EUR RADIOL:新型冠状病毒肺炎胸部CT影像学特征


近几日,随着防控力度和群众意识增强,新型冠状病毒(COVID-19)肺炎的新发病例已呈现显著下降趋势,尤其是除湖北以外地区。由于病毒核酸检测时间问题和假阴性问题,213日,武汉将胸部CT表现纳入确诊标准,肯定了CT结果在COVID-19肺炎诊断中的重要性。2020213日,《欧洲影像学杂志》发表了华中科技大学同济医院影像科的研究成果,分析了63例新型冠状病毒肺炎的CT影像学特征。


该研究纳入了从20191230日到2020131日确诊的63名患者,进行胸部高分辨率CT (HRCT)检查。记录每位患者胸部CT图像中受影响的肺叶、磨砂玻璃结节(GGO)、斑片状/点状磨砂玻璃混浊、斑片状实变、纤维条纹及不规则实性结节的数量。此外,还对这些患者进行了影像学随访。


统计结果显示,男女比33:30。平均年龄44.9±15.2岁。平均受累叶数为3.3±1.819(30.2%)患者有一个肺叶受累,5(7.9%)患者有两个肺叶受累,4(6.3%)患者有三个肺叶受累,7(11.1%)患者有四个肺叶受累的,28(44.4%)患者有五个肺叶受累。54(85.7%)患者为斑片状/点状磨砂玻璃样阴影,14(22.2%)患者为GGO, 12(19.0%)患者为斑片状实变,11(17.5%)患者为纤维状条纹,8(12.7%)患者为不规则实性结节。54(85.7%)患者进展,包括单个GGO增加、扩大和实变,纤维状条状增大,实性结节增大。


640 (1).jpg        

患者的各种病变表现。红色箭头和方框表示异常。ab: GGO;c, d:斑片状/点状磨砂玻璃混浊;e, f:斑片状融合;g:纤维状条纹;h:不规则实性结节


640 (2).jpg   

新型冠状病毒肺炎患者随访。a1-d1为患者第一次就诊时的图像,a2-d2为患者复诊时的图像。a1a2单叶GGO进展,多叶合并;右下肺b1b2呈纤维状条状进展为条状;c1c2右上肺实性结节增大;d1d2提示实性结节密度降低,范围增大。


该研究表明,胸部高分辨率CT (HRCT)对于新型冠状病毒肺炎患者的早期发现、疾病严重程度评估和随访至关重要。新型冠状病毒肺炎的表现多样且变化迅速。放射科医生应该了解疾病的各种特征和时间变化。

摘要原文

METHODS:

Sixty-three confirmed patients were enrolled from December 30, 2019 to January 31, 2020. High-resolution CT (HRCT) of the chest was performed. The number of affected lobes, ground glass nodules (GGO), patchy/punctate ground glass opacities, patchy consolidation, fibrous stripes and irregular solid nodules in each patient's chest CT image were recorded. Additionally, we performed imaging follow-up of these patients.


RESULTS:

CT images of 63 confirmed patients were collected. M/F ratio: 33/30. The mean age was 44.9 ± 15.2 years. The mean number of affected lobes was 3.3 ± 1.8. Nineteen (30.2%) patients had one affected lobe, five (7.9%) patients had two affected lobes, four (6.3%) patients had three affected lobes, seven (11.1%) patients had four affected lobes while 28 (44.4%) patients had 5 affected lobes. Fifty-four (85.7%) patients had patchy/punctate ground glass opacities, 14 (22.2%) patients had GGO, 12 (19.0%) patients had patchy consolidation, 11 (17.5%) patients had fibrous stripes and 8 (12.7%) patients had irregular solid nodules. Fifty-four (85.7%) patients progressed, including single GGO increased, enlarged and consolidated; fibrous stripe enlarged, while solid nodules increased and enlarged.


CONCLUSIONS:

Imaging changes in novel viral pneumonia are rapid. The manifestations of the novel coronavirus pneumonia are diverse. Imaging changes of typical viral pneumonia and some specific imaging features were observed. Therefore, we need to strengthen the recognition of image changes to help clinicians to diagnose quickly and accurately.


KEY POINTS:

• High-resolution CT (HRCT) of the chest is critical for early detection, evaluation of disease severity and follow-up of patients with the novel coronavirus pneumonia. • The manifestations of the novel coronavirus pneumonia are diverse and change rapidly. • Radiologists should be aware of the various features of the disease and temporal changes.


参考文献:

Pan Y  et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol. 2020 Feb 13.





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