Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center and National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA.
Philips Research North America, Cambridge, MA, USA.
Eur Radiol. 2021 May;31(5):3165-3176. doi: 10.1007/s00330-020-07401-8. Epub 2020 Nov 4.
The early infection dynamics of patients with SARS-CoV-2 are not well understood. We aimed to investigate and characterize associations between clinical, laboratory, and imaging features of asymptomatic and pre-symptomatic patients with SARS-CoV-2.
Seventy-four patients with RT-PCR-proven SARS-CoV-2 infection were asymptomatic at presentation. All were retrospectively identified from 825 patients with chest CT scans and positive RT-PCR following exposure or travel risks in outbreak settings in Japan and China. CTs were obtained for every patient within a day of admission and were reviewed for infiltrate subtypes and percent with assistance from a deep learning tool. Correlations of clinical, laboratory, and imaging features were analyzed and comparisons were performed using univariate and multivariate logistic regression.
Forty-eight of 74 (65%) initially asymptomatic patients had CT infiltrates that pre-dated symptom onset by 3.8 days. The most common CT infiltrates were ground glass opacities (45/48; 94%) and consolidation (22/48; 46%). Patient body temperature (p < 0.01), CRP (p < 0.01), and KL-6 (p = 0.02) were associated with the presence of CT infiltrates. Infiltrate volume (p = 0.01), percent lung involvement (p = 0.01), and consolidation (p = 0.043) were associated with subsequent development of symptoms.
COVID-19 CT infiltrates pre-dated symptoms in two-thirds of patients. Body temperature elevation and laboratory evaluations may identify asymptomatic patients with SARS-CoV-2 CT infiltrates at presentation, and the characteristics of CT infiltrates could help identify asymptomatic SARS-CoV-2 patients who subsequently develop symptoms. The role of chest CT in COVID-19 may be illuminated by a better understanding of CT infiltrates in patients with early disease or SARS-CoV-2 exposure.
• Forty-eight of 74 (65%) pre-selected asymptomatic patients with SARS-CoV-2 had abnormal chest CT findings. • CT infiltrates pre-dated symptom onset by 3.8 days (range 1-5). • KL-6, CRP, and elevated body temperature identified patients with CT infiltrates. Higher infiltrate volume, percent lung involvement, and pulmonary consolidation identified patients who developed symptoms.
目前人们对 SARS-CoV-2 感染者的早期感染动态了解甚少。本研究旨在调查并分析 SARS-CoV-2 无症状和症状前感染者的临床、实验室和影像学特征之间的关联。
本研究共纳入 74 例经 RT-PCR 确诊的 SARS-CoV-2 感染患者，这些患者在就诊时均无症状。所有患者均来自日本和中国在疫情爆发期间因接触或旅行而进行 RT-PCR 检测的 825 例胸部 CT 扫描阳性患者。每位患者入院后 1 天内均进行 CT 检查，并借助深度学习工具对浸润亚型和浸润百分比进行回顾性分析。分析了临床、实验室和影像学特征的相关性，并通过单变量和多变量逻辑回归进行了比较。
74 例最初无症状患者中，48 例（65%）的 CT 浸润早于症状出现 3.8 天。最常见的 CT 浸润类型为磨玻璃影（45/48；94%）和实变（22/48；46%）。患者体温（p<0.01）、CRP（p<0.01）和 KL-6（p=0.02）与 CT 浸润的存在相关。浸润体积（p=0.01）、肺受累百分比（p=0.01）和实变（p=0.043）与随后出现症状相关。
在三分之二的患者中，COVID-19 的 CT 浸润早于症状出现。体温升高和实验室评估可能有助于识别表现为无症状的 SARS-CoV-2 CT 浸润患者，而 CT 浸润的特征可以帮助识别随后出现症状的 SARS-CoV-2 无症状感染者。通过更好地了解早期疾病或 SARS-CoV-2 暴露患者的 CT 浸润情况，可能会进一步阐明 COVID-19 患者胸部 CT 的作用。
• 74 例经预筛选的无症状 SARS-CoV-2 患者中，48 例（65%）存在异常的胸部 CT 表现。• CT 浸润早于症状出现前 3.8 天（范围 1-5 天）。• KL-6、CRP 和体温升高可识别出存在 CT 浸润的患者。较高的浸润体积、肺受累百分比和肺部实变可识别出出现症状的患者。
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