Review Reports - Images of Chest Computer Tomography (CT) and Radiation (X-ray) Demonstrating Clinical Manifestations of COVID-19: Review Article

Round 1

Reviewer 1 Report

I think that this review does not provide significant contribution in this topic. I suggest adding a discussion to compare COVID presentation in CT and CXR and others viruses. Moreover, I suggest expanding the conclusion.

The authors provide a clear summary about COVID. However, the aim of the review is not cleary explain in the introduction.

It is necessary explain better the methods of the research: inclusion criteria? exclusion criteria? number of articles?

I suggest adding a table that summarizes the articles included.

Author Response

In detail, the authors corrected all respected reviewers comments.

Author Response File: Author Response.pdf

Reviewer 2 Report

The paper is quite well written. The article covers an interesting and current topic. Nevertheless, in my opinion, some parts need to be improved, I have some comments, as below reported.

In my opinion, some parts need to be improved, I have some comments:

- Abstract: Besides reverse-transcription polymerase chain reaction (RT-PCR) testing, chest radio- 9 graphs (CXR) and computed tomography (CT) scans were employed as crucial diagnostic methods 10 for detecting the 2019 new coronavirus disease (COVID-19). Our objective is to examine three nota- 11 ble COVID-19 instances from patients across the globe, along with their CXR and CT data. The eval- 12 uation of the imaging characteristics of the reported instances was the primary objective of a me- 13 thodical examination of the literature. We located more than several articles that had been published 14 between 2020 and 2023. After the papers were examined, three major cases were chosen for included 15 a COVID-19 assessment of imaging features (chest X-ray and CT scan). Corona viral diseases 16 (COVID-19) pose a significant risk to healthcare facilities, especially when the patient has additional 17 medical issues. It is challenging to understand the various chest radiography results because of the 18 use of specialized and ambiguous terminology like "airspace disease," "pneumonia," "infiltrates," 19 "patchy opacities," and "hazy opacities." Abstract might be beneficial to include a sentence that briefly summarizes the key findings of the study. This can provide readers with a quick overview of the research.

- The characteristic computed tomography (CT) findings for COVID-19 pneumonia 49 included aggregation and contralateral ground-glass opacity (GGOs) that were distrib- 50 uted equally across the back and outer areas of the lungs. The early radiological investi- 51 gations consistently corroborate these conclusions [52-54]. I suggest author to improve this information regarding the CT findings for COVID-19 pneumonia in order to complete the manuscript. Below you can find some works that could give useful ideas in expanding this part, I suggest to include these references:

a- Radiological-pathological signatures of patients with COVID-19-related pneumomediastinum: is there a role for the Sonic hedgehog and Wnt5a pathways? ERJ Open Res. 2021 Aug 23;7(3):00346-2021. doi: 10.1183/23120541.00346-2021.

b- Quantitative Computed Tomography Lung COVID Scores with Laboratory Markers: Utilization to Predict Rapid Progression and Monitor Longitudinal Changes in Patients with Coronavirus 2019 (COVID-19) Pneumonia. Biomedicines. 2024 Jan 6;12(1):120. doi: 10.3390/biomedicines12010120.

c- Interstitial Lung Disease at High Resolution CT after SARS-CoV-2-Related Acute Respiratory Distress Syndrome According to Pulmonary Segmental Anatomy. J Clin Med. 2021 Sep 2;10(17):3985. doi: 10.3390/jcm10173985.

- Figure 7. Chest CT images of a 63-year-old woman with fever for 11 days. Negative results of RT- 250 PCR assay for the SARS-CoV-2 using a swab samples were obtained on February 2 and 11, 2020, 251 respectively. (A-C) Chest CT scans show typical mixed ground-glass opacities and multifocal con- 252 solidation shadows in bilateral lungs without evidence of resolution without resolution over 16 days 253 [76]. If the images can be higher resolution that would be better for the reader.

- 4. Conclusion 334 The risk of Corona viral diseases (COVID-19) to healthcare facilities is high, espe- 335 cially when the patient has other health issues. It is challenging to understand the various 336 chest radiography results because of the use of specialized and ambiguous terminology 337 like "airspace disease," "pneumonia," "infiltrates," "patchy opacities," and "hazy opacities." The conclusion section needs to be improved. It is necessary to compare the different cases with published literature. Finally, underline the novelty of the study and the possible clinical implications.

Author Response

In detail, the authors corrected all respected reviewers comments.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

The authors improved significantly their article.

Author Response

The reviewer #1 did not ask for second round revision.

Thank you

Reviewer 2 Report

The manuscript has been improved, I suggest only to improve the introduction, as requested in the first revision to underline the novelty of the study.

I suggest authors to add some references, as previously suggested, to support this paragraph:

Since the COVID-19 pandemic, 57

research has examined the association between CT results and patient outcomes, and 58

chest CT's predictive usefulness at COVID-19 diagnosis has grown. Many studies have 59

linked ICU patients with poor prognoses to CT findings like scattered bilateral distribu- 60

tion of lesions, a higher number of involved lobes, diffuse GGO and consolidations, ab- 61

sence of mixed and reticular patterns, crazy paving, bronchus distortion, etc. Pathophys- 62

iology, radiological–pathological markers, and quantitative CT metrics and lung function 63

in COVID-19 patients have also been studied. CT findings are difficult to standardize as a 64

predictor because each study describes them differently. Other semi-quantitative studies 65

have assessed baseline chest CT's prognostic significance by awarding scores based on 66

parenchyma involvement. Recently, chest CT image analysis employing several AI mod- 67

els has classified patient risk, but its clinical relevance as a predictive tool must be inves- 68

tigated. The longitudinal alterations in chest CT scans of COVID-19 patients have been 69

studied throughout the epidemic. Few studies have examined these alterations using re- 70

peated clinical measures and quantitative CT ratings.

Author Response

Responses to Reviewer’s Comments

Title: Images of Chest Computer Tomography (CT) and Radiation (X-ray) Demonstrating Clinical Manifestations of COVID-19.: A Review of Case Reports.

ID#: Manuscript reference: covid-2992809

Dear Editor-in-Chief,

The authors sincerely appreciate the reviewers’ technical comments and the useful suggestions offered to us to revise our manuscript. Our responses to reviewers’ comments point by point are listed hereafter.

Comments from Reviewer #2:

The manuscript has been improved, I suggest only to improve the introduction, as requested in the first revision to underline the novelty of the study.

Answer: Dear respected reviewer, thanks for your valuable comments. Ok. Noted and done.

I suggest authors to add some references, as previously suggested, to support introduction paragraph “Since the COVID-19 pandemic……………………clinical measures and quantitative CT ratings”.

Answer: ok. Noted and done.

Dear Respected reviewer. Thank you very much for your valuable comments which enhance the manuscript with scientific information. Appreciate