Citation: Manolescu, D.; Timar, B.; Bratosin, F.; Rosca, O.; Citu, C.; Oancea, C. Predictors for COVID-19 Complete Remission with HRCT Pattern Evolution: A Monocentric, Prospective Study. Diagnostics 2022, 12, 1397. https://doi.org/10.3390/ diagnostics12061397 Academic Editor: Anna Baraniak Received: 2 May 2022 Accepted: 3 June 2022 Published: 5 June 2022 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). diagnostics Article Predictors for COVID-19 Complete Remission with HRCT Pattern Evolution: A Monocentric, Prospective Study Diana Manolescu 1,2 , Bogdan Timar 3,4, *, Felix Bratosin 5 , Ovidiu Rosca 5 , Cosmin Citu 6 and Cristian Oancea 2 1 Department of Radiology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; dmanolescu@umft.ro 2 Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; oancea@umft.ro 3 Department of Internal Medicine II, Division of Diabetes, Nutrition and Metabolic Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania 4 Center for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania 5 Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; felix.bratosin7@gmail.com (F.B.); ovidiu.rosca@umft.ro (O.R.) 6 Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; citu.ioan@umft.ro * Correspondence: bogdan.timar@umft.ro Abstract: There are growing concerns that some COVID-19 survivors may acquire fibrosis and other irreversible lung abnormalities. The purpose of this prospective study was to assess the rate and predictors of complete resolution of COVID-19 pneumonia by pursuing a hypothetical relation between time and imaging pattern evolution using HRCT findings. A monocentric prospective cohort study with a consecutive-case enrolment design was implemented during a five-month period, having a total of 683 post-COVID patients eligible for inclusion and 635 evaluations with complete follow-up for chest HRCT. The target for post-COVID evaluations consisted of performing HRCT 90 days after a confirmed SARS-CoV-2 infection. The studied patients had an average age of 54 years, ranging between 18 and 85 years old, and an average duration from the first symptoms until HRCT was performed of 74 days. At the post-COVID follow-up, 25.8% had a complete imagistic remission. The most common appearance with HRCT was “ground glass” in 86.6% in patients with persistent COVID-19, followed by reticulations, present in 78.8%, and respectively pleural thickening in 41.2% of cases. The mean total HRCT scores were statistically significantly higher in patients older than 65 years (10.6 ± 6.0) compared to the 40–65 group (6.1 ± 6.1) and the 18–40 age group (2.7 ± 4.8) (p < 0.001). Chest HRCT is a “time window” in documenting temporal persistent radiologic features of lung injury 90 days after SARS-CoV-2 infection, determining the pathologic basis of so-called “long COVID”. The complete remission was associated with a significantly higher average follow-up period and a significantly lower average patient age. Persistent HRCT features of ground glass, reticulation, and pleural thickening are associated with a higher total CT score and older age. Keywords: COVID-19; SARS-CoV-2 infection; imaging studies; HRCT; disease remission; prediction model 1. Introduction The coronavirus disease 2019 or COVID-19 is caused by the novel coronavirus known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1]. It has become a worldwide outbreak since the first report in December 2019 and was declared a pandemic by the World Health Organization on 11 March 2020 [2]. With more than 300 million cases, this disease carries the burden of a global impact with more than 5 million deaths [3]. Diagnostics 2022, 12, 1397. https://doi.org/10.3390/diagnostics12061397 https://www.mdpi.com/journal/diagnostics