甲型H1N1流感患者胸部CT首诊表现

CT manifestations of patients with swine-origin influenza A H1N1

目的探讨甲型H1N1流感患者的胸部MSCT首诊表现。方法回顾性分析19例经实验室检测显示甲型H1N1流感病毒阳性患者的首诊胸部MSCT影像资料。由3名副教授影像医师独立阅读并最终讨论达成一致。影像的异常表现包括实变、磨玻璃密度影、结节影，网格影。病变的分布包括单侧或双侧。病变部位按病变累及肺叶的解剖划分，同时评估胸腔积液单双侧及纵隔和肺门的淋巴结增大、心包积液及胸膜异常。用自建半定量甲型H1N1病变评分表评价磨玻璃密度影及实变影。采用Spearman相关分析检验半定量磨玻璃样变和实变CT评分与患者的发热时问之间有无相关关系。结果19例患者中18例胸部CT首诊为阳性，肺内见实变影3例、磨玻璃密度影3例、实变影＋磨玻璃密度影12例。病变全部为双侧分布，并且主要为弥漫分布（14例），多灶病变均分布在中下叶（4例）。2例患者首次胸部CT检查发现心脏增大，其中1例合并心包积液。5例胸腔积液患者中，2例为双侧，3例为单侧。2例纵隔淋巴结增大，1例胸膜增厚。半定量磨玻璃密度影CT评分有2例4．25分，1例3．75分，1例2．25分，1例1．75分，6例1．00分，2例0．75分，2例0．50分，4例0分。半定量实变影CT评分有1例4．25分，1例4．00分，1例3．75分，1例2．75分，3例1．25分，2例1．00分，2例0．75分，1例0．50分，3例0．25分，4例0分。半定量磨玻璃密度影CT评分与发热时间存在正相关性（r=0．776，P〈0．01），半定量实变影CT评分与发热时间无相关性（r：0．322，P〉0．01）。结论甲型H1N1患者胸部CT首诊表现多以双侧磨玻璃密度病变伴或不伴实变影为主，主要为弥漫分布。甲型H1N1肺炎在发病初期病程进展以磨玻璃密度影范围扩大为标志。

Objective To explore the manifestations of chest multi-slice spiral CT in patients with initial infection of swine-origin influenza A （H1N1） virus （S-OIV）. Methods The chest multi-slices spirals CT images of 19 firstly diagnosed patients with swine-origin i^ffluenza A （ H1N1 ） in our institution were retrospectively studied. CT manifestations were evaluated by three experienced radiologists. Location, appearance of lung abnormalities, abnormal distribution, pleural effusion and others （pericadiaum, lymphadenopathy and pleural thickening） were observed and quantitatively analyzed. The correlation of ground-glass and consolidation CT scores with the fever time was studied. Results The abnormal CT findings were observed bilaterally in 18 of 19 subjects including ground-glass （ n = 3 ）, consolidation （ n = 3 ）, consolidation accompanied with ground-glass （n = 12）. Most of these lesions were distributed diffusively （ n = 14 ） while the others located in the middle and low lobes （ n = 4 ）. Unilateral （ n = 3 ） or bilateral （ n = 2 ） pleural effusion were observed. Lymphadenopathy （ n = 2 ） , effusion of pericadium （ n = 1 ） , pleural thickening （n = 1 ）and cardiac enlargement （n = 2）were also found in patients with H1N1. CT scores of ground-glass were4.25（n=2）,3.75 （n = 1）,2.25（n = 1）,1.75（n = 1）,1.00（n =6）,0.75（n =2）, 0.50（n=2）,0（n=4）o CT scores of consolidation were 4. 25（n=1）,4.00（n=1）,3.75 （n =1）, 2.75（n=1）,1.25（n=3）,1.00（n=2）,0.75（n=2）,0.50（n=1）,0.25（n=3）,0（n=4）. CTscoresof ground-glass were significantly correlated with the fever time （ r = 0. 776, P 〈 0. 01 ）, CT scores of consolidation had no correlation with the fever time （ r = 0. 322,P 〉 0. 01 ）. Conclusions The most common CT findings in patients with S-OIV infection are diffuse distribution of bilateral ground-glass opacities with or without associated focal or muhifocal areas of consolidation. The increasing of ground-glass＇s range could be the marker of progression of H1N1 pulmonary infection at initial stage.