肺部CT对新型冠状病毒肺炎与支原体肺炎的鉴别诊断

Differential diagnosis of COVID-19 and Mycoplasma Pneumonia with Pulmonary CT

目的探讨肺部CT对新型冠状病毒肺炎(COVID-19)与支原体肺炎(MPP)的鉴别诊断价值。方法收集2020年1月20日至2020年2月5日于华润武钢总医院确诊的COVID-19患者45例,另选取2017年9月1-21日于中国人民解放军联勤保障部队第908医院住院诊断治疗的MPP患者38例。对COVID-19和MPP的肺部CT影像表现进行回顾性分析。结果COVID-19肺部CT征象1)分布:单侧发病5例,双肺发病40例,主要以胸膜下(40例)及小叶核心(38例)为主,2例重症患者见两肺弥漫分布;2)密度:仅为毛玻璃影(GGO)10例,GGO+实性兼有者35例;3)伴随征象:血管增粗43例,胸膜平行征33例,铺石路征38例,"反晕征"3例,2例出现胸腔积液,2例可见肺气囊征象,未见空洞出现。MPP肺部CT征象1)分布:病变呈大叶性分布2例,大部分呈小叶性分布36例;双肺下叶病灶27例;2)密度:GGO 36例,病灶有实变21例;3)伴随征象:典型树芽征25例,小叶间隔局限性增厚21例。纵隔和肺门未见明显肿大的淋巴结,两侧胸腔未见明显的积液征象。COVID-19实变率较MPP高(P<0.05),两者GGO及胸腔积液比较差异无统计学意义(P>0.05)。结论COVID-19和MPP的CT表现都以GGO为主,但COVID-19少见支气管壁增厚,分布为胸膜下及小叶核心区域,与支气管分布无关,病变实变率较高;MPP病灶与支气管分布关系密切,并有一定的特征性影像征象。

Objective To investigate the value of pulmonary CT in differential diagnosis of COVID-19 and Mycoplasma pneumonia(MPP).Methods Pulmonary CT findings of 45 cases of COVID-19 confirmed in China Resources Wisco General Hospital from January 20,2020 to February 5,2020 and 38 MPP patients treated in the 908th Hospital of the PLA Joint Logistic Support Force from September 1,2017 to September 21,2017 were analyzed retrospectively.Results The pulmonary CT findings of 45 patients with COVID-19 were as follows:1) distribution:unilateral lesions in 5 cases and bilateral lesions in 40 cases(subpleural distribution in 40 cases,intralobular distribution in 38 cases and bilateral diffuse distribution in 2 cases);2) density:round-glass opacity(GGO) in 10 cases and GGO and solid lesions in 35 cases;3) associated signs:vascular thickening in 43 cases,pleural parallelism in 33 cases,paving stone sign in 38 cases,reversed halo sign in 3 cases,pleural effusion in 2 cases and pulmonary air sac in 2 cases.No pulmonary cavities were found in all cases of COVID-19.The pulmonary CT findings of 38 patients with MPP were as follows:1) distribution:lobar distribution in 2 cases,lobular distribution in 36 cases and bilateral lower lobe lesions in 27 cases;2) density:GGO in 36 cases and solid lesions in 21 cases;3) associated signs:typical tree-in-bud sign in 25 cases and localized thickening of interlobular septa in 21 cases.No enlarged lymph nodes in the mediastinum and hilum and no obvious signs of effusion in the thorax were observed in MPP patients.The incidence of solid lesions in COVID-19 patients was higher than that in MPP patients(P<0.05).No significant differences in GGO and pleural effusion were found between COVID-19 and MPP(P>0.05).Conclusion The CT findings are dominated by GGO in both COVID-19 and MPP.However,bronchial wall thickening is infrequent in COVID-19,which is distributed in subpleural and lobular core area.In addition,COVID-19 is associated with a high incidence of solid lesions,but is not correlated with bronchial distribution.The MPP is closely related to bronchial distribution and has characteristic imaging signs.