Department of Radiology, The Second Hospital in Fuyang, Fuyang, Anhui, China.
Department of Radiology, People's Liberation Army General Hospital, Number 28, Fu Xing Road, Hai Dian District, Beijing, China.
Eur Radiol. 2021 Mar;31(3):1175-1184. doi: 10.1007/s00330-020-07268-9. Epub 2020 Sep 15.
OBJECTIVE: To determine CT's role in the early detection of COVID-19 infection and serial CT changes in the disease course in patients with COVID-19 pneumonia. METHODS: From January 21 to February 18, 2020, all of the patients who were suspected of novel coronavirus infection and verified by RT-PCR tests were retrospectively enrolled in our study. All of the patients underwent serial RT-PCR tests and serial CT imaging. The temporal relationship between the serial RT-PCR results (negative conversion to positive, positive to negative) and serial CT imaging was investigated, and serial CT changes were evaluated. RESULTS: A total of 155 patients with confirmed COVID-19 pneumonia were evaluated. Chest CT detection time of COVID-19 pneumonia was 2.61 days earlier than RT-PCR test (p = 0.000). The lung CT improvement time was significantly shorter than that of RT-PCR conversion to negative (p = 0.000). Three stages were identified from the onset of the initial symptoms: stage 1 (0-3 days), stage 2 (4-7 days), and stage 3 (8-14 days and later). Ground glass opacity (GGO) was predominant in stage 1, then consolidation and crazy paving signs were dramatically increased in stage 2. In stage 3, fibrotic lesions were rapidly increased. There were significant differences in the main CT features (p = 0.000), number of lobes involved (p = 0.001), and lesion distribution (p = 0.000) among the different stages. CONCLUSION: Chest CT detected COVID-19 pneumonia earlier than the RT-PCR results and can be used to monitor disease course. Combining imaging features with epidemiology history and clinical information could facilitate the early diagnosis of COVID-19 pneumonia. KEY POINTS: • The chest CT detection time of COVID-19 pneumonia was 2.61 days earlier than that of an initial RT-PCR positive result (t = - 7.31, p = 0.000). • The lung CT improvement time was significantly shorter than that of RT-PCR conversion to negative (t = - 4.72, p = 0.000). • At the early stage (0-3 days), the CT features of COVID-19 were predominantly GGO and small-vessel thickening; at stage 2 (4-7 days), GGO evolved to consolidation and crazy paving signs. At stage 3 (8-14 days and later), fibrotic lesions significantly increased, accompanied by consolidation, GGO, and crazy paving signs.
目的：确定 CT 在 COVID-19 感染的早期检测中的作用，以及 COVID-19 肺炎患者疾病过程中的连续 CT 变化。
方法：从 2020 年 1 月 21 日至 2 月 18 日，回顾性纳入所有经 RT-PCR 检测证实为新型冠状病毒感染的患者。所有患者均接受了连续的 RT-PCR 检测和连续 CT 成像。研究了连续 RT-PCR 结果（从阴性转为阳性，从阳性转为阴性）与连续 CT 成像之间的时间关系，并评估了连续 CT 变化。
结果：共评估了 155 例确诊的 COVID-19 肺炎患者。COVID-19 肺炎的胸部 CT 检测时间比 RT-PCR 检测早 2.61 天（p=0.000）。肺 CT 改善时间明显短于 RT-PCR 转为阴性（p=0.000）。从初始症状开始可分为三个阶段：第 1 阶段（0-3 天）、第 2 阶段（4-7 天）和第 3 阶段（8-14 天及以后）。第 1 阶段以磨玻璃影（GGO）为主，第 2 阶段实变和铺路石征明显增加。第 3 阶段纤维化病变迅速增加。不同阶段的主要 CT 特征（p=0.000）、累及肺叶数（p=0.001）和病变分布（p=0.000）均有显著差异。
结论：胸部 CT 比 RT-PCR 结果更早地检测到 COVID-19 肺炎，可用于监测疾病过程。结合影像学特征、流行病学史和临床信息有助于 COVID-19 肺炎的早期诊断。
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