普通型新型冠状病毒肺炎患者首诊胸部CT征象及动态变化分析

Manifestations of the initial chest CT and dynamic changes in patients with common Corona Virus Disease 2019

目的探讨普通型新型冠状病毒肺炎(COVID-19)患者首诊胸部CT征象及动态变化特征。方法收集2020年1月24日至3月8日济宁地区确诊的41例普通型COVID-19患者的胸部CT资料,基于病灶的CT形态特征、分布特点及动态变化,并结合患者肺部感染总体严重程度评分进行回顾性分析。结果41例患者共检出病灶181个,其中纯磨玻璃影124个(68.51%),磨玻璃并实变影51个(28.18%),纯实变影6个(3.31%)。病灶呈类圆形103个(56.91%)、带状57个(31.49%)、楔形21个(11.60%)。47个(25.97%)病灶呈铺路石征,46个(25.41%)见充气支气管征,68个(37.57%)见血管增粗。41例患者中,累及单侧肺12例(29.27%)、双侧肺29例(70.73%),累及1,2,3,4,5个肺叶的患者分别为10例(24.39%)、7例(17.07%)、8例(19.51%)、7例(17.07%)、9例(21.95%)。181个病灶分布于左肺上叶、左肺下叶、右肺上叶、右肺中叶、右肺下叶分别为31个(17.13%)、43个(23.76%)、26个(14.36%)、25个(13.81%)、56个(30.94%)。CT动态观察,在病程第11~15 d与第2~5 d和第6~10 d比较,病灶总数量减少(分别为143,178,165个),纯磨玻璃密度影数量[56个(39.61%),101个(56.74%),68个(41.21%)]呈下降趋势,磨玻璃密度影合并实变影数量[81个(56.64%),68个(38.20%),89个(53.94%)]逐渐增高,均差异有统计学意义(χ^2=12.46,13.26;均P<0.01)。患者首次及随后3次复查CT的肺部感染总体严重程度评分分别为[4.00(2.50,7.00)分,4.00(2.00,7.50)分,3.00(2.00,7.00)分,2.00(1.00,4.00)分],其中在病程第6~10 d与第11~15 d内复查的评分差值[2.00(1.00,2.50)分]大于首次CT与病程第2~5 d复查的评分差值[1.00(0.00,1.00)分],并大于第2~5 d与第6~10 d复查的评分差值[1.00(0.00,1.00)分],差异具有统计学意义(H=21.16,P<0.01)。结论COVID-19患者胸部CT表现具有一定的特征性,有助于临床的早期诊断和动态评估。

Objective To investigate the characteristics of the initial chest CT findings and their dynamic changes in patients with common Corona Virus Disease 2019(COVID-19).MethodsForty-one patients diagnosed with common COVID-19 in Jining from January 24,2020 to March 8,2020 were collected.The CT morphological characteristics,distribution characteristics and dynamic changes of the lesions and the total severity score of patients with lung infection were analyzed retrospectively.ResultsOne hundred and eighty-one lesions were detected in 41 patients.One hundred and twenty-four lesions(68.51%)presented with pure ground glass opacity(GGO),51 lesions(28.18%)with mixed GGO and consolidation,and 6 lesions(3.31%)with complete consolidation.Morphology of 103 lesions(56.91%)appeared as round-shaped,57 lesions(31.49%)as band-shaped,and 21 lesions(11.60%)as wedge-shaped.Crazy paving signs were shown in 47 lesions(25.97%),air bronchogram signs in 46 lesions(25.41%),and blood vessels dilatation in 68 lesions(37.57%).In 41 cases,12 cases(29.27%)showed unilateral involvement and 29 cases(70.73%)showed bilateral involvement.Patients with 1,2,3,4,and 5 lobes involvement were found in 10 cases(24.39%),7 cases(17.07%),8 cases(19.51%),7 cases(17.07%),and 9 cases(21.95%),respectively.According to the lobe distribution of lesions,the upper left lobe,the left lower lobe,the right upper lobe,the right middle lobe,and the right lower lobe accounted for 31(17.13%),43(23.76%),26(14.36%),25(13.81%),and 56(30.94%),respectively.For CT dynamic observation,comparing the 11th to 15th days of the course with the 2nd to 5th and 6th to 10th days,the total number of lesions(143,178,165)and the number of pure GGO[56(39.61%),101(56.74%),68(41.21%)]showed a downward trend,the number of mixed GGO and consolidation[81(56.64%),68(38.20%),89(53.94%)]showed a gradual increase,there were significant differences in the 3 CT reexaminations(χ^2=12.46,13.26,all P<0.01).Total severity score at the initial and subsequent 3 CT scans evaluations were 4.00(2.50,7.00),4.00(2.00,7.50),3.00(2.00,7.00),2.00(1.00,4.00)points,respectively.The score difference between the 6th to 10th days and the 11th to 15th days of the course[2.00(1.00,2.50)points]was greater than the difference between the first CT and the 2nd to 5th days of the course[1.00(0.00,1.00)points],and also greater than the difference between the 2nd to 5th days and 6th to 10th days of the cause[1.00(0.00,1.00)points],the differences were statistically significant(H=21.16,P<0.01).ConclusionCOVID-19 patients have certain chest CT characteristics,which are helpful for early clinical diagnosis and dynamic assessment.