新型冠状病毒肺炎胸部CT表现及其诊断价值

Manifestation and diagnostic value of chest CT in patients with COVID-19

目的探讨新型冠状病毒肺炎(COVID-19)胸部CT表现及其诊断价值。方法 242例患者入院24 h内行胸部CT检查及RT-PCR新型冠状病毒核酸检测,72 h内复查核酸1次,89例患者出院前接受新型冠状病毒血清特异性抗体检测。观察胸部CT有无病变,并分别评价以核酸检测、核酸或血清特异性抗体检测为诊断标准下的胸部CT诊断效能。结果 242例患者临床症状以发热(63.2%)和咳嗽(44.6%)为主。188例患者胸部CT可见炎症表现,以双肺受累多见(88.8%),病变多位于肺野外带及胸膜下(83.5%),右肺和左肺下叶常见(68.1%和62.8%),可见磨玻璃影(86.2%)、混合密度影(88.8%)及实变影(52.1%),磨玻璃影伴铺路石征(44.1%)、晕征(37.8%)、网格征(35.1%),实变病灶常伴空气支气管征(41.5%),部分实变内见肺小血管增粗(13.3%)。纵隔淋巴结增大(30.3%)较常见,胸腔少量积液(8.5%)、胸膜增厚(12.2%)、心包积液(4.8%)少见。以核酸检测为诊断标准时,胸部CT诊断COVID-19的灵敏度、特异度、阳性预测值、阴性预测值和AUC分别为89.8%、41.1%、70.2%、72.2%和0.65[95%CI(0.59~0.71)],而以核酸或血清特异性抗体检测为诊断标准时,胸部CT诊断COVID-19的灵敏度、特异度、阳性预测值、阴性预测值和AUC分别为91.3%、78.7%、94.7%、68.5%和0.85[95%CI(0.80~0.89)],后者诊断效能更高(P<0.01)。结论 COVID-19患者胸部CT特征表现是双肺下叶外带的磨玻璃影,以核酸或血清特异性抗体为诊断标准时的灵敏度和特异度均较高,具有重要的诊断价值。

Objective To investigate the manifestation and diagnostic value of chest CT in the patients with coronavirus disease 2019(COVID-19).Methods A total of 242 cases accepted chest CT and nucleic acid test in 24 h after hospitalization,and the nucleic acid test was acquired repeatedly after 72 h.Eighty-nine cases received serum anti-SARS-CoV-2 IgM/IgG test before discharge.The manifestation of chest CT was analyzed by radiologists,and the diagnostic performance was calculated using nucleic acid test and nucleic acid or serum anti-SARS-CoV-2 IgM/IgG test as referenced standard,respectively.Results The most common onset symptoms of COVID-19 were fever(63.2%) and cough(44.6%).Of 188 cases with inflammatory performance of chest CT,the bilateral lungs(88.8%),peripheral/subpleural zone(83.5%) and right and left inferior lobes(68.1% and 62.8%) were common.The most lesions were ground-glass opacity(86.2%),mixed density(88.8%) and consolidation(52.1%).The ground-glass opacity plus crazy paving(44.1%),halo sign(37.8%) and reticular sign(35.1%) were observed.The pulmonary consolidation lesions often accompanied by air bronchogram(41.5%) and subsegment vessel enlargement(13.3%).The mediastinal lymphadenopathy accounted for 30.3% of all the lesions,while the pleural thickening(12.2%),pleural effusion(8.5%) and pericardial effusion(4.8%) were rare.Taking the nucleic acid test as diagnostic standard,the sensitivity,specificity,positive predictive value,negative predictive value and AUC of chest CT in the diagnosis of COVID-19 were 89.8%,41.1%,70.2%,72.2% and 0.65 [95%CI(0.59-0.71)],while which were 91.3%,78.7%,94.7%,68.5% and 0.85 [95%CI(0.80-0.89)] when the nucleic acid or serum anti-SARS-CoV-2 IgM/IgG test was considered as a diagnostic standard(P<0.01).Conclusion The manifestation of chest CT in the patients with COVID-19 is ground-glass opacity located in peripheral zone of bilateral inferior lobes,and the sensitivity and specificity of CT in the diagnosis of COVID-19 are high using the nucleic acid or serum anti-SARS-CoV-2 IgM/IgG test as a diagnostic standard.