基于胸部CT探究新型冠状病毒感染患者肺部病灶体积与多脏器的关系

The relationship between the volume of lung lesions and multiple organs based on chest CT in COVID-19

目的基于胸部CT图像,探讨新型冠状病毒感染(COVID-19)患者肺部病灶体积与甲状腺、脾脏、心血管、胸椎及腹部脂肪改变的相关性。方法回顾性分析2020年2月至2021年1月首都医科大学附属北京地坛医院230例COVID-19患者的基线影像资料,经人工智能(AI)肺炎辅助诊断软件定量测算全肺病灶体积。根据病程将患者分为三组(<4周、4~6周、>6周)。应用ITK-SNAP 3.8.0软件测量甲状腺左/右叶与脾脏的最大横截面积、甲状腺与脾脏的平均密度和体积、脾厚径及脾最长径;应用RadiAnt Dicom Viewer 2021.2软件测算心胸比、肺动脉主干、升主动脉主干、降主动脉直径及下腔静脉最大径、主肺动脉比,应用GE公司smart score 4.0软件定量测定冠状动脉、主动脉、颈动脉钙化积分;应用QCT PRO Model 4软件测定并计算胸椎平均骨密度、腹部皮下及腹腔内脂肪面积。采用Spearman秩相关对上述指标与肺部病灶体积之间的关系进行统计学分析。结果所有患者中,冠状动脉、主动脉及颈动脉的钙化积分均与病灶体积间存在相关性(r=0.22,P<0.001;r=0.31,P<0.001;r=0.16,P=0.018),心胸比、肺动脉主干直径、升主动脉主干直径与病灶体积间有相关性(r=0.41,P<0.001;r=0.23,P<0.001;r=0.28,P<0.001);降主动脉短径、下腔静脉短径、下腔静脉/降主动脉直径比与病灶体积间有相关性(r=0.40,P<0.001;r=0.14,P=0.035;r=-0.19,P=0.003);甲状腺平均密度与病灶体积间有相关性(r=-0.27,P<0.001);脾脏厚径、脾脏平均密度与病灶体积间有相关性(r=0.15,P=0.022;r=-0.18,P=0.007);胸椎平均骨密度、腹部皮下脂肪面积、腹腔内脂肪面积、肝脏平均脂肪分数与病灶体积间有相关性(r=-0.31,P<0.001;r=0.26,P<0.001;r=0.35,P<0.0001;r=0.45,P<0.001)。病灶体积与脾脏平均密度在<4周和>6周组患者中均存在明显差异。结论肺部病灶体积与多个肺外器官存在相关关系,阐明了COVID-19是全身性疾病,在COVID-19的预后与随访中应关注其造成的全身多器官的改变。

Objective To investigate the correlations between the volume of lung lesions and thyroid,spleen,cardiovascular,thoracic spine and abdominal fat changes in patients with novel coronavirus pneumonia based on chest CT images.Methods The baseline imaging data of 230 patients with COVID-19 from Beijing Ditan Hospital Affiliated to Capital Medical University from February 2020 to January 2021 were retrospectively analyzed,and the volume of whole lung lesions was quantitatively measured using artificial intelligence pneumonia auxiliary diagnosis software.Patients were categorized into three groups(<4 w,4-6 w,>6 w)based on their disease durations.The ITK-SNAP 3.8.0 software was used to measure the maximum cross-sectional area of the left and right lobes of the thyroid gland and spleen,the average density and volume of the thyroid gland and the spleen,the thickness diameter of the spleen and the longest diameter of the spleen.RadiAnt Dicom Viewer software was used to measure cardiothoracic ratio,maximum diameter of pulmonary artery trunk,ascending aortic trunk,descending aorta and inferior vena cava and aortopulmonary artery ratio.GE′s SmartScore software was used to quantitatively determine the calcification points of coronary,aorta,and carotid arteries.QCT PRO Model 4 software was used to measure and calculate the mean bone density of the thoracic spine,and abdominal and intra-abdominal fat area.Spearman′s rank correlation was used to statistically analyze the correlation between the above indicators and the volume of lung lesions.Results Among all patients,the volume of lesions was correlated with the following elements:calcification scores of the coronary artery(r=0.22,P<0.001),aorta(r=0.31,P<0.001),carotid artery(r=0.16,P=0.018);cardiothoracic ratio(r=0.41,P<0.001),pulmonary artery trunk diameter(r=0.23,P<0.001),ascending aorta diameter(r=0.28,P<0.001),the short diameters of the descending abdominal aorta(r=0.40,P<0.001),the inferior vena cava(r=0.14,P=0.035),the diameter ratio of the inferior vena cava/descending abdominal aorta(r=-0.19,P=0.003),the thyroid density(r=-0.27,P<0.001),spleen thickness(r=0.15,P=0.022),mean spleen density(r=-0.18,P=0.007),mean thoracic bone density(r=-0.31,P<0.001),subcutaneous fat area(r=0.26,P<0.001),intra-abdominal fat area(r=0.35,P<0.0001),liver mean fat fraction(r=0.45,P<0.001).The lesion volume and mean splenic density also differed between<4 w and>6 w group of patients.Conclusion The correlation between the volume of lung lesions and multiple extrapulmonary organs demonstrates that COVID-19 is a systemic disease.The multiorgan changes caused by COVID-19 should be closely examined in the prognosis and follow-up of COVID-19.