Imaging of COVID-19 lung manifestations

Five years after the onset of the SARS-CoV-2 pandemic, chest radiology has evolved to play a central role in the characterization, severity stratification, and longitudinal monitoring of COVID-19-associated lung damage. In the acute phase, computed tomography (CT) remains the most sensitive method for identifying findings associated with inflammatory extent, temporality and risk of progression. Chest X-rays, although less sensitive, remain useful as a monitoring tool in high-demand healthcare settings. In post-acute sequelae and post-COVID syndrome, CT has made it possible to define relevant structural sequelae in the lung parenchyma that are persistent over time and evident on visual inspection, correlating with functional impairment and quality of life in patients. Although less widely used in clinical practice, pulmonary magnetic resonance imaging has expanded its use through ultra-fast sequences and perfusion techniques, revealing microvascular dysfunction in patients with persistent symptoms. In the last five years, the integration of artificial intelligence, automated quantification, and radiological biomarkers has become a fundamental axis for understanding COVID-19 and personalizing clinical management; this learning must be carried over to scenarios of promotion in projection, prevention, and research in respiratory health.