Department of Radiology and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
Department of radiology, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea.
J Korean Med Sci. 2021 Mar 1;36(8):e51. doi: 10.3346/jkms.2021.36.e51.
Few studies have classified chest computed tomography (CT) findings of coronavirus disease 2019 (COVID-19) and analyzed their correlations with prognosis. The present study aimed to evaluate retrospectively the clinical and chest CT findings of COVID-19 and to analyze CT findings and determine their relationships with clinical severity.
Chest CT and clinical features of 271 COVID-19 patients were assessed. The presence of CT findings and distribution of parenchymal abnormalities were evaluated, and CT patterns were classified as bronchopneumonia, organizing pneumonia (OP), or diffuse alveolar damage (DAD). Total extents were assessed using a visual scoring system and artificial intelligence software. Patients were allocated to two groups based on clinical outcomes, that is, to a severe group (requiring O₂ therapy or mechanical ventilation, n = 55) or a mild group (not requiring O₂ therapy or mechanical ventilation, n = 216). Clinical and CT features of these two groups were compared and univariate and multivariate logistic regression analyses were performed to identify independent prognostic factors.
Age, lymphocyte count, levels of C-reactive protein, and procalcitonin were significantly different in the two groups. Forty-five of the 271 patients had normal chest CT findings. The most common CT findings among the remaining 226 patients were ground-glass opacity (98%), followed by consolidation (53%). CT findings were classified as OP (93%), DAD (4%), or bronchopneumonia (3%) and all nine patients with DAD pattern were included in the severe group. Uivariate and multivariate analyses showed an elevated procalcitonin (odds ratio [OR], 2.521; 95% confidence interval [CI], 1.001-6.303, = 0.048), and higher visual CT scores (OR, 1.137; 95% CI, 1.042-1.236; = 0.003) or higher total extent by AI measurement (OR, 1.048; 95% CI, 1.020-1.076; < 0.001) were significantly associated with a severe clinical course.
CT findings of COVID-19 pneumonia can be classified into OP, DAD, or bronchopneumonia patterns and all patients with DAD pattern were included in severe group. Elevated inflammatory markers and higher CT scores were found to be significant predictors of poor prognosis in patients with COVID-19 pneumonia.
鲜有研究对 2019 年冠状病毒病（COVID-19）的胸部计算机断层扫描（CT）结果进行分类，并分析其与预后的关系。本研究旨在回顾性评估 COVID-19 的临床和胸部 CT 表现，并分析 CT 表现，确定其与临床严重程度的关系。
评估了 271 例 COVID-19 患者的胸部 CT 和临床特征。评估了实质异常的存在和分布，并使用视觉评分系统和人工智能软件对 CT 模式进行分类，分为支气管肺炎、机化性肺炎（OP）或弥漫性肺泡损伤（DAD）。使用视觉评分系统和人工智能软件评估总范围。根据临床结局将患者分为两组，即严重组（需要 O₂ 治疗或机械通气，n = 55）和轻症组（不需要 O₂ 治疗或机械通气，n = 216）。比较两组的临床和 CT 特征，并进行单变量和多变量逻辑回归分析，以确定独立的预后因素。
两组患者的年龄、淋巴细胞计数、C 反应蛋白和降钙素水平差异有统计学意义。271 例患者中有 45 例胸部 CT 正常。其余 226 例患者中最常见的 CT 表现为磨玻璃影（98%），其次为实变影（53%）。CT 表现分为 OP（93%）、DAD（4%）或支气管肺炎（3%），9 例 DAD 型患者均归入重症组。单变量和多变量分析显示，降钙素升高（比值比 [OR]，2.521；95%置信区间 [CI]，1.001-6.303， = 0.048）和 CT 评分升高（OR，1.137；95%CI，1.042-1.236； = 0.003）或人工智能测量的总范围升高（OR，1.048；95%CI，1.020-1.076； ＜0.001）与严重的临床病程显著相关。
COVID-19 肺炎的 CT 表现可分为 OP、DAD 或支气管肺炎模式，所有 DAD 型患者均归入重症组。发现升高的炎症标志物和更高的 CT 评分是 COVID-19 肺炎患者预后不良的显著预测指标。
