HRCT在新型冠状病毒肺炎诊断中的应用

Clinical application of HRCT in novel coronavirus pneumonia

目的探究常规CT以及HRCT对新型冠状病毒肺炎(COVID-19)检查中的影像学表现差异,分析HRCT的特异性影像学特征。方法回顾性分析经核酸检测阳性确诊的新型冠状病毒肺炎患者37例,先采用常规CT进行扫描,其中将肺部有渗出病变为CT阳性组,肺部无渗出病变患者为CT阴性组2例。然后针对CT阳性患者对病灶多平面重建和最大密度投影重建得出所有病灶HRCT图像。参照《新型冠状病毒肺炎的放射学诊断》1,推荐将CT影像分为早期、进展期、重症期和转归期,对不同期的HRCT及常规胸部CT的影像表现分别比较分析,找出影像表现差异。结果HRCT及常规CT影像学均表现为单侧肺或者双侧肺中外带肺野或胸膜下磨玻璃样病灶,分析常规CT及HRCT所有病灶中,病灶分布情况如下右肺上叶17例,右肺中叶18例,右肺下叶23例,左肺上叶19例,左肺下叶19例,其中双下肺分布25例(占71.4%),背侧分布26例(占74.3%)。形态特征磨玻璃,部分性或全实性,细网格、铺路石征,结节伴晕征,长轴与胸膜平行,空气支气管征,病灶沿支气管血管束分布,“增粗血管”征象。其中磨玻璃影、“细网格、铺路石”征象、结节伴晕征、“增粗血管”征象虽然在常规CT中可以显示,但HRCT通过薄层及三维重建能够清晰的显示出这种征象,其P值分别为0.006、0.008、0.042、0.035(P值<0.05),差异具有统计学意义。结论HRCT较常规CT扫描更能精确的显示出NCP的影像学细微特征,HRCT检查对新型冠状病毒肺炎患者的确诊具有十分重要意义。

Objective To explore the differences of imaging features between conventional CT and HRCT,and to find out the specific imaging features of HRCT.Methods 37 patients with novel coronavirus pneumonia diagnosed by positive nucleic acid test from were analyzed retrospectively.Routine CT scan was performed.Among them,the lungs were exuded into CT positive group.The lungs were not exuded into CT negative group,and the results were 35 cases and 2 cases respectively.The patients were scanned by conventional CT,then all lesions were reconstructed by HRCT.Referring to the novel coronavirus pneumonia radiology diagnosis 1,we recommended that CT images be divided into four phases early stage,advanced stage,critical stage and prognosis stage,and compared the imaging findings of HRCT in different stages and conventional chest CT,and found out the difference of imaging findings.Results Both HRCT and conventional CT showed unilateral or bilateral extramedullary lung field or subpleural ground glass lesions.The distribution of all lesions of conventional CT and HRCT was as follows right upper lobe in 17 cases,right middle lobe in 19 cases,right lower lobe in 24 cases,left upper lobe in 19 cases and left lower lobe in 19 cases,including bilateral lower lung distribution in 20 cases(66.7%),23 cases(76.7%).The morphological features were as follows ground glass,partial or full solid,fine grid,paving stone sign,nodule with halo sign,long axis parallel to pleura,air bronchogram sign,distribution of the focus along the bronchi vascular bundle,and"thickening of blood vessels"sign.Among them,ground glass shadow,fine grid,paver stone,nodule with halo and thickening blood vessel can be displayed in conventional CT,while HRCT can clearly display such signs through thin-layer and three-dimensional reconstruction,with P value of 0.006,0.008,0.042 and 0.035(P value<0.05),respectively,with statistical significance.Conclusion HRCT for novel coronavirus pneumonia is more accurate than CT scan,and HRCT is of great importance in the diagnosis of new coronavirus pneumonia.HRCT is a new diagnostic method.