新型冠状病毒肺炎CT表现及动态变化

CT Manifestations and Dynamic Changes of Corona Virus Disease 2019

目的探讨新型冠状病毒肺炎(COVID-19)胸部CT表现及动态变化,以期为COVID-19早期诊断及疗效评估提供影像学依据。方法回顾性分析经2019新型冠状病毒核酸检测确诊的COVID-1930例的临床及影像学资料。结果30例中发病1~3 d进行首次胸部CT检查19例,CT检查有片状影18例,主要表现为斑片状、节段性磨玻璃样密度影(GGO),病变局限,分布于外1/3肺野、胸膜下,以双肺下叶居多;CT检查阴性1例。11例初次胸部CT检查时已发病4~7 d,肺内病变表现为多发分布,部分融合,形态不规则,以胸膜下肺野分布为主,GGO与实变影、条索影共存。入院第3天,30例第1次进行了胸部CT复查,24例肺内影像学变化较大,表现为病灶数目增多,体积增大,密度增高,局部实变,GGO合并肺实变影及条索影病灶数目增多,血管束增粗明显。入院第8天,29例进行了第2次胸部CT复查,27例有较明显变化,密度呈现出多样性,病灶GGO与实变及条索影共存,血管束增粗减轻。入院第13天,27例进行了第3次胸部CT复查,主要表现为病灶密度减低,边界清晰,条索影增多,与邻近胸膜粘连、牵拉,部分病灶吸收消失。入院第26天,25例进行了第4次胸部CT复查,主要表现为GGO伴条索影。结论胸部CT检查可清楚反映COVID-19病变密度、形态和范围特点,显示肺间质纤维化改变,可以用于COVID-19早期诊断、了解病变动态变化和进行疗效评估。

Objective To explore the chest CT manifestations and dynamic changes of corona virus disease 2019(COVID-19),in order to provide imaging basis for the early diagnosis and efficacy evaluation of COVID-19.Methods The clinical and imaging data of 30 cases of COVID-19 diagnosed by novel coronaviras(2019-nCoV)nucleic acid test were analyzed retrospectively.Results Among the 30 cases,19 cases(63.33%)underwent chest CT examination within 1 to 3 days of onset initially,and 18 cases had flaky shadows on CT examination.The main manifestations were patchy and segmental ground-glass opacity(GGO).The lesions were limited and distributed in the outer 1/3 lung field and under the pleura,and mostly were in the lower lobes of both lungs.One patient had a negative CT performance.Eleven cases had onset for 4-7 days at the time of initial chest CT examination.The pulmonary lesions showed multiple distribution,partial fusion,irregular shape,and mainly subpleural lung field distribution,and GGO coexisted with consolidation shadow and strip shadow.In addition,of 30 cases who had the first chest CT review on the third day of admission,24 cases had greater changes in intra-pulmonary imaging,and the manifestations included increased number of lesions,increased volume,increased density,local consolidation,GGO combined with pulmonary consolidation,increased number of lesions of strip shadow,and the obvious thickening of vascular bundle.On the 8th day after admission,29 patients underwent the second chest CT re-examination,and 27 patients had obvious changes,including diverse density,the lesions GGO that coexisted with consolidation and strip shadow,and reduced thickening of the vascular bundle.On the 13th day after admission,27 patients underwent the third chest CT re-examination,which mainly showed decreased density of the lesions,clear boundary,increased striated shadow,adhesion and stretching with the adjacent pleura,and some lesions were absorbed and disappeared.On the 26th day after admission,25 patients underwent the fourth chest CT reexamination,and the main manifestations were GGO with strip shadow.Conclusion Chest CT examination can clearly reflect the characteristics of COVID-19 lesion density,morphology and range,showing changes in pulmonary interstitial fibrosis,which can be used for early diagnosis of COVID-19,understanding of the dynamic changes of the lesion and evaluation of efficacy.