《COVID-19 大流行期间患者管理中的胸部影像学作用：Fleischner 学会的一项多国共识声明》。
The Role of Chest Imaging in Patient Management during the COVID-19 Pandemic: A Multinational Consensus Statement from the Fleischner Society.
机构信息
From the Department of Radiology, Duke University School of Medicine, Box 3808, Durham, NC 27705 (G.D.R.); Department of Medicine, University of British Columbia, Vancouver, Canada (C.J.R.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (L.B.H.); Department of Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy (N.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); Division of Pulmonary, Critical Care & Sleep Medicine, Lenox Hill Hospital, New York, NY (S.R.); Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY (N.W.S.); 1st Anesthesia and Intensive Care Unit, University Hospital of Parma, Parma, Italy (A.V.); Division of Pulmonary and Critical Medicine, Seoul National University College of Medicine, Seoul, South Korea (J.J.Y.); Department of Emergency Medicine, The Medical College of Wisconsin School of Medicine, Milwaukee, Wis (I.B.K.M.); Director, Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, NC (D.J.A.); Medical Director of Pathology and Clinical Laboratory Medicine, Stanford University Medical Center, Stanford, Calif (C.K.); Department of Radiology, University of Missouri, Columbia, Mo (T.A.); Department of Paediatrics and Paediatric Respirology, Royal Brompton Hospital, London, England (A.B.); Department of Radiology, Royal Brompton & Harefield NHS Foundation Trust, London, England (S.R.D.); National Heart and Lung Institute, Imperial College, London, England (S.R.D.); Department of Radiology, David Geffen School of Medline at University of California Los Angeles, Los Angeles, Calif (J.G.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Respiratory and Intensive Care Medicine, Université Paris-Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France (M.H.); Department of Pathology, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan (Y.I.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (H.U.K.); Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan, China (F.L.); Respiratory Institute, Cleveland Clinic, Cleveland,Ohio (P.J.M.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (M.P.); Department of Thoracic Imaging-Hospital Calmette, University Centre of Lille, Lille, France (M.R.J.); Divisionof Pulmonary Medicine, Università Cattolica del Sacro Cuore, Rome, Italy (L.R.); Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (N.T.); Department of Pulmonary Medicine, Royal Brompton Hospital, London, England (A.U.W.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.N.L.).
出版信息
Radiology. 2020 Jul;296(1):172-180. doi: 10.1148/radiol.2020201365. Epub 2020 Apr 7.
With more than 900 000 confirmed cases worldwide and nearly 50 000 deaths during the first 3 months of 2020, the coronavirus disease 2019 (COVID-19) pandemic has emerged as an unprecedented health care crisis. The spread of COVID-19 has been heterogeneous, resulting in some regions having sporadic transmission and relatively few hospitalized patients with COVID-19 and others having community transmission that has led to overwhelming numbers of severe cases. For these regions, health care delivery has been disrupted and compromised by critical resource constraints in diagnostic testing, hospital beds, ventilators, and health care workers who have fallen ill to the virus exacerbated by shortages of personal protective equipment. Although mild cases mimic common upper respiratory viral infections, respiratory dysfunction becomes the principal source of morbidity and mortality as the disease advances. Thoracic imaging with chest radiography and CT are key tools for pulmonary disease diagnosis and management, but their role in the management of COVID-19 has not been considered within the multivariable context of the severity of respiratory disease, pretest probability, risk factors for disease progression, and critical resource constraints. To address this deficit, a multidisciplinary panel comprised principally of radiologists and pulmonologists from 10 countries with experience managing patients with COVID-19 across a spectrum of health care environments evaluated the utility of imaging within three scenarios representing varying risk factors, community conditions, and resource constraints. Fourteen key questions, corresponding to 11 decision points within the three scenarios and three additional clinical situations, were rated by the panel based on the anticipated value of the information that thoracic imaging would be expected to provide. The results were aggregated, resulting in five main and three additional recommendations intended to guide medical practitioners in the use of chest radiography and CT in the management of COVID-19.
截至 2020 年 3 月的头 3 个月，全球已有超过 90 万例确诊病例，近 5 万人死亡，2019 年冠状病毒病（COVID-19）大流行已成为一场前所未有的卫生保健危机。COVID-19 的传播具有异质性，导致一些地区的传播呈散发性，COVID-19 住院患者相对较少，而另一些地区的传播导致大量重症病例。对于这些地区，由于诊断检测、医院床位、呼吸机和感染病毒的医护人员等关键资源的严重短缺，医疗服务的提供受到了干扰和损害，个人防护设备的短缺使情况进一步恶化。虽然轻症病例类似于常见的上呼吸道病毒感染，但随着疾病的进展，呼吸功能障碍成为发病率和死亡率的主要来源。胸部 X 线摄影和 CT 是诊断和管理肺部疾病的关键工具，但它们在 COVID-19 管理中的作用尚未在疾病严重程度、检测前概率、疾病进展风险因素和关键资源限制等多变量背景下得到考虑。为了弥补这一不足，一个由来自 10 个国家的放射科医生和肺病专家组成的多学科小组，在各种医疗环境中管理了一系列 COVID-19 患者，评估了影像学在三种不同风险因素、社区条件和资源限制下的应用价值。该小组根据胸部影像学预期提供的信息的预期价值，对代表不同风险因素、社区条件和资源限制的三种情况中的 14 个关键问题进行了评分，对应于三种情况中的 11 个决策点和三个额外的临床情况。结果进行了汇总，形成了五个主要建议和三个额外建议，旨在指导临床医生在 COVID-19 的管理中使用胸部 X 线摄影和 CT。
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