放射科医生在胸部 CT 鉴别 COVID-19 与非 COVID-19 病毒性肺炎中的表现。

Performance of Radiologists in Differentiating COVID-19 from Non-COVID-19 Viral Pneumonia at Chest CT.

机构信息

From the Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI (H.X.B., B.H., K.H., I.P., T.K.E., S.A., T.H., M.K.A.); Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China 410008 (Z.X., D.C.W., F.F.X., S.L., W.H.L.); Brown University Warren Alpert Medical School, Providence, RI (K.H., J.W.C., T.M.L.T., I.P., T.K.E.); Department of Radiology, Yongzhou Central Hospital, Yongzhou, Hunan, China 425006 (L.B.S.); Department of Radiology, Changde Second People's Hospital, Changde, Hunan, China (J.M.); Department of Radiology, Affiliated Nan Hua Hospital, University of South China, Hengyang, Hunan, China (X.L.J.); Department of Radiology, Loudi Central Hospital, Loudi, Hunan, China (Q.H.Z.); and Department of Radiology, Chenzhou Second People's Hospital, Chenzhou, Hunan, China (P.F.H.).

出版信息

Radiology. 2020 Aug;296(2):E46-E54. doi: 10.1148/radiol.2020200823. Epub 2020 Mar 10.

DOI:10.1148/radiol.2020200823

PMID:32155105

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7233414/

Abstract

Background Despite its high sensitivity in diagnosing coronavirus disease 2019 (COVID-19) in a screening population, the chest CT appearance of COVID-19 pneumonia is thought to be nonspecific. Purpose To assess the performance of radiologists in the United States and China in differentiating COVID-19 from viral pneumonia at chest CT. Materials and Methods In this study, 219 patients with positive COVID-19, as determined with reverse-transcription polymerase chain reaction (RT-PCR) and abnormal chest CT findings, were retrospectively identified from seven Chinese hospitals in Hunan Province, China, from January 6 to February 20, 2020. Two hundred five patients with positive respiratory pathogen panel results for viral pneumonia and CT findings consistent with or highly suspicious for pneumonia, according to original radiologic interpretation within 7 days of each other, were identified from Rhode Island Hospital in Providence, RI. Three radiologists from China reviewed all chest CT scans ( = 424) blinded to RT-PCR findings to differentiate COVID-19 from viral pneumonia. A sample of 58 age-matched patients was randomly selected and evaluated by four radiologists from the United States in a similar fashion. Different CT features were recorded and compared between the two groups. Results For all chest CT scans ( = 424), the accuracy of the three radiologists from China in differentiating COVID-19 from non-COVID-19 viral pneumonia was 83% (350 of 424), 80% (338 of 424), and 60% (255 of 424). In the randomly selected sample ( = 58), the sensitivities of three radiologists from China and four radiologists from the United States were 80%, 67%, 97%, 93%, 83%, 73%, and 70%, respectively. The corresponding specificities of the same readers were 100%, 93%, 7%, 100%, 93%, 93%, and 100%, respectively. Compared with non-COVID-19 pneumonia, COVID-19 pneumonia was more likely to have a peripheral distribution (80% vs 57%, < .001), ground-glass opacity (91% vs 68%, < .001), fine reticular opacity (56% vs 22%, < .001), and vascular thickening (59% vs 22%, < .001), but it was less likely to have a central and peripheral distribution (14% vs 35%, < .001), pleural effusion (4% vs 39%, < .001), or lymphadenopathy (3% vs 10%, = .002). Conclusion Radiologists in China and in the United States distinguished coronavirus disease 2019 from viral pneumonia at chest CT with moderate to high accuracy. © RSNA, 2020 ترجمه چکیده این مقاله به فارسی، در ضمیمه موجود است.

摘要

背景尽管在筛查人群中，胸部 CT 对诊断 2019 年冠状病毒病（COVID-19）具有很高的敏感性，但 COVID-19 肺炎的胸部 CT 表现被认为是非特异性的。目的评估美国和中国的放射科医生在区分 COVID-19 与病毒性肺炎方面的表现。材料与方法在这项研究中，从中国湖南省的七家医院回顾性地确定了 219 例经逆转录聚合酶链反应（RT-PCR）检测为 COVID-19 阳性且胸部 CT 异常的患者，时间为 2020 年 1 月 6 日至 2 月 20 日。从罗德岛普罗维登斯的罗德岛医院，回顾性地确定了 205 例呼吸道病原体呈阳性且 CT 表现与病毒性肺炎一致或高度疑似的患者，这些患者的 RT-PCR 结果呈阳性，且在 7 天内进行了原始影像学解释。来自中国的三位放射科医生对所有胸部 CT 扫描（=424）进行了盲法检查，以区分 COVID-19 与病毒性肺炎。从美国的四位放射科医生中随机选择了 58 名年龄匹配的患者，并以类似的方式对其进行评估。记录并比较了两组之间的不同 CT 特征。结果对于所有胸部 CT 扫描（=424），来自中国的三位放射科医生区分 COVID-19 与非 COVID-19 病毒性肺炎的准确率为 83%（350/424）、80%（338/424）和 60%（255/424）。在随机选择的样本（=58）中，来自中国的三位放射科医生和来自美国的四位放射科医生的敏感度分别为 80%、67%、97%、93%、83%、73%和 70%，相应的特异度分别为 100%、93%、7%、100%、93%、93%和 100%。与非 COVID-19 肺炎相比，COVID-19 肺炎更可能呈外周分布（80%比 57%，<.001）、磨玻璃影（91%比 68%，<.001）、细网状影（56%比 22%，<.001）和血管增厚（59%比 22%，<.001），但更可能呈中央和外周分布（14%比 35%，<.001）、胸腔积液（4%比 39%，<.001）和淋巴结病（3%比 10%，=.002）。结论中国和美国的放射科医生使用中等至高度的准确性区分了 COVID-19 与病毒性肺炎的胸部 CT 表现。