Zhou Hua, Xu Kaijin, Shen Yihong, Fang Qiang, Chen Feng, Sheng Jifang, Zhao Feng, Lou Haiyan
Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Ann Transl Med. 2020 Jun;8(11):679. doi: 10.21037/atm-20-2119a.
The current outbreak of coronavirus disease 2019 (COVID-19), epi-centered in Wuhan, Hubei Province of the China, has become a global health emergency. Several studies from China have recently provided the evidence of epidemiological, clinical, laboratory, and outcomes of COVID-19 patients. Investigation on the role of chest CT in patient screening and management course in a large cohort remains paucity.
This was a retrospective observational study based on the data collected between January 19 and 2020 to February 15, 2020. A clinic workflow using chest CT and RT-PCR assay to screen suspected patient was reviewed. Clinical data were evaluated and patients were classified to mild, common, severe and critical group. Chest CT characteristics of each patient were evaluated and a CT scoring system was applied to grade the lung involvement.
Of 98 enrolled patients, 1, 29, 51 and 17 were clinically classified into mild, common, severe and critical group, respectively. Eighty-three patients (84.7%) demonstrated ground-glass opacity (GGO), 76 patients (77.5%) demonstrated consolidation and 18 patients (18.4%) demonstrated crazy-paving pattern on chest CT. Based on the CT scoring, 2, 35, 55 and 6 patients were categorized to grade 0, grade 1, grade 2 and grade 3, respectively, which significantly consistent with clinical classification (kappa =0.638, P﹤0.05). Twenty-nine patients admitted from fever clinic, with an average interval of 1.2 days (range, 0-4 days) between CT examination and onset of symptom. Three of these patients had negative initial RT-PCR result while abnormalities displayed on the initial chest CT.
Peripheral lung distributed GGO and consolidation, without subpleural sparing, are the most common manifestations on chest CT of COVID-19. Abnormalities on chest CT can occur in an early stage of COVID-19, even when RT-PCR assay negative, which may help to early recognition and rapid diagnosis of this disease.
当前以中国湖北省武汉市为疫情中心爆发的2019冠状病毒病（COVID-19）已成为全球突发公共卫生事件。中国最近的几项研究提供了COVID-19患者的流行病学、临床、实验室及转归方面的证据。关于胸部CT在大规模队列患者筛查及管理过程中的作用的研究仍较少。
这是一项基于2020年1月19日至2月15日收集的数据的回顾性观察研究。回顾了一种使用胸部CT和逆转录聚合酶链反应（RT-PCR）检测来筛查疑似患者的临床工作流程。评估临床数据并将患者分为轻症、普通、重症和危重症组。评估每位患者的胸部CT特征，并应用CT评分系统对肺部受累情况进行分级。
98例入组患者中，分别有1例、29例、51例和17例在临床上被分类为轻症、普通、重症和危重症组。83例患者（84.7%）胸部CT显示磨玻璃影（GGO），76例患者（77.5%）显示实变，18例患者（18.4%）显示铺路石样改变。根据CT评分，分别有2例、35例、55例和6例患者被分类为0级、1级、2级和3级，与临床分类显著一致（kappa =0.638，P﹤0.05）。29例来自发热门诊的患者，CT检查与症状出现之间的平均间隔为1.2天（范围0 - 4天）。其中3例患者初始RT-PCR结果为阴性，但初始胸部CT显示异常。
外周肺分布的GGO和实变，不累及胸膜下，是COVID-19胸部CT最常见的表现。胸部CT异常可出现在COVID-19的早期，即使RT-PCR检测为阴性，这可能有助于该病的早期识别和快速诊断。
