Medical Imaging Department, First Affiliated Hospital of Kunming Medical University, Kunming, China.
Medical Imaging Department, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China.
Ann Palliat Med. 2021 Jan;10(1):560-571. doi: 10.21037/apm-20-2479.
Multicenter retrospective comparison of the first high-resolution computed tomography (HRCT) findings of coronavirus disease 2019 (COVID-19) and other viral pneumonias.
We retrospectively collected clinical and imaging data from 262 cases of confirmed viral pneumonia in 20 hospitals in Yunnan Province, China, from March 1, 2015 to March 15, 2020. According to the virus responsible for the pneumonia, the pneumonias were divided into non-COVID-19 (141 cases) and COVID-19 (121 cases). The non-COVID-19 pneumonias comprised cytomegalovirus (CMV) (31 cases), influenza A virus (82 cases), and influenza B virus (20 cases). The differences in the basic clinical characteristics, lesion distribution, location and imaging signs among the four viral pneumonias were analyzed and compared.
Fever and cough were the most common clinical symptoms of the four viral pneumonias. Compared with the COVID-19 patients, the non-COVID-19 patients had higher proportions of fatigue, sore throat, expectorant and chest tightness (all P<0.000). In addition, in the CMV pneumonia patients, the proportions of acquired immunodeficiency syndrome (AIDS) and leukopenia were high (all PP<0.000). Comparison of the imaging findings of the four viral pneumonias showed that the pulmonary lesions of COVID-19 were more likely to occur in the peripheral and lower lobes of both lungs, whereas those of CMV pneumonia were diffusely distributed. Compared with the non-COVID-19 pneumonias, COVID-19 pneumonia was more likely to present as ground-glass opacity, intralobular interstitial thickening, vascular thickening and halo sign (all PP<0.05). In addition, in the early stage of COVID-19, extensive consolidation, fibrous stripes, subpleural lines, crazy-paving pattern, tree-in-bud, mediastinal lymphadenectasis, pleural thickening and pleural effusion were rare (all PP<0.05).
The HRCT findings of COVID-19 pneumonia and other viral pneumonias overlapped significantly, but many important differential imaging features could still be observed.
回顾性比较 2019 年冠状病毒病（COVID-19）与其他病毒性肺炎的首次高分辨率计算机断层扫描（HRCT）结果。
我们从 2015 年 3 月 1 日至 2020 年 3 月 15 日，在中国云南省 20 家医院回顾性收集了 262 例确诊病毒性肺炎的临床和影像学资料。根据引起肺炎的病毒，将肺炎分为非 COVID-19（141 例）和 COVID-19（121 例）。非 COVID-19 肺炎包括巨细胞病毒（CMV）（31 例）、甲型流感病毒（82 例）和乙型流感病毒（20 例）。分析比较了四种病毒性肺炎的基本临床特征、病变分布、部位和影像学征象的差异。
发热和咳嗽是四种病毒性肺炎最常见的临床症状。与 COVID-19 患者相比，非 COVID-19 患者乏力、咽痛、咳痰和胸闷的比例更高（均 P<0.000）。此外，在 CMV 肺炎患者中，艾滋病（AIDS）和白细胞减少的比例较高（均 P<0.000）。四种病毒性肺炎的影像学表现比较显示，COVID-19 肺炎的肺部病变更易发生在双肺的外周和下叶，而 CMV 肺炎则呈弥漫性分布。与非 COVID-19 肺炎相比，COVID-19 肺炎更易表现为磨玻璃样混浊、小叶间间质增厚、血管增厚和晕征（均 P<0.05）。此外，在 COVID-19 的早期阶段，广泛实变、纤维条纹、肋胸膜下线、碎石路征、树芽征、纵隔淋巴结肿大、胸膜增厚和胸腔积液少见（均 P<0.05）。
COVID-19 肺炎和其他病毒性肺炎的 HRCT 表现有明显重叠，但仍能观察到许多重要的鉴别影像学特征。
