新型冠状病毒肺炎(COVID-19)二代病例首诊胸部DR的诊断价值

Value of chest digital radiography in the initial diagnosis of secondary cases of COVID-19

目的探讨新型冠状病毒肺炎(COVID-19)病人首诊胸部数字化X线摄影(DR)的诊断价值。方法回顾性分析北京新冠肺炎全病程信息与样本资源管理平台"新冠肺炎影像专题库"中确诊为COVID-19的北京本地病人首诊影像学资料,纳入首诊同时具备胸部CT及DR检查的病人共20例,男14例,女6例,年龄32~80岁,平均(51.2±15.1)岁。CT与DR检查间隔时间1~53 h,平均间隔(25.4±22.8)h。以胸部CT检查结果为标准,分析DR对COVID-19的诊断能力。采用McNemar’s检验比较2种检查的诊断结果,并采用Bland-Altman检验或Kappa检验分析2种检查方法对病灶数量、位置分布、形态等特征判断的一致性。结果 20例COVID-19病人中,CT共检出19例病人(107个病灶),DR检出17例(54个病灶)。CT对病人检出率为95%,DR为85%,2种检查的诊断能力差异无统计学意义(P=0.5)。2种检查对病灶特征的分析显示,对双侧病变、肺野分布、弥漫性分布及形态的诊断一致性较好(均κ>0.6)。对于多发病灶(≥5个),DR与CT对病灶数量判断一致性不佳。2例病人DR判断为阴性,病灶均为单发磨玻璃密度影,最长径分别为0.8 cm(≤1 cm)、1.9 cm(1~3 cm)。结论结合流行病史,胸部DR能够识别COVID-19病人。DR不易识别单发的小磨玻璃密度病灶,对多发病灶数量判断欠佳,及时行胸部CT检查可增加诊断信息。

Objective To analyze the value of chest digital radiography(DR)in the initial diagnosis of secondary cases of COVID-19.Methods The radiological data from Beijing COVID-19 information and resource management platform“COVID-19 image database”were retrospectively analyzed.Twenty confirmed cases,including 14 males and 6 females(32-80 years old,mean 51.2±15.1 years old),who performed chest computed tomography(CT)scan and DR during his/her first visit to clinic were included.The interval times between CT and DR examination were from 1 to 53 hours,(mean 25.4±22.8 hours).According to the results of CT scan,the diagnostic ability of DR was analyzed.McNemar’s test was used to analyze the agreement between the diagnoses based on the CT and DR findings.Bland-Altman or Kappa analysis was used to analyze the consistency in number,distribution,and morphological features of the lesions identified on the CT and DR.Results COVID-19 was identified in 19 of 20 cases by using CT(107 lesions),and 17 of 20 cases by using DR(54 lesions),respectively.The diagnostic accuracy of CT and DR was 95%,85%,respectively.There was no statistical significance in diagnostic ability between DR and CT(P=0.5).For the determination of bilaterally distributed lesions,patterns of distribution among different lobes,diffused distribution and the morphological features of the lesions,the consistencies between the results of DR and CT were well(κ>0.6,respectively).The consistency between DR and CT is poor when recognizing multiple lesions(≥5).DR diagnosed two cases as normal,both presented as single pure ground glass opacity on CT,and the longest orthogonal diameters were 0.8 cm(≤1 cm)and 1.9 cm(1-3 cm).Conclusion Chest DR can be used to diagnose patients with COVID-19 if combined with the epidemic hsitory.However,it is difficult for DR to identify single lesion with lower density in patients with mild symptom.A CT scan in time will provide additional information.