新型冠状病毒肺炎轻症患者胸部高分辨率CT动态影像演变的初步研究

A preliminary study on the dynamic imaging of chest high resolution CT in patients with mild COVID-19

目的初步探讨新型冠状病毒肺炎(COVID-19)轻症患者的连续动态胸部高分辨率CT(HRCT)影像的演变过程。方法回顾性分析2020年1月至2月烟台市奇山医院确诊并治愈出院的COVID-19轻症患者的临床资料和胸部HRCT影像资料。共入组25例患者(普通型24例,轻型1例),男14例,女11例,年龄(42±12)岁,住院时间(19±5)d。对患者胸部HRCT的基本影像及动态影像进行分析。结果临床表现为发热(22例)、咳嗽(18例)、咳痰(8例)、咽痛(6例)等。实验室检查大部分缺乏特异性。1例轻型患者胸部CT均未见明显异常。普通型患者胸部HRCT表现:(1)病变分布:双肺多发病变为主(19例),受累肺叶数(3±1)个,大部分位于肺外带近胸膜下(22例);(2)病变形态和密度:以磨玻璃密度灶为主(22例),表现为斑片状及大片状(18例)、结节状(10例)及弧形宽带样(7例);随着疾病进展,部分病灶密度增高呈局限性肺实变表现(10例),伴随空气支气管征(5例)及晕征(5例)。胸部HRCT影像动态变化:胸部CT约自发病第5(5,6)天呈阳性表现,CT病变进展时间为5(5,7)d,CT病变峰值时间为11(10,13)d,CT病变转归时间9(8,11)d。结论连续动态胸部HRCT影像能够监测COVID-19轻症患者的基本演变过程,为临床的早期诊断和治疗提供更直观的依据。

Objective To explore the evolution of imaging findings on dynamic chest high resolution CT(HRCT)in patients with mild COVID-19.Methods The data of epidemiology,clinical data and continuous dynamic chest high-resolution CT images of the patients with mild COVID-19 were analyzed retrospectively.Twenty-five patients(including 24 common type and 1 mild)were enrolled in the group,including 14 males and 11 females,with age of(42±12)years and hospital stay of(19±5)days.The basic images and dynamic images of HRCT were analyzed and compared by the radiologists.Results The clinical manifestations were fever(22 cases),cough(18 cases),expectoration(8 cases),pharyngeal pain(6 cases).Most laboratory tests lacked specificity.There were no significant abnormalities on chest CT of one mild patient.HRCT findings of the common type were as follows:(1)the distribution of the lesions:most of the multiple lesions involved both lungs(19 cases),with average of 3(3±1)lobes,located in the peripheral pulmonary zone near the pleura(22 cases);(2)the morphology and density of the lesions:most of the lesions were ground glass density foci(22 cases),which were patchy and massive(18 cases),nodular(10 cases)and arc broadband(7 cases);with the development of the disease,the density of some lesions increased with localized pulmonary consolidation(10 cases),accompanied by air bronchus sign(5 cases)and halo sign(5 cases).Dynamic changes of HRCT images in the chest:the positive manifestations were found on the 5th(5,6)day after the onset of the disease,the progressive time of CT lesions was 5(5,7)days,the peak time of CT lesions was 11(10,13)days,and the turning time of CT lesions was 9(8,11)days.Conclusions Dynamic chest HRCT can monitor the basic evolution process of the disease in patients with mild COVID-19,and provide a more intuitive basis for clinical early diagnosis and treatment.