新型冠状病毒肺炎（COVID-19）的胸部CT特征：初次CT检查中的哪些表现可预测不良短期预后？
Chest CT features of coronavirus disease-19 (COVID-19) pneumonia: which findings on initial CT can predict an adverse short-term outcome?
作者信息
Parry Arshed Hussain, Wani Abdul Haseeb, Shah Naveed Nazir, Yaseen Mudasira, Jehangir Majid
机构信息
Department of Radiodiagnosis, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
Department of Radiodiagnosis, Government Medical College, Srinagar, Jammu and Kashmir, India.
出版信息
BJR Open. 2020 Jun 19;2(1):20200016. doi: 10.1259/bjro.20200016. eCollection 2020.
OBJECTIVE
To study the spectrum of chest CT features in coronavirus disease-19 (COVID-19) pneumonia and to identify the initial CT findings that may have the potential to predict a poor short-term outcome.
METHODS
This was a retrospective study comprising 211 reverse transcriptase-polymerase chain reaction (RT-PCR) positive patients who had undergone non-contrast chest CT. Prevalence, extent, pattern, distribution and type of abnormal lung findings were recorded. Patients with positive CT findings were divided into two groups; clinically stable (requiring in-ward hospitalization) and clinically unstable [requiring intensive care unit (ICU) admission or demised] based on short-term follow-up.
RESULTS
Lung parenchymal abnormalities were present in 42.2% (89/211) whereas 57.8% (122/211) cases had a normal chest CT. The mean age of clinically unstable patients (63.6 ± 8.3 years) was significantly different from the clinically stable group (44.6 ± 13.2 years) (-value < 0.05). Bilaterality, combined involvement of central-peripheral and anteroposterior lung along with a higher percentage of the total lung involvement, presence of crazy paving, coalescent consolidations with air bronchogram and segmental pulmonary vessel enlargement were found in a significantly higher proportion of clinically unstable group (ICU/demised) compared to the stable group (in-ward hospitalization) with all values < 0.05.
CONCLUSION
Certain imaging findings on initial CT have the potential to predict short-term outcome in COVID-19 pneumonia. Extensive pulmonary abnormalities, evaluated by combined anteroposterior, central-peripheral and a higher percentage of the total lung involvement, indicate a poor short-term outcome. Similarly, the presence of crazy paving pattern, consolidation with air bronchogram and segmental vascular changes are also indicators of poor short-term outcome.
ADVANCES IN KNOWLEDGE
Certain findings on initial CT can predict an adverse short-term prognosis in COVID-19 pneumonia.
目的
研究新型冠状病毒肺炎（COVID-19）的胸部CT特征谱，并确定可能预测短期不良预后的初始CT表现。
方法
这是一项回顾性研究，纳入了211例接受了非增强胸部CT检查且逆转录聚合酶链反应（RT-PCR）呈阳性的患者。记录肺部异常表现的发生率、范围、模式、分布和类型。根据短期随访结果，将CT检查结果阳性的患者分为两组：临床稳定组（需住院治疗）和临床不稳定组[需入住重症监护病房（ICU）或死亡]。
结果
42.2%（89/211）的患者存在肺实质异常，而57.8%（122/211）的患者胸部CT正常。临床不稳定组患者的平均年龄（63.6±8.3岁）与临床稳定组（44.6±13.2岁）有显著差异（P值<0.05）。与稳定组（住院治疗）相比，临床不稳定组（ICU/死亡）中双侧病变、中央-外周及前后肺联合受累以及肺受累总面积比例更高、出现铺路石征、融合性实变伴空气支气管征和节段性肺血管增粗的比例显著更高，所有P值均<0.05。
结论
初始CT上的某些影像学表现有可能预测COVID-19肺炎的短期预后。通过前后位、中央-外周联合及肺受累总面积比例更高评估的广泛肺部异常提示短期预后不良。同样，铺路石征、实变伴空气支气管征和节段性血管改变的存在也是短期预后不良的指标。
知识进展
初始CT上的某些表现可预测COVID-19肺炎的不良短期预后。
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