新型冠状病毒肺炎的多层螺旋CT表现及动态观察

Performance and dynamic observation of multislice spiral CT for the imported 2019 novel coronavirus disease

目的探讨新型冠状病毒肺炎(COVID-19)的胸部影像学征象及治疗前后动态变化。方法回顾性分析18例COVID-19患者的胸部MSCT表现,观察病变的影像学特点及治疗前后动态变化。结果胸部MSCT表现及动态变化特点1)18例患者中胸部影像表现阴性2例;2)双肺分布12例(67%),累及多个肺叶9例(50%),呈外周及中心同时分布8例(44%),病灶多处13例(72%);3)病灶形态多样磨玻璃影15例(83%),实变影5例(28%),网格影5例(28%),两者以上5例(28%);4)病灶内部形态支气管血管束增粗3例(17%),血管穿行6例(33%),空气支气管征5例(28%);5)治疗前后对比观察确诊患者治疗后3天内复查实变影变淡8例(44%),磨玻璃影局部密度变实9例(50%),单发磨玻璃结节影边界变清晰、密度增高1例(6%),多发磨玻璃结节影范围增大、呈簇状改变1例(6%),网格影密度增高、范围略减小5例(28%),另有新发斑片影2例(11%);6天内复查,实变影进一步吸收、可见反晕征8例(44%),实变区域增多10例(56%),单发实性结节形成1例(6%),磨玻璃影密度进一步减低、其内血管影明显9例(50%),网格影范围减小、呈条状改变,边界清晰5例(28%),部分新发斑片影融合2例(11%),胸腔积液较前减少1例(6%);10天以上复查,肺内斑片影完全吸收18例(100%),实变影范围减小,呈纤维化改变16例(89%),实变结节密度变淡,周围见晕征1例(6%)。结论COVID-19胸部MSCT表现有一定特征性,影像学检查与诊断仍是其临床诊断、疗效评价、预后分析的重要方法。

Objective To discus the imported novel coronavirus pneumonia(COVID-19)in chest imaging appearance and the dynamic changes before and after treatment.Methods The MSCT data of 18 confirmed imported COVID-19 patients(including HRCT)were retrospectively analyzed.Then,we observed the imaging features before and after treatment-related change dynamically.Results The features of MSCT and its dynamic changes were as follows 1)in 18 patients,there were 2 cases with negative chest imaging;2)there were 12 cases(67%)with double lung distribution,9 cases(50%)with multiple lobes involved,and 8 cases(44%)with simultaneous peripheral and central distribution,and 13 cases(72%)with multiple lesions;3)various lesions ground-glass opacity was found in 15 cases(83%),solid shadow in 5 cases(28%),gridding shadow in 5 cases(28%),more than both in 5 cases(28%);4)internal morphology of the lesions thickening of the bronchovascular bundle was found in 3 cases(17%),vascular perforation in 6 cases(33%),air bronchogram in 5 cases(28%);5)comparative observation before and after treatment within 3 days after treatment,8 cases(44%)were found to be light,9 cases(50%)were local density of ground glass opacity,1 case(6%)was single ground glass opacity nodule with clear boundary and increased density,1 case(6%)was multiple ground glass opacity nodules with increased range and clustered change,5 cases(28%)were grid shadow with higher density and slightly reduced range,and 2 cases(11%)were new spot shadow;reexamination within 6 days,in 8 cases(44%),consolidation area was increased in 10 cases(56%),single solid nodule was formed in 1 case(6%),ground glass opacity density was further reduced,internal vascular shadow was obvious in 9 cases(50%),grid shadow range was reduced and strip shape was changed,boundary was clear in 5 cases(28%),some new spots were fused in 2 cases(11%),pleural effusion was decreased in 1 case;After 10 days'reexamination,18 cases(100%)were completely absorbed,the range of consolidation shadow was reduced,16 cases(89%)showed fibrosis,the density of consolidation nodule was weakened,and 1 c-ase(6%)showed halo sign.Conclusion The appearance of imported COVID-19 had certain characteristics,imaging examination and diagnosis were still important methods for clinical diagnosis,curative effect evaluation,prognosis analysis.