19. Numbers associated with the lobar involvement are not as accurate as COVID-19 because of the limited number of cases and studies. Bilateral involvement was the most findings in confirmed cases with 86.5% following by peripheral involvement and multifocal involvement with 50% and 55.7%, respectively. Other lobar involvement was unifocal involvement (42%) and central involvement (14%).
| Discussion | | |
COVID-19 and MERS-COV are both from the same type of β-coronavirus with the same clinical and radiologic symptoms and disease stages in both adults and children.[11],[46],[47] The fatality rate for COVID-19 is less than MERS. Some scholars argue the answer to this issue is within the number of studies and its populations. The studies were limited and performed on hospitalized MERS cases, so the high mortality rate was somehow predictable.[11] While COVID-19 has much more reproductive value and cause a pandemic, MERS remained localized with less transmission rate.[4] Thus, early diagnosis of both diseases is of great importance to stop the transmission chain and maintain the epidemic. RT-PCR is a known gold standard for COVID-19 and MERS diagnosis. However, with its low sensitivity and other limitations like not evaluating the severity of the disease, chest CT scan is suggested as a substitution with its high sensitivity, availability, timely, and rapid scans.[48],[49]
In terms of CT scan findings in this review, it is concluded in [Table 1].
Ground-glass opacity
There are no meaningful statistical differences among mean number of GGOs in diagnosed cases of MERS and COVID-19, according to Mann–Whitney test (P > 0.05, U = 37.00).
Consolidation
There are no significant statistical differences among the mean number of consolidations in diagnosed cases of MERS and COVID-19 according Mann–Whitney test (P > 0.05, U = 28.00).
Mixed ground-glass opacity and consolidation
There are no significant statistical differences among the average cases with mixed GGO and consolidation in diagnosed cases of MERS and COVID-19, according to Mann–Whitney test (U = 6.50, P > 0.05).
Fibrous lesion
There are no significant statistical differences among the average cases with fibrous lesions in diagnosed cases of MERS and COVID-19, according to the Mann–Whitney test (U = 11.00, P > 0.05).
Air bronchogram
There are no significant statistical differences among the average cases with air bronchograms in diagnosed cases of MERS and COVID-19, according to the Mann–Whitney test (U = 1.00, P > 0.05).
Pleural effusion
T-test results demonstrated that average cases with pleural effusions in COVID-19 cases are statistically and significantly lower than MERS cases (U = 20.00, P < 0.05).
Central involvement
There are no significant statistical differences among the average cases with central involvements in diagnosed cases of MERS and COVID-19, according to Mann–Whitney test (U = 6.00, P > 0.05).
Peripheral involvement
There are no significant statistical differences among the average cases with peripheral involvements in diagnosed cases of MERS and COVID-19, according to the Mann–Whitney test (U = 3.00, P > 0.05).
Bilateral involvement
There are no significant statistical differences among the average cases with bilateral involvements in diagnosed cases of MERS and COVID-19, according to the Mann–Whitney test (U = 6.00, P > 0.05).
Multifocal involvement
There are no significant statistical differences among the average cases with multifocal involvements in diagnosed cases of MERS and COVID-19, according to Mann–Whitney tests (U = 0.00, P > 0.05).
All other CT scan symptoms provided beforehand in the text are the same and had no significant statistical differences among the average cases with their respective groups.
This study had some limitations that is worth mentioning. First, most of the articles had inclusion and exclusion bias in single centers. Second, the severity and stages of the diseases were unclarified. Studies about MERS were limited in numbers and population and the statistical results should be taken with a grain of salt.
| Conclusion | | |
This review included the similarities and differences of MERS-COV and COVID-19 in terms of CXR results and clinical symptoms. The most similar Chest CT-Scan findings are GGO, peripheral consolidation, and GGO superimposed by consolidation in both studied diseases. The most similarities and common clinical signs in MERS and COVID-19 are cough, fever, and sore throat. This review brings forth insight on the differential diagnosis of both diseases and monitoring their progression with a focus on current findings and their challenges.
Financial support and sponsorship
None.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun 2020;109:102433.  |
| 2. | Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: A descriptive study. Lancet Infect Dis 2020;20:425-34. |
| 3. | Mirbeyk M, Saghazadeh A, Rezaei N. A systematic review of pregnant women with COVID-19 and their neonates. Arch Gynecol Obstet 2021:1-34. |
| 4. | Liu Y, Gayle AA, Wilder-Smith A, Rocklöv J. The reproductive number of COVID-19 is higher compared to SARS coronavirus. J Travel Med 2020;27:taaa021. |
| 5. | Niu R, Ye S, Li Y, Ma H, Xie X, Hu S, et al. Chest CT features associated with the clinical characteristics of patients with COVID-19 pneumonia. Ann Med 2021;53:169-80. |
| 6. | Muniyappa R, Gubbi S. COVID-19 pandemic, coronaviruses, and diabetes mellitus. Am J Physiol Endocrinol Metab 2020;318:E736-41. |
| 7. | |
| 8. | Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT findings in coronavirus disease-19 (COVID-19): Relationship to duration of infection. Radiology 2020;200463. [doi: 10.1148/radiol. 2020200463]. |
| 9. | Hu T, Liu Y, Zhao M, Zhuang Q, Xu L, He Q. A comparison of COVID-19, SARS and MERS. Peer J 2020;8:e9725. |
| 10. | Kwee TC, Kwee RM. Chest CT in COVID-19: What the radiologist needs to know. Radiographics 2020;40:1848-65. |
| 11. | Petrosillo N, Viceconte G, Ergonul O, Ippolito G, Petersen E. COVID-19, SARS and MERS: Are they closely related? Clin Microbiol Infect 2020;26:729-34. |
| 12. | Dai WC, Zhang HW, Yu J, Xu HJ, Chen H, Luo SP, et al. CT imaging and differential diagnosis of COVID-19. Can Assoc Radiol J 2020;71:195-200. |
| 13. | Wong HY, Lam HY, Fong AH, Leung ST, Chin TW, Lo CS, et al. Frequency and distribution of chest radiographic findings in patients positive for COVID-19. Radiology 2020;296:E72-8. |
| 14. | Wu J, Feng LC, Xian XY, Qiang J, Zhang J, Mao QX, et al. Novel coronavirus pneumonia (COVID-19) CT distribution and sign features. Zhonghua Jie He He Hu Xi Za Zhi 2020;43:321-6. |
| 15. | Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): A systematic review of imaging findings in 919 patients. AJR Am J Roentgenol 2020;215:87-93. |
| 16. | Nicastri E, Petrosillo N, Ascoli Bartoli T, Lepore L, Mondi A, Palmieri F, et al. National Institute for the Infectious Diseases “L. Spallanzani”, IRCCS. Recommendations for COVID-19 clinical management. Infect Dis Rep 2020;12:8543. |
| 17. | Xu YH, 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;80:394-400. |
| 18. | Alshazly H, Linse C, Barth E, Martinetz T. Explainable COVID-19 detection using chest CT scans and deep learning. Sensors (Basel) 2021;21:455. |
| 19. | Haqqani M, Ghadimi Moghadam AK, Qaderian M, Kiani M. Evaluation of clinical signs and computed tomography findings of Coronavirus (COVID 19) and Acute Respiratory Syndrome of the Middle East (MERS): A review article. Armaghane Danesh 2020;25:881-92. |
| 20. | Diao K, Han P, Pang T, Li Y, Yang Z. HRCT imaging features in representative imported cases of 2019 novel coronavirus pneumonia. Precis Clin Med 2020;3:9-13. |
| 21. | Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19). Radiology 2020;295:715-21. |
| 22. | Lu C, Yang W, Hu Y, Hui J, Zhou G, Shu J, et al. Coronavirus disease 2019 (COVID-19) pneumonia: Early stage chest CT imaging features and clinical relevance. 2020;3543606. [doi: 10.2139/ssrn. 3543606]. |
| 23. | Liu H, Liu F, Li J, Zhang T, Wang D, Lan W. Clinical and CT imaging features of the COVID-19 pneumonia: Focus on pregnant women and children. J Infect 2020;80:e7-13. |
| 24. | Pan Y, Guan H, Zhou S, Wang Y, Li Q, Zhu T, et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): A study of 63 patients in Wuhan, China. Eur Radiol 2020;30:3306-9. |
| 25. | 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;296:E41-5. |
| 26. | Yang W, Cao Q, Qin L, Wang X, Cheng Z, Pan A, et al. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19): A multi-center study in Wenzhou city, Zhejiang, China. J Infect 2020;80:388-93. |
| 27. | Yoon SH, Lee KH, Kim JY, Lee YK, Ko H, Kim KH, 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. |
| 28. | Yuan M, Yin W, Tao Z, Tan W, Hu Y. Association of radiologic findings with mortality of patients infected with 2019 novel coronavirus in Wuhan, China. PLoS One 2020;15:e0230548. |
| 29. | Zhu Z, Tang J, Chai X, Fang Z, Liu Q, Hu X, et al. How to differentiate COVID-19 pneumonia from heart failure with computed tomography at initial medical contact during epidemic period. medRxiv 2020;doi:10.1101/2020.03.04.20031047v1. |
| 30. | Ng MY, Lee EY, 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;2:e200034. |
| 31. | Das KM, Lee EY, Langer RD, Larsson SG. Middle east respiratory syndrome coronavirus: What does a radiologist need to know? AJR Am J Roentgenol 2016;206:1193-201. |
| 32. | Cha MJ, Chung MJ, Kim K, Lee KS, Kim TJ, Kim TS. Clinical implication of radiographic scores in acute Middle East respiratory syndrome coronavirus pneumonia: Report from a single tertiary-referral center of South Korea. Eur J Radiol 2018;107:196-202. |
| 33. | Das KM, Lee EY, Al Jawder SE, Enani MA, Singh R, Skakni L, et al. Acute middle east respiratory syndrome coronavirus: Temporal lung changes observed on the chest radiographs of 55 patients. AJR Am J Roentgenol 2015;205:W267-74. |
| 34. | Das KM, Lee EY, Enani MA, AlJawder SE, Singh R, Bashir S, et al. CT correlation with outcomes in 15 patients with acute Middle East respiratory syndrome coronavirus. AJR Am J Roentgenol 2015;204:736-42. |
| 35. | Hamimi A. MERS-CoV: Middle East respiratory syndrome corona virus: Can radiology be of help? Initial single center experience. Egypt J Radiol Nucl Med 2016;47:95-106. |
| 36. | Das KM, Lee EY, Singh R, Enani MA, Al Dossari K, Van Gorkom K, et al. Follow-up chest radiographic findings in patients with MERS-CoV after recovery. Indian J Radiol Imaging 2017;27:342-9. [ PUBMED] [Full text] |
| 37. | Ajlan AM, Ahyad RA, Jamjoom LG, Alharthy A, Madani TA. Middle East respiratory syndrome coronavirus (MERS-CoV) infection: Chest CT findings. Am J Roentgenol 2014;203:782-7. |
| 38. | Majumder J, Minko T. Recent developments on therapeutic and diagnostic approaches for COVID-19. AAPS J 2021;23:14. |
| 39. | Taha BA, Mashhadany YA, Mokhtar MH, Bin Zan MS, Arsad N. An analysis review of detection coronavirus disease 2019 (COVID-19) based on biosensor application. Sensors (Basel) 2020;20:6764. |
| 40. | Mortazavi SAR, Ghadimi-Moghadam A, Haghani M, Kaveh-Ahangar A, Mortazavi SMJ, Jafarzadeh A. Health care policy makers' response to COVID-19 pandemic; Pros and cons of “flattening the curve” from the “selective pressure” point of view: A review. Iran J Public Health 2020;49:1053-9. |
| 41. | Ghadimi-Moghadam A, Haghani M, Bevelacqua J, Kaveh-Ahangar A, Mortazavi SM, Ghadimi-Moghadam A, et al. COVID-19 tragic pandemic: Concerns over unintentional “directed accelerated evolution” of novel Coronavirus (SARS-CoV-2) and introducing a modified treatment method for ARDS. J Biomed Phys Eng 2020;10:241. |
| 42. | Sharifi-Razavi A, Karimi N, Rouhani N. COVID 19 and Intra cerebral hemorrhage: Causative or coincidental. New Microbes New Infect 2020;35:100669. |
| 43. | Li Y, Li M, Wang M, Zhou Y, Chang J, Xian Y, et al. Acute cerebrovascular disease following COVID-19: A single center, retrospective, observational study. Stroke Vasc Neurol 2020;5:279-84. |
| 44. | Shih HI, Wu CJ, Tu YF, Chi CY. Fighting COVID-19: A quick review of diagnoses, therapies, and vaccines. Biomed J 2020;43:341-54. |
| 45. | Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized Patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020;77:683-90. doi: 10.1001/jamaneurol.2020.1127. |
| 46. | Al-Hameed FM. Spontaneous intracranial hemorrhage in a patient with Middle East respiratory syndrome corona virus. Saudi Med J 2017;38:196-200. |
| 47. | Zhu J, Zhong Z, Li H, Ji P, Pang J, Li B, et al. CT imaging features of 4121 patients with COVID-19: A meta-analysis. J Med Virol 2020;92:891-902. |
| 48. | Bayramoglu Z, Canıpek E, Comert RG, Gasimli N, Kaba O, Yanartaş MS, et al. Imaging features of pediatric COVID-19 on chest radiography and chest CT: A retrospective, single-center study. Acad Radiol 2021;28:18-27. |
| 49. | Li Y, Xia L. Coronavirus disease 2019 (COVID-19): Role of chest CT in diagnosis and management. AJR Am J Roentgenol 2020;214:1280-6. |
[Table 1], [Table 2], [Table 3], [Table 4]
|
Search Pubmed for