Imaging, Covid, Long Covid, Radiology, Diagnosis, Chest, trials, biomarker

Chest Imaging and the Diagnosis of Long Covid

Leading Consultant Radiologist, Dr Riz Basit, discusses the long-term impact of the disease, and the key role of imaging. 

Despite capacity reduction due to decontamination protocols, medical imaging has been at the forefront of diagnosing Covid. 

The Office for National Statistics estimates more than 1 million people across the UK have experienced symptoms of long Covid, or post-Covid Syndrome.

The illness differs from person to person but common symptoms include mental fog, extreme fatigue and long term respiratory issues- including frequent breathlessness. 

As an increasing number of patients experience long Covid, imaging is being widely used to identify cases. Often large sites will have 'hot' and 'cold' Covid scanners. 

Dr Riz Basit, Consultant Radiologist and medical director at Choice TeleMed, highlights the importance the imaging sector has played during the pandemic: “During Covid, Radiology was thrust to the centre of aiding diagnosis. Before PCR testing was readily available, Covid patients were often identified through chest x-rays alone.

“If the clinical suspicion was of Covid, and findings on a chest x-ray or CT scans were supportive, we would approve the diagnosis.” On an X-ray this process includes looking for bilateral and peripheral air space opacities. Similarly, a CT scan looks for glass opacities, crazy paving appearance and bronchovascular thickening; these have been key imaging biomarker indicators for Covid clinical trials.

Chest X-rays allow for the identification of changes in the lungs or lining of the chest cavities. After the initial acute viral episode, some cases include scarring as a result of the infection and the bodies healing response, or the lungs have not completely cleared. Cross sectional imaging, characterising abnormalities of the chest, abdomen and pelvis, can also pick up more serious cases such as blood clots in veins or arteries.

Imaging has also played a significant role in diagnosing asymptomatic carriers of Covid. 

“Interestingly there were quite a few patients, who were not clinically flagged as covid, who underwent imaging for another reason, suspicious features of Covid were identified in the lungs, which were later confirmed with PCR testing”, said Dr Basit. When diagnosing patients with long Covid, the aim is to detect areas of worsening imaging characteristics, “we specifically look for features of deterioration rather than expected improvement in the imaging, with particular emphasis on lung fibrosis.”

NHS England have introduced Long Covid Clinics across the UK, to help patients manage the debilitating long term symptoms, which can affect ‘any system in the body.’ National initiatives such as the BSTI UK Covid database have been really encouraging as a collaborative effort to share learning.

Dr Basit can be contacted at


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