Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin Er Rd, Shanghai, 200025, China.
AJR Am J Roentgenol. 2020 Jul;215(1):121-126. doi: 10.2214/AJR.20.22959. Epub 2020 Mar 14.
Confronting the new coronavirus infection known as coronavirus disease 2019 (COVID-19) is challenging and requires excluding patients with suspected COVID-19 who actually have other diseases. The purpose of this study was to assess the clinical features and CT manifestations of COVID-19 by comparing patients with COVID-19 pneumonia with patients with non-COVID-19 pneumonia who presented at a fever observation department in Shanghai, China. Patients were retrospectively enrolled in the study from January 19 through February 6, 2020. All patients underwent real-time reverse transcription-polymerase chain reaction (RT-PCR) testing. Eleven patients had RT-PCR test results that were positive for severe acute respiratory syndrome coronavirus 2, whereas 22 patients had negative results. No statistical difference in clinical features was observed ( > 0.05), with the exception of leukocyte and platelet counts ( < 0.05). The mean (± SD) interval between onset of symptoms and admission to the fever observation department was 4.40 ± 2.00 and 5.52 ± 4.00 days for patients with positive and negative RT-PCR test results, respectively. The frequency of opacifications in patients with positive results and patients with negative results, respectively, was as follows: ground-glass opacities (GGOs), 100.0% versus 90.9%; mixed GGO, 63.6% versus 72.7%; and consolidation, 54.5% versus 77.3%. In patients with positive RT-PCR results, GGOs were the most commonly observed opacification (seen in 100.0% of patients) and were predominantly located in the peripheral zone (100.0% of patients), compared with patients with negative results (31.8%) ( = 0.05). The median number of affected lung lobes and segments was higher in patients with positive RT-PCR results than in those with negative RT-PCR results (five vs 3.5 affected lobes and 15 vs nine affected segments; < 0.05). Although the air bronchogram reticular pattern was more frequently seen in patients with positive results, centrilobular nodules were less frequently seen in patients with positive results. At the point during the COVID-19 outbreak when this study was performed, imaging patterns of multifocal, peripheral, pure GGO, mixed GGO, or consolidation with slight predominance in the lower lung and findings of more extensive GGO than consolidation on chest CT scans obtained during the first week of illness were considered findings highly suspicious of COVID-19.
面对新型冠状病毒感染，即 2019 年冠状病毒病（COVID-19），这是一项挑战，需要排除实际上患有其他疾病的疑似 COVID-19 患者。本研究的目的是通过比较在中国上海发热观察部门就诊的 COVID-19 肺炎患者与非 COVID-19 肺炎患者，评估 COVID-19 的临床特征和 CT 表现。患者于 2020 年 1 月 19 日至 2 月 6 日接受回顾性研究。所有患者均接受实时逆转录聚合酶链反应（RT-PCR）检测。11 例患者的严重急性呼吸综合征冠状病毒 2 的 RT-PCR 检测结果呈阳性，而 22 例患者的 RT-PCR 检测结果呈阴性。除白细胞和血小板计数外（<0.05），临床特征无统计学差异（>0.05）。阳性 RT-PCR 检测结果和阴性 RT-PCR 检测结果患者症状出现至发热观察部门就诊的平均（±SD）间隔分别为 4.40±2.00 天和 5.52±4.00 天。阳性结果和阴性结果患者分别显示以下混浊程度：磨玻璃混浊（GGOs），100.0%和 90.9%；混合 GGO，63.6%和 72.7%；实变，54.5%和 77.3%。在 RT-PCR 检测结果阳性的患者中，GGO 是最常见的混浊（100.0%的患者均可见），主要位于外周区（100.0%的患者），而 RT-PCR 检测结果阴性的患者（31.8%）则较少见（=0.05）。与 RT-PCR 检测结果阴性的患者相比，RT-PCR 检测结果阳性的患者受累肺叶和肺段的中位数更高（5 个与 3.5 个受累肺叶和 15 个与 9 个受累肺段；<0.05）。虽然 RT-PCR 检测结果阳性的患者中更常出现空气支气管征网状模式，但 RT-PCR 检测结果阳性的患者中较少出现中央小叶结节。在进行本研究的 COVID-19 爆发期间，胸部 CT 扫描显示多发、外周、单纯 GGO、混合 GGO 或实变，下肺优势轻微，第一周发病时 GGO 比实变更广泛的影像学模式被认为高度怀疑 COVID-19。
