Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Rd, Qiaokou District, Wuhan, Hubei 430030, China.
AJR Am J Roentgenol. 2020 Jun;214(6):1287-1294. doi: 10.2214/AJR.20.22975. Epub 2020 Mar 5.
The purpose of this study was to investigate 62 subjects in Wuhan, China, with laboratory-confirmed coronavirus disease (COVID-19) pneumonia and describe the CT features of this epidemic disease. A retrospective study of 62 consecutive patients with laboratory-confirmed COVID-19 pneumonia was performed. CT images and clinical data were reviewed. Two thoracic radiologists evaluated the distribution and CT signs of the lesions and also scored the extent of involvement of the CT signs. The Mann-Whitney test was used to compare lesion distribution and CT scores. The chi-square test was used to compare the CT signs of early-phase versus advanced-phase COVID-19 pneumonia. A total of 62 patients (39 men and 23 women; mean [± SD] age, 52.8 ± 12.2 years; range, 30-77 years) with COVID-19 pneumonia were evaluated. Twenty-four of 30 patients who underwent routine blood tests (80.0%) had a decreased lymphocyte count. Of 27 patients who had their erythrocyte sedimentation rate and high-sensitivity C-reactive protein level assessed, 18 (66.7%) had an increased erythrocyte sedimentation rate, and all 27 (100.0%) had an elevated high-sensitivity C-reactive protein level. Multiple lesions were seen on the initial CT scan of 52 of 62 patients (83.9%). Forty-eight of 62 patients (77.4%) had predominantly peripheral distribution of lesions. The mean CT score for the upper zone (3.0 ± 3.4) was significantly lower than that for the middle (4.5 ± 3.8) and lower (4.5 ± 3.7) zones ( = 0.022 and = 0.020, respectively), and there was no significant difference in the mean CT score of the middle and lower zones ( = 1.00). The mean CT score for the anterior area (4.4 ± 4.1) was significantly lower than that for the posterior area (7.7 ± 6.3) ( = 0.003). CT findings for the patients were as follows: 25 patients (40.3%) had ground-glass opacities (GGO), 21 (33.9%), consolidation; 39 (62.9%), GGO plus a reticular pattern; 34 (54.8%), vacuolar sign; 28 (45.2%), microvascular dilation sign; 35 (56.5%), fibrotic streaks; 21 (33.9%), a subpleural line; and 33 (53.2%), a subpleural transparent line. With regard to bronchial changes seen on CT, 45 patients (72.6%) had air bronchogram, and 11 (17.7%) had bronchus distortion. In terms of pleural changes, CT showed that 30 patients (48.4%) had pleural thickening, 35 (56.5%) had pleural retraction sign, and six (9.7%) had pleural effusion. Compared with early-phase disease (≤ 7 days after the onset of symptoms), advanced-phase disease (8-14 days after the onset of symptoms) was characterized by significantly increased frequencies of GGO plus a reticular pattern, vacuolar sign, fibrotic streaks, a subpleural line, a subpleural transparent line, air bronchogram, bronchus distortion, and pleural effusion; however, GGO significantly decreased in advanced-phase disease. CT examination of patients with COVID-19 pneumonia showed a mixed and diverse pattern with both lung parenchyma and the interstitium involved. Identification of GGO and a single lesion on the initial CT scan suggested early-phase disease. CT signs of aggravation and repair coexisted in advanced-phase disease. Lesions presented with a characteristic multifocal distribution in the middle and lower lung regions and in the posterior lung area. A decreased lymphocyte count and an increased high-sensitivity C-reactive protein level were the most common laboratory findings.
本研究旨在调查中国武汉 62 例经实验室确诊的冠状病毒病（COVID-19）肺炎患者，并描述该传染病的 CT 特征。对 62 例连续经实验室确诊的 COVID-19 肺炎患者进行回顾性研究。回顾性分析患者 CT 图像和临床资料。两位胸部放射科医生评估了病变的分布和 CT 征象，并对 CT 征象的受累程度进行了评分。采用 Mann-Whitney U 检验比较病变分布和 CT 评分。采用卡方检验比较 COVID-19 肺炎早、晚期 CT 征象。共评估了 62 例患者（39 例男性，23 例女性；平均年龄 52.8±12.2 岁；范围，30-77 岁）的 COVID-19 肺炎。在 30 例行常规血常规检查的患者中，24 例（80.0%）淋巴细胞计数减少。在 27 例测定红细胞沉降率和高敏 C 反应蛋白水平的患者中，18 例（66.7%）红细胞沉降率升高，所有 27 例（100.0%）高敏 C 反应蛋白水平升高。52 例（83.9%）患者在初次 CT 扫描时发现多发病变。62 例患者中，48 例（77.4%）病变主要分布在外周。上区 CT 评分（3.0±3.4）显著低于中区（4.5±3.8）和下区（=0.022 和=0.020），中区和下区 CT 评分无显著差异（=1.00）。前区 CT 评分（4.4±4.1）显著低于后区（7.7±6.3）（=0.003）。患者 CT 表现如下：25 例（40.3%）为磨玻璃密度影（GGO），21 例（33.9%）为实变，39 例（62.9%）为 GGO 合并网状影，34 例（54.8%）为空泡征，28 例（45.2%）为微血菅扩张征，35 例（56.5%）为纤维性条纹，21 例（33.9%）为胸膜下线，33 例（53.2%）为胸膜下线透亮影。CT 上支气管改变，45 例（72.6%）有空支气管征，11 例（17.7%）有支气管扭曲。胸膜改变，30 例（48.4%）有胸膜增厚，35 例（56.5%）有胸膜回缩征，6 例（9.7%）有胸腔积液。与早期病变（症状出现后≤7 天）相比，晚期病变（症状出现后 8-14 天）的 GGO 合并网状影、空泡征、纤维性条纹、胸膜下线、胸膜下线透亮影、空支气管征、支气管扭曲和胸腔积液的频率显著增加，而 GGO 在晚期病变中显著减少。COVID-19 肺炎患者 CT 检查显示出混合性和多样性模式，既有肺实质受累，也有间质受累。在初次 CT 扫描中出现 GGO 和单个病变提示为早期病变。晚期病变中存在 CT 征象加重和修复并存。病变表现为特征性的中下肺和后肺多发分布。淋巴细胞计数减少和高敏 C 反应蛋白水平升高是最常见的实验室发现。
