Abstract
Background: Coronavirus disease 2019 (COVID-19) and influenza are two infectious diseases that can pose a great threat to human health. We aimed to compare the differences in chest images between patients with COVID-19 and influenza to deepen the understanding of these two diseases. Methods: We searched PubMed, Embase and Web of Science for articles published before December 25, 2023, and performed a meta-analysis using Stata 14.0 with a random-effects model. The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Twenty-six articles with 2,159 COVID-19 patients and 1,568 influenza patients were included in the meta-analysis. By comparing chest computed tomography (CT) and chest X-ray, we found that COVID-19 patients had more peripheral lung lesions (OR=3.66, 95% CI: 1.84-7.31). Although COVID-19 patients had more bilateral lung involvement (OR=1.74, 95% CI: 0.90-3.38) and less unilateral lung involvement (OR=0.67, 95% CI: 0.44-1.02), these two results were not statistically significant. Patients with COVID-19 showed more ground-glass opacities (OR=2.83, 95% CI: 1.85-4.32), reverse halo signs (OR=3.47, 95% CI: 2.37-5.08), interlobular septal thickening (OR=2.16, 95% CI: 1.55-3.01), vascular enlargement (OR=5.00, 95% CI: 1.80-13.85) and crazy-paving patterns (OR=2.63, 95% CI: 1.57-4.41) on chest images than patients with influenza. We also found that compared with influenza patients, pleural effusion was rare in COVID-19 patients (OR=0.15, 95% CI: 0.07-0.31). Conclusions: There are some differences in the manifestations and distributions of lesions between patients with COVID-19 and influenza on chest images, which is helpful to distinguish these two infectious diseases.