Role of chest CT scan in patients with preexisting cancer and COVID-19 pneumonia

Sep 24, 2026

Detection of COVID-19 in cancer patients is difficult because preexisting pulmonary infiltration may come from multiple infectious and non-infectious causes. The study assessed chest CT findings of COVID-19 pneumonia in cancer patients and examined whether imaging patterns predict mortality. Among 266 patients (2020–2022), RSNA structured reporting and CT scoring were used, followed by multivariate logistic regression to link CT features with death outcomes.

LanguageEnglish

CategoryHealthcare

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Pages7

Reading Time18 min

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Abstract

Background

Methods

Results

Conclusion

Introduction

Khorasanizadeh etal. BMC Medical Imaging (2023) 23:27 [https://doi.org/10.1186/s12880-023-00984-w](https://doi.org/10.1186/s12880-023-00984-w) BMC Medical Imaging RESEARCH Open Access Role of chest CT scan in patients with preexisting cancer and COVID-19 pneumonia Faezeh Khorasanizadeh 1, Soori Kaviani2*, Shadi Salamroudi2, Monireh Sadat Seyyedsalehi3,4, Masoumeh Gity1 and Kazem Zendehdel3 Abstract Background Detection of COVID-19 in cancer patients is challenging due to probable preexisting pulmonary infiltration caused by many infectious and non-infectious etiologies. We evaluated chest CT scan findings of COVID-19 pneumonia in cancer patients and explored its prognostic role in mortality. Methods We studied 266 COVID-19 patients with a history of cancer diagnosis between 2020 and 2022. Chest CT images were reported based on Radiological Society of North America (RSNA) structural report and the CT score and pattern of involvement were noted. We used multivariate logistic regression models to determine the association between CT scan findings and mortality of the cancer COVID-19 patients. Results The mean age was 56.48 (± 18 . 59), and 53% were men. Gastrointestinal (29 . 3%), hematologic (26 . 3%), and breast (10 . 5%) cancers were the most frequent types of cancer. The prevalence of atypical or indeterminate findings in the chest CT was 42. 8% . Most radiologic findings were consolidation mixed with ground-glass opacity (44 .4%), pleural effusion (33 . 5%), and pure ground-glass opacity (19 . 5%) . The risk of death was higher among those who had typical chest CT for COVID-19 (OR 3 .47; 95% CI 1.14–8. 98) and those who had a severity of score higher than 18 (OR 1. 89; 95% CI 1.07–3. 34) . Also, presence of consolidation (P value 0 . 040), pleural effusion (P value 0 . 000), centrilobular nodules (P value 0 . 013), and architectural distortion (P value 0 . 005) were associated with a poorer prognosis. Conclusion Less than half of COVID-19 patients with a history of cancer had typical imaging features of COVID-19 . Radiologists should be aware of atypical, rare, or subtle chest CT findings in patients with pre-existing cancer. Keywords COVID-19, Chest CT scan, Cancer, Atypical finding, Radiology *Correspondence: Soori Kaviani [soorikavianis87@gmail.com](soorikavianis87@gmail.com) 1 Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran 2 Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran 3 Cancer Research Centre, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran 4 Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy Introduction Cancer patients, with an annual incidence of more than 18 million new cases, may account for a sizable portion of the COVID-19 infected population [1]. They are more susceptible to infection, with higher hospitalization rates and severe outcomes than the general population. Several reports identify potential prognostic factors for severe illness and higher mortality, such as increased age, male sex, smoking status, number of comorbidities, and poorer performance status [2, 3]. However, evidence on the prognostic role of cancer type, active cancer, © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulat

FAQs

Why is detecting COVID-19 in cancer patients challenging?

Because cancer patients may already have pulmonary infiltration from many infectious and non-infectious etiologies, which can obscure COVID-19 findings.

How was chest CT interpreted in the study?

Chest CT images were reported using the Radiological Society of North America (RSNA) structural report, with CT score and pattern of involvement recorded.

Which CT findings were associated with higher mortality?

Typical COVID-19 chest CT and higher CT severity scores increased death risk; consolidation, pleural effusion, centrilobular nodules, and architectural distortion were also linked to poorer prognosis.

Sep 24, 2026

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