Xie Linjun, Hou Keke, Xu Huayan, Fu Hang, Xu Rong, Liu Hui, Zhou Zhongqin, Li Zhenlin, Yang Ming, Guo Yingkun
Department of Radiology; Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education; West China Second University Hospital, Sichuan University;20# South Renmin Road, Chengdu, Sichuan 610041, China.
Department of Radiology, Public Health Clinical Center of Chengdu, Chengdu, China.
Br J Radiol. 2020 Dec 1;93(1116):20200219. doi: 10.1259/bjr.20200219. Epub 2020 Nov 13.
Coronavirus disease 2019 (COVID-19) is a major public health emergency. It poses a grave threat to human life and health. The purpose of the study is to investigate the chest CT findings and progression of the disease observed in COVID-19 patients.
Forty-nine confirmed cases of adult COVID-19 patients with common type, severe and critically severe type were included in this retrospective single-center study. The thin-section chest CT features and progress of the disease were evaluated. The clinical and chest imaging findings of COVID-19 patients with different severity types were compared. The CT severity score and MuLBSTA score (a prediction of mortality risk) were calculated in those patients.
Among the 49 patients, 35 patients (71%) were common type and 14 patients (28%) were severe and critically severe type. Nearly all patients (98%) had pure ground-glass opacities (GGO) in CT imaging. Of the severe and critically severe type patients, 86% exhibited GGO with consolidation, in comparison with 54% of the patients with common type. Fibrosis presented in 79% of the severe and critically severe type patients and 43% of the common type patients. The severe and critically severe type patients were significantly more prone to experience five-lobe involvement compared to the common type patients ( = 0.002). The severe and critically severe type patients also had higher CT severity and MuLBSTA scores than the common type patients (5.43 ± 2.38 3.37 ± 2.40, < 0.001;and 10.21 ± 3.83 4.63 ± 3.43, < 0.001, respectively). MuLBSTA score was positively correlated with admittance to the intensive care unit ( = 0.005, = 0.351). Nineteen patients underwent three times CT scan. The interval between first and second CT scan was 4[4,8] days, second and third was 3[2,4] days. There were greater improvements in the third CT follow-up findings compared to the second ( = 0.002).
The severe and critically severe type patients often experienced more severe lung lesions, including GGO with consolidation. The CT severity score and MuLBSTA score may be helpful for the assessment of COVID-19 severity and progression.
Chest CT has the value of evaluated radiographical features of COVID-19 and allow for dynamic observation of the disease progression. Considering coagulation disorder of COVID-19, MuLBSTA score may need to be updated to increase new understanding of COVID-19.
2019冠状病毒病（COVID-19）是一项重大突发公共卫生事件。它对人类生命和健康构成严重威胁。本研究旨在调查COVID-19患者的胸部CT表现及疾病进展情况。
本回顾性单中心研究纳入了49例确诊的普通型、重型和危重型成年COVID-19患者。评估了胸部薄层CT特征及疾病进展情况。比较了不同严重程度类型COVID-19患者的临床和胸部影像学表现。计算了这些患者的CT严重程度评分和MuLBSTA评分（一种死亡风险预测指标）。
49例患者中，35例（71%）为普通型，14例（28%）为重型和危重型。几乎所有患者（98%）在CT影像上表现为单纯磨玻璃影（GGO）。重型和危重型患者中，86%表现为GGO合并实变，而普通型患者中这一比例为54%。79%的重型和危重型患者以及43%的普通型患者出现纤维化。与普通型患者相比，重型和危重型患者更易出现五叶受累（P = 0.002）。重型和危重型患者的CT严重程度评分和MuLBSTA评分也高于普通型患者（分别为5.43±2.38对3.37±2.40，P < 0.001；以及10.21±3.83对4.63±3.43，P < 0.001）。MuLBSTA评分与入住重症监护病房呈正相关（P = 0.005，r = 0.351）。19例患者接受了三次CT扫描。首次和第二次CT扫描间隔为4[4,8]天，第二次和第三次为3[2,4]天。第三次CT随访结果较第二次有更大改善（P = 0.002）。
重型和危重型患者常出现更严重的肺部病变，包括GGO合并实变。CT严重程度评分和MuLBSTA评分可能有助于评估COVID-19的严重程度和进展情况。
胸部CT对于评估COVID-19的影像学特征及动态观察疾病进展具有价值。考虑到COVID-19的凝血功能障碍，可能需要更新MuLBSTA评分以加深对COVID-19的新认识。
