新型冠状病毒肺炎CT影像学特征

The characteristics of CT imaging of novel coronavirus pneumonia

目的了解新冠肺炎CT影像学变化特征,为新冠肺炎的筛查及诊断提供依据。方法收集60例新冠肺炎确诊病例,根据病情轻重分为普通型、重型及危重症型,根据临床疾病发展过程分为早期、中期、恢复期。收集患者入院时、入院后4~7天、入院后14~21天CT检查图像,在计算机上阅读患者的DICOM图像,对病变的分析按数量、形态、分布、密度、内部结构等进行描述。结果对60例新冠肺炎患者入院时CT影像分析,显示病变分布双肺明显多于单肺;下肺野明显多于中、上肺野;外周明显多于中央;病灶多发明显高于单发;病变的特征性表现为"蝙蝠翼征"或"反翼征"。从病变密度分析,主要表现为磨玻璃影、实变影、胸膜下线、网格影、索条影、条带影、小叶间隔增厚、血管增粗等。动态观察,完成3次CT检查的45例普通型患者早期表现以磨玻璃影、斑片状实变影为主;中期,病变密度逐渐增高,形成网格、索条影为主的表现,中期磨玻璃影及网格索条影所占比例与早期相比均有统计学差异,P均<0.01;恢复期,病变逐渐变淡、吸收,或遗留局灶性纤维索条影,与中期比较,各种病变发生比例均有显著差异,P均<0.01;5例重症/危重症患者病变发展迅速,3~5天即成为"白肺"。结论新冠肺炎CT影像具有特征性变化,对临床诊断及评估病情具有重要价值。

Objective To understand the characteristics of CT imaging of novel coronavirus pneumonia to provide the evidence for its screening and diagnosing. Methods 60 cases of patients with novel coronavirus pneumonia were collected and divided into common type, severe type, critical and severe type. They were also divided into early stage, mid-term and recovery stage according to the process of disease development. CT images of patient at admission,4~7 days after admission and 14~21 days after admission were collected. The DICOM images were analyzed on the computer. The lesions were described in terms of quantity, morphology, distribution, density, internal structure, etc. Results The CT images revealed that for the distribution of lesions bilateral lungs were involved more frequently than unilateral lung;abnormality on the lower lung field was more than on the middle and upper lung field;peripheral area was more than central area;multiple lesions were significantly higher than single lesions. The "bat-wing sign" or "reversed wing sign" were main manifestations. For the density of disease, most were ground glass opacity, pulmonary consolidation, subpleural lines, reticular pattern, fibrous strip shadows, band shadows, thickened interlobular septum and thickened blood vessels. The 45 common type patients’ early stage lesions mainly manifested as ground glass opacity and patchy consolidation;for mid-term patients, manifestations were mainly reticular pattern and fibrous strip shadows.Comparing with earlystage, the proportion of ground glass opacity and reticular and strip shadows at mid-term was statistically different, P<0.01. At recovery stage, the lesions gradually faded and disappeared or left fibrous strip shadows.Comparing with mid-term, the proportion of each lesion at recovery stage was statistically different, P<0.01. 5 cases of severe and critical type progressed rapidly so that the CT images demonstrated "white lung" in 3~5 days. Conclusion The CT imaging of novel coronavirus pneumonia are characteristic, which is very important for clinical diagnosis and evaluation.