胸部CT对COVID-19的临床应用价值探索

The clinical value of chest CT in the diagnosis of COVID-19

目的:探讨胸部CT在新型冠状病毒肺炎(COVID-19)诊断中的应用价值。方法:回顾性分析36例我院首诊最终经核酸检测证实的COVID-19患者的CT及临床资料。结果:36例中CT表现为阴性3例,阳性33例。双肺同时受累30例,单肺受累3例;单个肺叶受累2例,2个及以上肺叶受累31例;胸膜下分布为主29例,肺中央分布为主4例;单发磨玻璃影3例,多发磨玻璃影8例,多发磨玻璃影为主伴部分实变13例,多发实变为主伴磨玻璃影9例;病灶内可见微血管影增粗16例;病变内可见细网格影20例;未见胸腔积液及纵隔淋巴结肿大。首诊CT半定量评分与发病时间呈正相关,差异有统计学意义(r=0.70,P<0.05)。结论:COVID-19首诊胸部CT具有一定特异性,以胸膜下多发磨玻璃影或实变为主要表现,灶内血管增粗及网格状改变具有特异性,且随着病程的进展CT表现加重。

Objective:To analyze the value of chest CT in the diagnosis of COVID-19.Method:The CT and clinical data of 36 patients with COVID-19 confirmed by nucleic acid test in our hospital were retrospectively analyzed.Results:Among the 36 cases,CT findings were negative in 3 cases and positive in 33 cases.There were 30 cases of both lungs involvement and 3 cases of single lung involvement.There were 2 cases of single lobe involvement,and 31 cases of 2 or more lobes involvement.The subpleural distribution was dominant in 29 cases,and the central pulmonary distribution was dominant in 4 cases.There were 3 cases of single ground glass opacity,8 cases of multiple ground glass opacities,13 cases of multiple ground glass opacities combined with partial consolidation and 9 cases of consolidation combined with multiple ground glass opacities.Microvascular shadow thickening was observed in 16 cases.Fine mesh-like shadow was observed in 20 cases.Pleural effusion and mediastinal lymph node enlargement were not observed.The semi-quantitative CT score of the first diagnosis was positively correlated with the onset time(r=0.70,P<0.05).Conclusion:The first diagnosis of COVID-19 by chest CT shows certain specificity,with multiple ground glass opacities or consolidation under the pleura becoming the main manifestation,vascular thickening and mesh-like changes in the lesion are specific,and the CT manifestations becomes worse with the progress of the disease course.