新型冠状病毒肺炎胸部高分辨率CT的表现与变化特点

The features and longitudinal changes on high-resolution computed tomography for patients with coronavirus disease 2019

目的明确新型冠状病毒肺炎(简称新冠肺炎)的影像学表现及其变化特点。方法回顾性分析2020年1月17日到2020年2月26日我院15例经核酸检测确诊为新冠肺炎的患者胸部高分辨率CT(HRCT)检查像。主要观察影像学征象及其变化的特点。进一步以肺叶为单位进行等级评分(0~4分),计算观察病例的严重程度总评分(0~20分)。结果患者中男8例,女7例,中位年龄47(33~49)岁。其中,14例(93.3%)首次胸部HRCT检查像显示磨玻璃影,6例(40.0%)显示肺实变影,3例(20.0%)显示纤维性病变。5例(33.3%)患者多个肺叶受累。胸膜下分布为主要的解剖分布类型(12例,占80.0%)。第二次胸部HRCT严重程度评分明显高于首次HRCT评分(4.6±3.4比3.5±2.5,P=0.018 2),5例(33.3%)患者肺部病变分布发展为任意型。结论新冠肺炎患者的胸部HRCT主要表现为胸膜下分布为主的磨玻璃影,短时间内出现明显进展。HRCT是监测疾病进展的有效指标。

Objective To investigate the high-resolution computed tomography(HRCT) signs of patients diagnosed with the coronavirus disease 2019(COVID-19) and explore its evolution features during hospitalization.Methods From January 17, 2020 to February 26, 2020, HRCT images from 15 COVID-19 patients were analyzed. All the patients had positive nucleic acid test results of SARS-CoV-2. The imaging features of initial and follow-up of each patient were reviewed and graded based on the severity of lung lesions. Results Among the 15 COVID-19 patients, ground-glass opacity(GGO) was found in 14 cases. Six patients presented with consolidation and 3 with fibrosis. Five patients had multi-lobe involvement. Subpleural distribution pattern was present in 12 patients(80.0%) and peribronchovascular distribution pattern was present in 2 patients(13.3%). The severity score on HRCT images at the follow-up was significantly higher than that at the initial(4.6±3.4 vs. 3.5±2.5, P=0.018 2). Increase of random distribution pattern(5 cases) were also noted at the follow-up. Conclusions Chest HRCT of COVID-19 patients is characterized with GGO mainly distributed in subpleural areas and a rapid progression within a short time interval. HRCT could provide a sensitive monitor to observe disease progression for COVID-19 patients.