Differences in chest imaging between Omicron and non–Omicron coronavirus disease 2019 (COVID-19) patients: a systematic review and meta-analysis

Abstract Background Coronavirus disease 2019 (COVID-19) have posed a great threat to human health. We carried out this systematic review and meta-analysis for two objectives. First, to evaluate the differences in lung infection between the Omicron variants and the non-Omicron strains by chest comput...

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Main Authors: Yingying Han, Zhijia Wang, Xingzhao Li, Zhuan Zhong
Format: Article
Language:English
Published: BMC 2025-04-01
Series:BMC Infectious Diseases
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Online Access:https://doi.org/10.1186/s12879-025-11032-z
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author Yingying Han
Zhijia Wang
Xingzhao Li
Zhuan Zhong
author_facet Yingying Han
Zhijia Wang
Xingzhao Li
Zhuan Zhong
author_sort Yingying Han
collection DOAJ
description Abstract Background Coronavirus disease 2019 (COVID-19) have posed a great threat to human health. We carried out this systematic review and meta-analysis for two objectives. First, to evaluate the differences in lung infection between the Omicron variants and the non-Omicron strains by chest computed tomography (CT); second, to evaluate the differences in chest CT features between COVID-19 patients with the Omicron variants and those with non-Omicron strains in CT-positive cases. Methods We searched PubMed, Embase, Web of Science and China National Knowledge Infrastructure for articles and performed a meta-analysis using Stata 14.0 with a random effects model. Results Our study included a total of 8126 patients with COVID-19, 4113 with the Omicron variants, and 4013 with non-Omicron strains. Patients with the Omicron variants were less likely to be CT-positive (OR = 0.14, 95% CI: 0.08–0.25), and further analysis among CT-positive patients was performed. Compared with the CT images of patients with non-Omicron strains, those of patients with the Omicron variants showed atypical pulmonary features (OR = 4.02, 95% CI: 2.31–6.98). Moreover, patients with the Omicron variants typically had lesions that were mainly located in the center of the lung (OR = 4.51, 95% CI: 1.38–14.76) and in a single lobe (OR = 1.72, 95% CI: 1.10–2.70). The patients with the Omicron variants were less likely to have lesions in both lungs (OR = 0.33, 95% CI: 0.15–0.69), more likely to have bronchial wall thickening (OR = 1.99, 95% CI: 1.05–3.77) and less likely to have the crazy-paving pattern (OR = 0.51, 95% CI: 0.33–0.81), linear opacity (OR = 0.26, 95% CI: 0.12–0.60), and vascular enlargement (OR = 0.54, 95% CI: 0.35–0.84). Conclusions Through meta-analysis, which yields the highest level of evidence for evidence-based medicine, we further confirmed that there were significant differences in the distribution and manifestations of lesions between patients with non-Omicron strains and those with the Omicron variants on chest CT. The variation in SARS-CoV-2 has never stopped. Our findings are useful for the diagnosis and treatment of new SARS-CoV-2 variants that may appear in the future and provide a basis for public health decision-making. PROSPERO registration number CRD42024581869.
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spelling doaj-art-8ca7b4aef43341738ad89c658ea4b2a02025-08-20T01:47:33ZengBMCBMC Infectious Diseases1471-23342025-04-0125111410.1186/s12879-025-11032-zDifferences in chest imaging between Omicron and non–Omicron coronavirus disease 2019 (COVID-19) patients: a systematic review and meta-analysisYingying Han0Zhijia Wang1Xingzhao Li2Zhuan Zhong3Department of Neurology, China-Japan Union Hospital of Jilin UniversityDepartment of Radiology, China-Japan Union Hospital of Jilin UniversityDepartment of Ultrasound, China-Japan Union Hospital of Jilin UniversityDepartment of Orthopaedics, The Second Hospital of Jilin UniversityAbstract Background Coronavirus disease 2019 (COVID-19) have posed a great threat to human health. We carried out this systematic review and meta-analysis for two objectives. First, to evaluate the differences in lung infection between the Omicron variants and the non-Omicron strains by chest computed tomography (CT); second, to evaluate the differences in chest CT features between COVID-19 patients with the Omicron variants and those with non-Omicron strains in CT-positive cases. Methods We searched PubMed, Embase, Web of Science and China National Knowledge Infrastructure for articles and performed a meta-analysis using Stata 14.0 with a random effects model. Results Our study included a total of 8126 patients with COVID-19, 4113 with the Omicron variants, and 4013 with non-Omicron strains. Patients with the Omicron variants were less likely to be CT-positive (OR = 0.14, 95% CI: 0.08–0.25), and further analysis among CT-positive patients was performed. Compared with the CT images of patients with non-Omicron strains, those of patients with the Omicron variants showed atypical pulmonary features (OR = 4.02, 95% CI: 2.31–6.98). Moreover, patients with the Omicron variants typically had lesions that were mainly located in the center of the lung (OR = 4.51, 95% CI: 1.38–14.76) and in a single lobe (OR = 1.72, 95% CI: 1.10–2.70). The patients with the Omicron variants were less likely to have lesions in both lungs (OR = 0.33, 95% CI: 0.15–0.69), more likely to have bronchial wall thickening (OR = 1.99, 95% CI: 1.05–3.77) and less likely to have the crazy-paving pattern (OR = 0.51, 95% CI: 0.33–0.81), linear opacity (OR = 0.26, 95% CI: 0.12–0.60), and vascular enlargement (OR = 0.54, 95% CI: 0.35–0.84). Conclusions Through meta-analysis, which yields the highest level of evidence for evidence-based medicine, we further confirmed that there were significant differences in the distribution and manifestations of lesions between patients with non-Omicron strains and those with the Omicron variants on chest CT. The variation in SARS-CoV-2 has never stopped. Our findings are useful for the diagnosis and treatment of new SARS-CoV-2 variants that may appear in the future and provide a basis for public health decision-making. PROSPERO registration number CRD42024581869.https://doi.org/10.1186/s12879-025-11032-zOmicronCoronavirus disease 2019Computed tomographySystematic reviewMeta-analysis
spellingShingle Yingying Han
Zhijia Wang
Xingzhao Li
Zhuan Zhong
Differences in chest imaging between Omicron and non–Omicron coronavirus disease 2019 (COVID-19) patients: a systematic review and meta-analysis
BMC Infectious Diseases
Omicron
Coronavirus disease 2019
Computed tomography
Systematic review
Meta-analysis
title Differences in chest imaging between Omicron and non–Omicron coronavirus disease 2019 (COVID-19) patients: a systematic review and meta-analysis
title_full Differences in chest imaging between Omicron and non–Omicron coronavirus disease 2019 (COVID-19) patients: a systematic review and meta-analysis
title_fullStr Differences in chest imaging between Omicron and non–Omicron coronavirus disease 2019 (COVID-19) patients: a systematic review and meta-analysis
title_full_unstemmed Differences in chest imaging between Omicron and non–Omicron coronavirus disease 2019 (COVID-19) patients: a systematic review and meta-analysis
title_short Differences in chest imaging between Omicron and non–Omicron coronavirus disease 2019 (COVID-19) patients: a systematic review and meta-analysis
title_sort differences in chest imaging between omicron and non omicron coronavirus disease 2019 covid 19 patients a systematic review and meta analysis
topic Omicron
Coronavirus disease 2019
Computed tomography
Systematic review
Meta-analysis
url https://doi.org/10.1186/s12879-025-11032-z
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AT xingzhaoli differencesinchestimagingbetweenomicronandnonomicroncoronavirusdisease2019covid19patientsasystematicreviewandmetaanalysis
AT zhuanzhong differencesinchestimagingbetweenomicronandnonomicroncoronavirusdisease2019covid19patientsasystematicreviewandmetaanalysis