Department of Medicine, The Bryn Mawr Hospital, Bryn Mawr, PA 19010, USA.
Department of Health Services, Bryn Mawr College, Bryn Mawr, PA 19010, USA.
Eur J Radiol. 2020 Jul;128:108988. doi: 10.1016/j.ejrad.2020.108988. Epub 2020 Apr 23.
Human metapneumovirus has been increasingly identified as a cause of lower respiratory tract infection in adults worldwide. The CT imaging features of human metapneumovirus in adults have not been characterized. The purpose of this paper is to determine the imaging features of human metapneumovirus and to compare them with features of other viruses.
Two clinicians retrospectively reviewed the medical records of 104 adults with lower respiratory tract infection due to human metapneumovirus at four hospitals in the northeast USA over 32 months. CT images were evaluated by two chest radiologists for airspace consolidation, bronchiectasis, bronchial wall thickening, ground-glass opacities, pleural effusion and tree-in-bud opacities and the dominant imaging pattern. Results for human metapneumovirus were compared with results previously reported for other viruses.
Human metapneumovirus predominantly caused an airway-centric pattern (71-81/104, 68-77%) of infection characterized by bronchial wall thickening, tree-in-bud opacities, peri-bronchial consolidation and/or peri-bronchial ground-glass opacities. The airway-centric pattern has been previously reported with other paramyxoviridae (parainfluenza virus and respiratory syncytial virus). However, human metapneumovirus was significantly more likely (p = 0.03-0.001) to cause bronchopneumonia (46-55%) than parainfluenza virus (17%) or respiratory syncytial virus (21%). Follow-up CT in 41 (39%) patients with hMPV revealed resolution of findings in 38/41 (91%).
The paramyxoviridae, including human metapneumovirus, are known to have a propensity to infect ciliated respiratory cells and we have demonstrated this leads to a propensity to cause bronchitis, bronchiolitis and bronchopneumonia on CT scans. Of these, human metapneumovirus is most likely to cause bronchopneumonia. Healthcare providers should consider human metapneumovirus as a cause of pneumonia on chest CT.
人类偏肺病毒（HMPV）已被越来越多地确认为全球成人下呼吸道感染的病因。成人 HMPV 的 CT 成像特征尚未明确。本文旨在确定 HMPV 的影像学特征，并将其与其他病毒的特征进行比较。
两位临床医生回顾性分析了美国东北部四家医院 32 个月内 104 例成人下呼吸道感染 HMPV 的病历。两名胸部放射科医生评估了 CT 图像的空气腔实变、支气管扩张、支气管壁增厚、磨玻璃影、胸腔积液和树芽征的存在，并确定主要的影像学模式。将 HMPV 的结果与先前报道的其他病毒的结果进行比较。
HMPV 主要引起气道中心性感染模式（71-81/104，68-77%），表现为支气管壁增厚、树芽征、支气管周围实变和/或支气管周围磨玻璃影。气道中心性模式以前也与其他副粘病毒（副流感病毒和呼吸道合胞病毒）有关。然而，HMPV 引起支气管肺炎（46-55%）的可能性明显高于副流感病毒（17%）或呼吸道合胞病毒（21%）（p=0.03-0.001）。在 41 例（39%）HMPV 患者中进行了随访 CT 检查，41 例（91%）患者的发现得到了缓解。
副粘病毒包括 HMPV，已知其具有感染纤毛呼吸道细胞的倾向，我们已经证明这导致 CT 扫描上更易引起支气管炎、细支气管炎和支气管肺炎。在这些病毒中，HMPV 最有可能引起支气管肺炎。医疗保健提供者应将 HMPV 视为肺炎的病因之一，这在胸部 CT 上有所体现。
