Zhou Xiuxiu, Pu Yu, Zhang Di, Xia Yi, Guan Yu, Liu Shiyuan, Fan Li
Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, PR China.
Acta Radiol. 2022 Mar;63(3):291-310. doi: 10.1177/0284185121992655. Epub 2021 Feb 25.
Quick screening patients with COVID-19 is the most important way of controlling transmission by isolation and medical treatment. Chest computed tomography (CT) has been widely used during the initial screening process, including pneumonia diagnosis, severity assessment, and differential diagnosis of COVID-19. The course of COVID-19 changes rapidly. Serial CT imaging could observe the distribution, density, and range of lesions dynamically, monitor the changes, and then guide towards appropriate treatment. The aim of the review was to explore the chest CT findings and dynamic CT changes of COVID-19 using systematic evaluation methods, instructing the clinical imaging diagnosis. A systematic literature search was performed. The quality of included literature was evaluated with a quality assessment tool, followed by data extraction and meta-analysis. Homogeneity and publishing bias were analyzed. A total of 109 articles were included, involving 2908 adults with COVID-19. The lesions often occurred in bilateral lungs (74%) and were multifocal (77%) with subpleural distribution (81%). Lesions often showed ground-glass opacity (GGO) (68%), followed by GGO with consolidation (48%). The thickening of small vessels (70%) and thickening of intralobular septum (53%) were also common. The dynamic changes of chest CT manifestations showed that lesions were absorbed and improved gradually after reaching the peak (80%), had progressive deterioration (55%), were absorbed and improved gradually (46%), fluctuated (22%), or remained stable (26%). The review showed the common and key CT features and the dynamic imaging change patterns of COVID-19, helping with timely management during COVID-19 pandemic.
快速筛查新型冠状病毒肺炎（COVID-19）患者是通过隔离和治疗控制传播的最重要方式。胸部计算机断层扫描（CT）在初始筛查过程中已被广泛应用，包括COVID-19的肺炎诊断、严重程度评估和鉴别诊断。COVID-19的病程变化迅速。系列CT成像可以动态观察病变的分布、密度和范围，监测变化，进而指导适当的治疗。本综述的目的是采用系统评价方法探索COVID-19的胸部CT表现及动态CT变化，指导临床影像诊断。进行了系统的文献检索。使用质量评估工具评估纳入文献的质量，随后进行数据提取和荟萃分析。分析了同质性和发表偏倚。共纳入109篇文章，涉及2908例成年COVID-19患者。病变常发生于双肺（74%），多灶性（77%），胸膜下分布（81%）。病变常表现为磨玻璃影（GGO）（68%），其次是GGO合并实变（48%）。小血管增粗（70%）和小叶间隔增厚（53%）也很常见。胸部CT表现的动态变化显示，病变达到高峰后逐渐吸收改善（80%），病情进行性恶化（55%），逐渐吸收改善（46%），波动（22%）或保持稳定（26%）。本综述显示了COVID-19常见和关键的CT特征以及动态影像变化模式，有助于在COVID-19大流行期间进行及时管理。
