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新型冠状病毒肺炎(COVID-19)的初步 CT 影像学表现。

Preliminary CT findings of coronavirus disease 2019 (COVID-19).

机构信息

Medical Imaging Center, Shiyan Taihe Hospital, Shiyan, Hubei 442000, China.

Department of Interventional Radiology, Zhongshan People's Hospital, Zhongshan, Guangdong 528403, China.

出版信息

Clin Imaging. 2020 Sep;65:124-132. doi: 10.1016/j.clinimag.2020.04.042. Epub 2020 May 12.


DOI:10.1016/j.clinimag.2020.04.042
PMID:32464579
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7214302/
Abstract

OBJECTIVES: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This paper aims to examine the CT imaging characteristics of COVID-19. METHODS: We evaluated CT images obtained between 10 January 2019 and 16 February 2020 at Taihe Hospital. Scans were conducted 2-6 times per patient and the re-testing interval was 2-7 days. Ninety-five patients with positive SARS-CoV-2 nucleic acid test results were included in this study and we retrospectively analysed their CT imaging characteristics. RESULTS: Ninety-five patients underwent 2-3 SARS-CoV-2 nucleic acid tests and received a definitive diagnosis of COVID-19. Fifty-three were male and 42 were female, and their mean age was 42 ± 12 years (range: 10 months to 81 years). Sixty-nine patients (72.6%) experienced fever, fatigue, and dry cough, while 15 (15.8%) had poor appetite and fatigue, and 11 (11.6%) had a dry cough and no fever. On CT imaging, early stage patients (n = 53, 55.8%) showed peripheral subpleural ground-glass opacities; these were mainly local patches (22/53, 41.5%), while some lesions were accompanied by interlobular septal thickening. Thirty-four (35.8%) patients were classified in the 'progression stage' based on CT imaging; these patients typically showed lesions in multiple lung segments and lobes (21/34,61.8%), and an uneven increase in ground-glass opacity density accompanied by consolidation and grid-like or cord-like shadows(30.5%). Two patients (2.1%) showed a severe presentation on CT. These showed diffuse bilateral lung lesions, mixed ground-glass opacities and consolidation with cord-like interstitial thickening and air bronchograms, entire lung involvement with a "white lung" presentation, and mild pleural effusion. Six patients in remission (6.3%), visible lesion absorption, fibrotic lesions. Based on clinical signs, 71 (74.7%), 22 (23.2%), and 2 (2.1%) patients had mild or moderate, severe, and critical disease, respectively. Within the follow-up period, 93 patients recovered and were discharged, including the 53 early stage patients and 34 progression stage patients. The length of hospitalisation was 7-28 days (mean: 10 ± 3.5 days). On discharge, lesions were significantly reduced in area and had in many cases completely disappeared, while slight pulmonary fibrosis was present in some patients. One severe stage patient was still hospitalised at the end of the follow-up period and the other severe stage patient died. The overall mortality rate was 1.05%. CONCLUSIONS: Understanding the CT imaging characteristics of COVID-19 is important for early lesion detection, determining the nature of lesions, and assessing disease severity.

摘要

目的:由严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)引起的 2019 年冠状病毒病(COVID-19)。本文旨在研究 COVID-19 的 CT 影像学特征。

方法:我们评估了 2019 年 1 月 10 日至 2020 年 2 月 16 日在泰和医院进行的 CT 图像。每位患者进行 2-6 次扫描,重新检测间隔为 2-7 天。本研究纳入了 95 例 SARS-CoV-2 核酸检测阳性的患者,并对其 CT 影像学特征进行了回顾性分析。

结果:95 例患者进行了 2-3 次 SARS-CoV-2 核酸检测,最终确诊为 COVID-19。其中 53 例为男性,42 例为女性,平均年龄为 42±12 岁(10 个月至 81 岁)。69 例患者(72.6%)有发热、乏力、干咳症状,15 例(15.8%)有纳差、乏力症状,11 例(11.6%)有干咳、无发热症状。CT 影像学表现为早期(n=53)患者表现为外周胸膜下磨玻璃影;主要为局部斑片状(22/53,41.5%),部分病变伴有小叶间隔增厚。34 例(35.8%)患者根据 CT 影像学表现分为“进展期”;这些患者通常表现为多肺段和肺叶病变(21/34,61.8%),磨玻璃密度不均匀增加伴实变和网格状或条索状影(30.5%)。2 例(2.1%)患者 CT 表现严重。这些患者表现为弥漫性双侧肺部病变,磨玻璃影和实变混合存在,伴有索状间质增厚和空气支气管征,全肺受累呈“白肺”表现,少量胸腔积液。6 例(6.3%)患者缓解,可见病变吸收,纤维化病变。根据临床症状,71 例(74.7%)、22 例(23.2%)和 2 例(2.1%)患者的疾病分别为轻度或中度、重度和危重型。在随访期间,93 例患者康复出院,包括 53 例早期患者和 34 例进展期患者。住院时间为 7-28 天(平均 10±3.5 天)。出院时,病变面积明显缩小,多数完全消失,部分患者有轻微肺纤维化。1 例重症患者在随访期末仍住院,另 1 例重症患者死亡。总的死亡率为 1.05%。

结论:了解 COVID-19 的 CT 影像学特征对于早期发现病变、确定病变性质和评估疾病严重程度非常重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76c5/7214302/b4c61b980c12/gr7_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76c5/7214302/e972f9d88646/gr1_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76c5/7214302/2c13f5cc8fa2/gr2_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76c5/7214302/efe36fe9444a/gr3_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76c5/7214302/b5d2fcc4ae02/gr4_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76c5/7214302/f6cf3d31203e/gr5_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76c5/7214302/1108a66bef12/gr6_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76c5/7214302/b4c61b980c12/gr7_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76c5/7214302/e972f9d88646/gr1_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76c5/7214302/2c13f5cc8fa2/gr2_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76c5/7214302/efe36fe9444a/gr3_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76c5/7214302/b5d2fcc4ae02/gr4_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76c5/7214302/f6cf3d31203e/gr5_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76c5/7214302/1108a66bef12/gr6_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76c5/7214302/b4c61b980c12/gr7_lrg.jpg

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