Kotoku Akiyuki, Horinouchi Hiroki, Nishii Tatsuya, Fukuyama Midori, Ohta Yasutoshi, Fukuda Tetsuya
Radiology, National Cerebral and Cardiovascular Center, Suita, JPN.
Cureus. 2024 Sep 11;16(9):e69161. doi: 10.7759/cureus.69161. eCollection 2024 Sep.
Background The post-pandemic phase of the coronavirus infectious disease that emerged in 2019 (COVID-19) has necessitated updates in radiology, with emerging evidence suggesting tracheobronchial wall thickness as a potential new diagnostic marker. Purpose To evaluate the accuracy of chest computed tomography (CT) scans in identifying COVID-19 by assessing tracheobronchial wall thickness in mid-2023. Material and methods A retrospective review was conducted on 60 patients who underwent thoracoabdominal CT and the severe acute respiratory syndrome coronavirus (SARS-CoV-2) antigen tests during emergency visits between June and August 2023. Tracheobronchial wall thickness was measured using a 4-point scale (1=no thickening, 2=mild, 3=moderate, 4=significant). Lung assessment employed the COVID-19 Reporting and Data System (CO-RADS). Patients were classified based on antigen test results. The Mann-Whitney U test and Fisher's exact test compared characteristics and CT findings. Diagnostic performance was evaluated using the area under the receiver operating characteristic curves (AUC). Results The SARS-CoV-2-positive group showed significantly thicker tracheobronchial walls (median 1.5 mm vs. 1.2 mm, P < 0.001), especially in the trachea's membranous wall (median 1.2 mm vs. 0.9 mm, P < 0.001) and higher scores (median 3 vs. 2, P < 0.001). CO-RADS scores showed no significant difference. Quantitative and qualitative wall thickness assessments demonstrated high diagnostic value, with AUCs of 0.90 and 0.94, and accuracies of 85% and 87%, respectively. Conclusion Tracheobronchial wall thickness on chest CT exhibited high diagnostic accuracy, establishing it as a reliable marker for COVID-19 detection in mid-2023.
背景 2019 年出现的冠状病毒感染疾病（COVID-19）的大流行后阶段使得放射学需要更新，新出现的证据表明气管支气管壁厚度是一种潜在的新诊断标志物。目的 于2023年年中通过评估气管支气管壁厚度来评估胸部计算机断层扫描（CT）在识别 COVID-19 方面的准确性。材料和方法 对 2023 年 6 月至 8 月急诊就诊期间接受胸腹 CT 和严重急性呼吸综合征冠状病毒（SARS-CoV-2）抗原检测的 60 例患者进行回顾性研究。气管支气管壁厚度采用 4 分制测量（1 = 无增厚，2 = 轻度，3 = 中度，4 = 显著）。肺部评估采用 COVID-19 报告和数据系统（CO-RADS）。根据抗原检测结果对患者进行分类。采用 Mann-Whitney U 检验和 Fisher 精确检验比较特征和 CT 表现。使用受试者操作特征曲线下面积（AUC）评估诊断性能。结果 SARS-CoV-2 阳性组的气管支气管壁明显更厚（中位数 1.5 mm 对 1.2 mm，P < 0.001），尤其是气管膜壁（中位数 1.2 mm 对 0.9 mm，P < 0.001）且得分更高（中位数 3 对 2，P < 0.001）。CO-RADS 评分无显著差异。定量和定性的壁厚度评估显示出较高的诊断价值，AUC 分别为 0.90 和 0.94，准确率分别为 85%和 87%。结论 胸部 CT 上的气管支气管壁厚度显示出较高的诊断准确性，使其成为 2023年年中 COVID-19 检测的可靠标志物。
