Ooi Gaik C, Khong Pek L, Müller Nestor L, Yiu Wai C, Zhou Lin J, Ho James C M, Lam Bing, Nicolaou Savvas, Tsang Kenneth W T
Department of Diagnostic Radiology, University of Hong Kong, Queen Mary Hospital, Rm 405, Block K, Pokfulam Rd, Hong Kong, Special Administrative Region, China.
Radiology. 2004 Mar;230(3):836-44. doi: 10.1148/radiol.2303030853.
To evaluate lung abnormalities on serial thin-section computed tomographic (CT) scans in patients with severe acute respiratory syndrome (SARS) during acute and convalescent periods.
Serial thin-section CT scans in 30 patients (17 men, aged 42.5 years +/- 12.2 [SD]) with SARS were reviewed by two radiologists together for predominant patterns of lung abnormalities: ground-glass opacities, ground-glass opacities with superimposed linear opacities, consolidation, reticular pattern, and mixed pattern (consolidation, ground-glass opacities, and reticular pattern). Scans were classified according to duration in weeks after symptom onset. Longitudinal changes of specific abnormalities were documented in 17 patients with serial scans obtained during 3 weeks. Each lung was divided into three zones; each zone was evaluated for percentage of lung involvement. Summation of scores from all six lung zones provided overall CT score (maximal CT score, 24).
Median CT scores increased from 1 in the 1st week to 12.5 in the 2nd week. Ground-glass opacities with or without smooth interlobular septal thickening and consolidation were predominant patterns found during the 1st week. Ground-glass opacities with superimposed irregular reticular opacities, mixed pattern, and reticular opacities were noted from the 2nd week and peaked at or after the 4th week. After the 4th week, 12 (55%) of 22 patients had irregular linear opacities with or without associated ground-glass opacities and CT scores greater than 5; five of these patients had bronchial dilatation. When specific opacities were analyzed in 17 patients, consolidation generally resolved completely (n = 4) or to minimal residual opacities; six (55%) of 11 patients with ground-glass opacities had substantial residual disease (CT scores > 5) on final scans.
There is a temporal pattern of lung abnormalities at thin-section CT in SARS. Predominant findings at presentation are ground-glass opacities and consolidation. Reticulation is evident after the 2nd week and persists in half of all patients evaluated after 4 weeks. Long-term follow-up is required to determine whether the reticulation represents irreversible fibrosis.
评估严重急性呼吸综合征（SARS）患者在急性期和恢复期的系列薄层计算机断层扫描（CT）上的肺部异常情况。
由两名放射科医生共同回顾30例SARS患者（17例男性，年龄42.5岁±12.2[标准差]）的系列薄层CT扫描，以观察肺部异常的主要模式：磨玻璃影、伴有叠加线性影的磨玻璃影、实变、网状影及混合模式（实变、磨玻璃影和网状影）。扫描根据症状出现后的周数进行分类。对17例在3周内进行系列扫描的患者记录特定异常的纵向变化。每侧肺分为三个区域；评估每个区域的肺受累百分比。所有六个肺区的分数总和得出总体CT评分（最大CT评分为24分）。
CT评分中位数从第1周的1分升至第2周的12.5分。第1周发现的主要模式为伴有或不伴有光滑小叶间隔增厚及实变的磨玻璃影。第2周开始出现伴有叠加不规则网状影、混合模式和网状影，并在第4周或之后达到峰值。第4周后，22例患者中有12例（55%）出现伴有或不伴有相关磨玻璃影的不规则线性影，且CT评分大于5分；其中5例患者有支气管扩张。对17例患者的特定影像进行分析时，实变一般完全消退（n = 4）或残留最小程度的影像；11例磨玻璃影患者中有6例（55%）在最终扫描时有大量残留病变（CT评分>5分）。
SARS患者薄层CT上的肺部异常存在时间模式。表现时的主要发现为磨玻璃影和实变。网状影在第2周后明显，在4周后评估的所有患者中有一半持续存在。需要长期随访以确定网状影是否代表不可逆纤维化。
