新型冠状病毒肺炎CT影像特征及其诊断价值分析

Analysis of novel coronavirus pneumonia CT image features and its diagnostic value

目的总结新型冠状病毒肺炎(Coronavirus disease 19,COVID-19)不同临床分型的CT影像学特征,分析其临床诊断价值。方法回顾性分析安徽省阜阳地区54例COVID-19患者的临床表现、实验室检查及胸部CT影像学资料。不同临床分型患者的年龄、初诊时间、发热、咳嗽等之间的比较采用t检验或Wilcoxon秩和检验;CT特征之间的比较采用χ^2或Fisher确切概率法,分析其诊断价值。结果普通型最常见CT影像学表现为双肺(25/41,60.98%)、多发(26/41,63.41%)、磨玻璃影(23/41,56.10%),直径大于3 cm者24例(58.54%),空气支气管征4例(9.76%)、支气管扩张2例(4.88%);重型CT影像学表现为双肺(13/13,100.00%)、多发(13/13,100.00%)、混合密度影(11/13,84.62%),直径大于3 cm者12例(92.31%),空气支气管征7例(53.85%)、支气管扩张5例(38.46%);普通型与重型CT影像学在病灶分布、数目、直径、密度方面P<0.05,差异具有统计学意义。54例患者均无纵隔淋巴结肿大及胸腔积液。所有病例均为核酸检测确诊病例,1次检测阳性43例(79.63%)、2次检测阳性8例(14.81%)、3次及以上检测阳性3例(5.56%),提示1次核酸检测存在假阴性。结论COVID-19核酸检测存在假阴性可能,CT特异性影像学改变有助于临床医师早期识别及判断疾病严重程度,避免漏诊、误诊。

Objective To summarize the novel coronavirus pneumonia(COVID-19)clinical classification of CT imaging characteristics,and to analyze its clinical diagnostic value.Methods The clinical manifestations,laboratory examinations and chest CT imaging data of 54 patients with COVID-19 in Fuyang area of Anhui Province were retrospectively analyzed.The age,initial diagnosis,fever,cough,etc.of patients with different clinical types were compared using t test or Wilcoxon rank sum test.The comparison between CT features was performed usingχ^2 or Fisher exact probability method to analyze its diagnostic value.Results The most common CT imaging manifestations of the common type were double lung(25/41,60.98%),multiple(26/41,63.41%),ground glass shadow(23/41,56.10%),24 cases(58.54%)with a diameter greater than 3 cm,4 cases with air bronchi sign(9.76%),and 2 cases with bronchiectasis(4.88%).The imaging manifestations of severe type CT were double lung(13/13,100%),multiple(13/13,100%),mixed density shadow(11/13,84.62%),12 patients(92.31%)with a diameter greater than 3 cm,7 cases with air bronchi sign(53.85%)and 5 cases with bronchiectasis(38.46%).There were significant differences in the distribution,number,diameter and density of lesions between the common type and the severe type CT images(P<0.05).There was no mediastinal lymphadenopathy or pleural effusion in 54 patients.All cases were confirmed by nucleic acid test,43 cases were positive for the first test(79.63%),8 cases were positive for twice tests(14.81%),and 3 cases were positive for triple or multiple tests(5.56%),indicating that there was false negative for the first test.Conclusion The detection of COVID-19 nucleic acid may be false negative.The change of CT specific imaging is helpful for clinicians to identify and judge the severity of the disease in the early stage and avoid missed diagnosis and misdiagnosis.