250例新型冠状病毒肺炎高分辨率CT特征分析

The analysis of imaging characteristics of high-resolution CT in 250 cases with coronavirus disease 2019

目的对250例新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)高分辨率CT(HRCT)表现特征进行分析总结,以期提高对COVID-19的HRCT精准诊断水平。方法采取整群抽取法抽取2020年1月1日至2月20日期间武汉市肺科医院收治的COVID-19疑似患者492例,对其中250例核酸检测阳性的确诊患者,回顾分析其HRCT的病灶形态特征性表现。250例患者中,男169例(67.6%),女81例(32.4%);年龄21~83岁,中位年龄51岁。临床症状中,发热患者229例,其中中低热型患者210例(84.0%);出现呼吸道症状者195例(78.0%);无临床症状但是有与患者密切接触史而体检发现肺部异常者38例(15.2%)。采用SPSS 23.0软件进行统计学分析,采用描述性统计方法,计数资料采用"率或构成比(%)"表示。结果 (1)患者性别与年龄特点:男169例(67.6%),女81例(32.4%),男性高于女性35.2个百分点。在21~83岁患者的不同年龄组中,21~岁年龄组6例(2.4%,最低值):50~岁年龄组89例(35.6%,最高值)。(2)临床表现特点:低热患者(210例,84.0%)与发生呼吸道症状者较多(195例,78.0%),密切接触者无症状体检发现肺部异常者38例(15.2%)。250例核酸检测阳性而最后得到确诊的患者中,HRCT首诊诊断为COVID-19者221例(84.4%)。(3)HRCT表现特征:表现为多发肺磨玻璃样密度影(ground-glass opacity,GGO)者195例(78.0%);多发片状影者36例(14.4%);弥漫间质性浸润影者27例(10.8%);多发大片状实变影者20例(8.0%);出现病灶中血管束增多影者207例(82.8%);病灶发生于两肺下叶外带及胸膜下者207例(82.8%);动态观察中,间隔3d短期复查病灶呈爆炸性方式增多者221例(88.4%)。结论掌握上述COVID-19典型的HRCT表现特征后,将大大提高COVID-19的CT诊断准确率,从而大幅度提高COVID-19的临床综合诊断水平。

Objective To analyze and summarize the imaging characteristics of high-resolution CT(HRCT in 250 cases with coronavirus disease 2019(COVID-19),so as to improve the accuracy of HRCT diagnosis of COVID-19. Methods Four hundred and ninety-two suspected COVID-19 cases were selected from Wuhan Pulmonary Hospital(2020.01.01-2020.02.20)by cluster sampling,250 of them were definitely diagnosed with positive nucleic acid test,and their HRCT imaging characteristics were analyzed retrospectively.Among the 250 cases,169(67.6%)were males and 81(32.4%)were females.The age ranged from 21 to 83 years old with the median age of 51 years old.Among the clinical symptoms,229 cases had fever,among which 210(84.0%)had moderate or low fever.There were 195 cases(78.0%)with respiratory symptoms.There were 38 cases(15.2%)without any clinical symptoms but had close contact with the confirmed patients,and their abnormal lung conditions were found through physical examination.SPSS 23.0 software was used for statistical analysis.Descriptive statistical method was used for this group of data,and the enumeration data was expressed as"rate or composition ratio(%)". Results(1)Gender and age characteristics:there were 169 male patients(67.6%)and 81 female patients(32.4%),and the percentage difference was 35.2%.In different age groups from 21 to 83 years old,there were 6 cases(2.4%)in the age group from 21 to 30 years old,which was the lowest percentage,89 cases(35.6%)in the age group from 50 to 60 years old,was the highest percentage.(2)Clinical features:there were 210(84.0%)cases with low fever,195(78.0%)cases with respiratory symptoms,and 38(15.2%)cases in close contact with the confirmed patients,asymptomatic but with pulmonary abnormalities.Of the 250 cases who tested positive for nucleic acid and were finally confirmed,221(84.4%)were diagnosed with COVID-19 at the first HRCT diagnosis.(3)HRCT imaging characteristics are:Multiple pulmonary ground-glass opacity(GGO)in 195 cases(78.0%),multiple patchy shadows in 36 cases(14.4%),27 cases(10.8%)with diffuse interstitial infiltrating shadows,multiple large patchy consolidation in 20 cases(8.0%),increased vascular bundle in 207 cases(82.8%).The lesions were found in 207 cases(82.8%)in the external areas of subpleural areas.In the dynamic observation,221 cases(88.4%)with interval 3 days short-term reexamination showed an increase in an explosive mode. Conclusion After mastering the typical HRCT imaging characteristics of COVID-19 mentioned above,the CT diagnostic accuracy of COVID-19 will be greatly improved,and the clinical comprehensive diagnosis level of COVID-19 will be greatly improved.