Ultrasound, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
Ultraschall Med. 2020 Jun;41(3):300-307. doi: 10.1055/a-1154-8795. Epub 2020 Apr 15.
This study was conducted to explore the clinical value of noninvasive assessment of bedside ultrasound in the diagnosis of lung lesions of Coronavirus Disease-19.
In this retrospective study, 30 patients with Coronavirus Disease-19 admitted to our hospital from January 18 to February 5, 2020, were selected as the research subjects. All cases were examined by lung ultrasound and CT. Lung lesions were reviewed by blinded observers, with imaging scores being used to analyze the ultrasound findings of lung lesions in patients with Coronavirus Disease-19 and with chest CT being used as the reference standard. The clinical value of ultrasound in the noninvasive assessment of lung lesions was evaluated.
Lung ultrasound signs in patients with Coronavirus Disease-19 were mainly manifested as interstitial pulmonary edema (90.0 %, 27/30) and pulmonary consolidations (20.0 %, 6/30). The lung lesions were mainly distributed in the subpleural and peripheral pulmonary zones. The lower lobe and the dorsal region had a greater tendency to be involved. There was moderate agreement (Kappa = 0.529) between the noninvasive assessment of bedside ultrasound for lung lesions in patients with Coronavirus Disease-19 and CT. The ultrasound scores to evaluate mild, moderate and severe lung lesions exhibited sensitivity of 68.8 % (11/16), 77.8 % (7/9), 100.0 % (2/2), specificity of 85.7 % (12/14), 76.2 % (16/21), 92.9 % (26/28), and diagnostic accuracy of 76.7 % (23/30), 76.7 % (23/30), 93.3 % (28/30), respectively. The follow-up dynamic ultrasound examination showed that the condition of all patients worsened gradually, with the ultrasound scores of lung lesions increasing to varying degrees.
Though the diagnostic efficacy of bedside ultrasound is relatively low for mild to moderate patients, it is high for severe patients. Bedside ultrasound has important clinical significance for noninvasive assessment and dynamic observation of lung lesions in patients with Coronavirus Disease-19, which is worth further consideration.
本研究旨在探讨床边超声无创评估在新型冠状病毒肺炎（Coronavirus Disease-19，COVID-19）肺部病变诊断中的临床价值。
本回顾性研究选取了 2020 年 1 月 18 日至 2 月 5 日我院收治的 30 例 COVID-19 患者作为研究对象。所有病例均经肺部超声和 CT 检查。由盲法观察者对肺部病变进行复查，采用影像学评分分析 COVID-19 患者肺部病变的超声表现，并以胸部 CT 为参考标准。评估超声在肺部病变无创评估中的临床价值。
COVID-19 患者肺部超声征象主要表现为间质性肺水肿（90.0%，27/30）和肺部实变（20.0%，6/30）。肺部病变主要分布在胸膜下和外周肺区。下叶和背部受累倾向较大。COVID-19 患者肺部病变的床边超声无创评估与 CT 之间具有中度一致性（Kappa=0.529）。评估轻度、中度和重度肺部病变的超声评分的灵敏度分别为 68.8%（11/16）、77.8%（7/9）、100.0%（2/2），特异性分别为 85.7%（12/14）、76.2%（16/21）、92.9%（26/28），诊断准确率分别为 76.7%（23/30）、76.7%（23/30）、93.3%（28/30）。随访动态超声检查显示，所有患者病情逐渐加重，肺部病变超声评分逐渐升高。
虽然床边超声对轻度至中度患者的诊断效果相对较低，但对重度患者的诊断效果较高。床边超声对 COVID-19 患者肺部病变的无创评估和动态观察具有重要的临床意义，值得进一步考虑。
