Department of Radiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weitzman Street, Tel Aviv 64239, Israel.
Radiology. 2010 Apr;255(1):252-9. doi: 10.1148/radiol.10092240.
To retrospectively evaluate whether findings on initial chest radiographs of influenza A (H1N1) patients can help predict clinical outcome.
Institutional review board approval was obtained; informed consent was waived. All adult patients admitted to the emergency department (May to September 2009) with a confirmed diagnosis of H1N1 influenza who underwent frontal chest radiography within 24 hours were included. Radiologic findings were characterized by type and pattern of opacities and zonal distribution. Major adverse outcome measures were mechanical ventilation and death.
Of 179 H1N1 influenza patients, 97 (54%) underwent chest radiography at admission; 39 (40%) of these had abnormal radiologic findings likely related to influenza infection and five (13%) of these 39 had adverse outcomes. Fifty-eight (60%) of 97 patients had normal radiographs; two (3%) of these had adverse outcomes (P = .113). Characteristic imaging findings included the following: ground-glass (69%), consolidation (59%), frequently patchy (41%), and nodular (28%) opacities. Bilateral opacities were common (62%), with involvement of multiple lung zones (72%). Findings in four or more zones and bilateral peripheral distribution occurred with significantly higher frequency in patients with adverse outcomes compared with patients with good outcomes (multizonal opacities: 60% vs 6%, P = .01; bilateral peripheral opacities: 60% vs 15%, P = .049).
Extensive involvement of both lungs, evidenced by the presence of multizonal and bilateral peripheral opacities, is associated with adverse prognosis. Initial chest radiography may have significance in helping predict clinical outcome but normal initial radiographs cannot exclude adverse outcome.
回顾性评估甲型 H1N1 流感患者初始胸部 X 线片的表现是否有助于预测临床转归。
获得机构审查委员会批准；豁免知情同意。纳入 2009 年 5 月至 9 月所有因确诊甲型 H1N1 流感而收入急诊的成年患者，这些患者均于发病 24 小时内行正位胸部 X 线摄影。通过类型和模式的不透明性和区域分布对放射学发现进行特征描述。主要不良结局指标为机械通气和死亡。
在 179 例甲型 H1N1 流感患者中，97 例（54%）在入院时行胸部 X 线摄影；其中 39 例（40%）有疑似流感感染的异常放射学发现，这 39 例中有 5 例（13%）有不良结局。97 例患者中 58 例（60%）有正常 X 线片；这 58 例中有 2 例（3%）有不良结局（P =.113）。特征性影像学表现包括：磨玻璃影（69%）、实变影（59%）、斑片状分布（41%）和结节状影（28%）。双侧病变常见（62%），多肺区受累（72%）。与预后良好的患者相比，不良结局患者的多灶性和双侧周边分布的病变发生率显著更高（多灶性不透明性：60%比 6%，P =.01；双侧周边性不透明性：60%比 15%，P =.049）。
双肺广泛受累，表现为多灶性和双侧周边性不透明性，与不良预后相关。初始胸部 X 线摄影可能对帮助预测临床结局有意义，但正常的初始 X 线片不能排除不良结局。
