AP-HP, Hôpital Bichat, Service de radiologie, 46 rue Henri Huchard, 75018 Paris, France; Université de Paris Cité; INSERM UMR 1152, Paris, France.
Sorbonne Université, UPMC, Paris VI, Paris, France ; AP-HP, Hôpital Tenon, Service de radiologie, 4 rue de la Chine, 75970 Paris Cedex 20, France.
Respir Med Res. 2022 May;81:100892. doi: 10.1016/j.resmer.2022.100892. Epub 2022 Apr 28.
Chest computed tomography (CT) was reported to improve the diagnosis of community-acquired pneumonia (CAP) as compared to chest X-ray (CXR). The aim of this study is to describe the CT-patterns of CAP in a large population visiting the emergency department and to see if some of them are more frequently missed on CXR.
This is an ancillary analysis of the prospective multicenter ESCAPED study including 319 patients. We selected the 163 definite or probable CAP based on adjudication committee classification; 147 available chest CT scans were reinterpreted by 3 chest radiologists to identify CAP patterns. These CT-patterns were correlated to epidemiological, biological and microbiological data, and compared between false negative and true positive CXR CAP.
Six patterns were identified: lobar pneumonia (51/147, 35%), including 35 with plurifocal involvement; lobular pneumonia (43/147, 29%); unilobar infra-segmental consolidation (24/147, 16%); bronchiolitis (16/147, 11%), including 4 unilobar bronchiolitis; atelectasis and bronchial abnormalities (8/147, 5.5%); interstitial pneumonia (5/147, 3.5%). Bacteria were isolated in 41% of patients with lobar pneumonia-pattern (mostly Streptococcus pneumoniae and Mycoplasma pneumonia) versus 19% in other patients (p = 0.01). Respiratory viruses were equally distributed within all patterns. CXR was falsely negative in 46/147 (31%) patients. Lobar pneumonia was significantly less missed on CXR than other patterns (p = 0.003), especially lobular pneumonia and unilobar infra-segmental consolidation, missed in 35% and 58% of cases, respectively.
Lobar and lobular pneumonias are the most frequent CT-patterns. Lobar pneumonia is appropriately detected on CXR and mainly due to Streptococcus pneumoniae or Mycoplasma pneumoniae. Chest CT is very useful to identify CAP in other CT-patterns. Prior the COVID pandemic, CAP was rarely responsible for interstitial opacities on CT.
与胸部 X 光（CXR）相比，胸部计算机断层扫描（CT）被报道可提高社区获得性肺炎（CAP）的诊断。本研究的目的是描述在急诊科就诊的大人群中 CAP 的 CT 模式，并观察是否有些模式在 CXR 上更容易漏诊。
这是一项前瞻性多中心 ESCAPED 研究的辅助分析，包括 319 名患者。我们根据裁决委员会分类选择了 163 例明确或可能的 CAP；147 例可获得的胸部 CT 扫描由 3 名胸部放射科医生重新解读，以确定 CAP 模式。这些 CT 模式与流行病学、生物学和微生物学数据相关，并在假阴性和真阳性 CXR CAP 之间进行比较。
确定了六种模式：大叶性肺炎（51/147，35%），其中 35 例为多灶性受累；小叶性肺炎（43/147，29%）；单侧亚段实变（24/147，16%）；细支气管炎（16/147，11%），其中 4 例为单侧细支气管炎；不张和支气管异常（8/147，5.5%）；间质性肺炎（5/147，3.5%）。在大叶性肺炎模式的 41%的患者中分离出细菌（主要为肺炎链球菌和肺炎支原体），而在其他患者中为 19%（p=0.01）。所有模式中呼吸道病毒的分布均相等。在 147 例患者中，CXR 假阴性 46 例（31%）。与其他模式相比，CXR 对大叶性肺炎的漏诊明显较少（p=0.003），特别是小叶性肺炎和单侧亚段实变，分别漏诊 35%和 58%的病例。
大叶性和小叶性肺炎是最常见的 CT 模式。CXR 能适当检测到大叶性肺炎，主要是由肺炎链球菌或肺炎支原体引起的。胸部 CT 对于识别其他 CT 模式的 CAP 非常有用。在 COVID 大流行之前，CAP 在 CT 上很少导致间质性混浊。
