新型冠状病毒肺炎首次胸部HRCT表现及其病理学基础

Early features of chest high resolution CT images and pathological basis of COVID⁃19

目的:探讨新型冠状病毒肺炎(corona virus disease 2019,COVID-19)首次胸部高分辨CT(HRCT)特征及其病理学基础,以提高对COVID-19的认识。方法:回顾性分析2020年1月25日-2月18日南京市确诊的61例COVID-19患者的首次胸部HRCT影像,对病变分布、数量、位置及形态进行统计和分析。结果:61例COVID-19患者首次胸部HRCT均存在病变,双侧肺分布55例(90.1%),单侧肺分布6例(9.9%),其中左肺分布2例(3.3%),右肺分布4例(6.6%);胸膜下分布36例(59.0%),胸膜下与中心同时分布25例(41.0%);1个病变4例(6.6%),2个及2个以上病变57例(93.4%);磨玻璃病变56例(91.8%),实性病变5例(8.2%),纤维化病变3例(4.9%),2种及2种以上的病变9例(14.8%);支气管充气征35例(57.4%),细网格征38例(62.3%),铺路石征32例(52.5%),晕征6例(9.8%),病灶中见增粗扩张的血管32例(52.4%);胸腔积液5例(8.2%),心包积液3例(4.9%),纵隔淋巴结肿大3例(4.9%),胸膜增厚7例(11.5%)。结论:HRCT是诊断COVID-19的首选影像学检查方法,其首次胸部HRCT表现具有一定的特征性,在结合流行病学、临床表现和核酸检测结果的基础上可辅助诊断COVID-19。

Objective:To investigate the first chest high resolution CT(HRCT)imaging manifestations of corona virus disease 2019(COVID⁃19)and its pathological basis.Methods:A retrospective analysis of the first chest HRCT images of 61 patients with COVID⁃19 clinically diagnosed in Nanjing from January 25 to February 18,2020.Lesion distribution,number,location and morphology were analyzed.Results:Lesions were found in the first HRCT of 61 patients,with bilateral lung distribution in 55 cases(90.1%),unilateral lung distribution in 6 cases(9.9%),left lung distribution 2 cases(3.3%)and right lung distribution 4 cases(6.6%);subpleural distribution of lung in 36 cases(59.0%),25 cases(41.0%)were found subpleural and central distribution at the same time;4 cases(6.6%)got one lesion,57 cases(93.4%)got two and more lesions;ground⁃glass lesions appeared in 56 cases(91.8%),solid lesions in 5 cases(8.2%),cord⁃like lesions in 3 cases(4.9%),coexisting lesions of two or more forms in 9 cases(14.8%);air bronchogram in 35 cases(57.4%),refined net sign in 38 cases(62.3%),paving stone sign in 32 cases(52.5%),halo sign in 6 cases(9.8%);thickening of blood vessels in 32 cases(52.4%);5 cases(8.2%)with pleural effusion,3 cases(4.9%)with pericardial effusion,3 cases(4.9%)with enlarged mediastinal lymph nodes;and 7 cases(11.5%)had pleural thickening.Conclusion:HRCT is preferred imaging method of COVID⁃19.The first chest HRCT manifestations have certain characteristics.Therefore,it could help the early diagnosis of COVID⁃19 based on epidemiology,clinical manifestations,and nucleic acid testing.