重庆地区172例新型冠状病毒感染患者的肺部CT表现分析

Pulmonary CT manifestations of 172 patients with coronavirus disease 2019 in Chongqing

目的:分析重庆地区新型冠状病毒感染(coronavirus disease 2019,COVID-19)患者的肺部CT表现,加深对本地区该疾病影像特征的了解。方法:收集重庆地区172例COVID-19患者的首次胸部CT检查资料,分析患者肺部病灶的分布、累及位置和范围、形态、密度等特征,并对不同时期确诊患者肺部病变的影像学表现进行统计对比。结果:172例患者中,143例(83.1%)在首次胸部CT图像上可见肺部炎症病灶,其CT表现如下:①累及范围:单肺受累者37例(25.9%),双肺受累者106例(74.1%);累及单一、2个和3个及以上肺叶者分别为33例(23.1%)、23例(16.1%)和87例(60.8%),平均受累肺叶(3.2±1.6)个,其中以右肺下叶(113例,79.0%)受累最常见,其次为左肺下叶(98例,68.5%);累及单一、2个和3个及以上肺段者分别为18例(12.6%)、18例(12.6%)和107例(74.8%),平均受累肺段(7.4±5.7)个;②病灶数量、形态及密度:133例(93.0%)肺部病灶呈多发,其中以类圆形或斑片状实变影伴少许磨玻璃密度影(ground glass opacity,GGO)最常见(37例,27.8%),其次为斑片状GGO(28例,21.1%)和类圆形或斑片状GGO伴少许实变(26例,19.6%);10例(7.0%)肺部病灶呈单发,其中表现为类圆形或斑片状GGO者各5例(50.0%);③病灶分布:病灶呈胸膜下分布为主者87例(60.8%),支气管血管束周围分布为主者7例(4.9%),二者均有分布或呈散在分布者总计49例(34.3%)。随确诊时间推移,不同时间段内患者肺部病灶均以多发常见,其中以单纯GGO表现者占比逐渐增高,而GGO合并实变者占比逐渐下降。结论:重庆地区COVID-19患者肺部病灶以双肺、多肺叶、肺段、胸膜下区受累为主,主要表现为类圆形或斑片状GGO伴或不伴实变,随时间推移早期病灶者占比逐渐增高,少数局限性病变者仍需密切结合临床进行鉴别。

Objective:To analyze the pulmonary CT manifestations of patients with coronavirus disease 2019(COVID-19)in Chongqing for further understanding the imaging features of COVID-19. Methods:The initial CT data of 172 patients with COVID-19 in Chongqing were retrospectively collected. The distribution,location,shape,and density of pulmonary lesions were mainly analyzed,and the CT findings of cases diagnosed at different periods were compared. Results:Among the 172 patients,143(83.1%)cases had pulmonary inflammatory lesions on CT images,their CT manifestations were as follows:① range of involvement:37(25.9%)and 106(74.1%)cases had unilateral and bilateral lung involvement,respectively;lesions involving single,two,and three or more lobes were detected in 33(23.1%),23(16.1%)and 87(60.8%)cases,respectively,with an average of(3.2 ± 1.6)lobes;the right lower lobe(113 cases,79.0%)was most frequently involved,followed by the left lower lobe(98 cases,68.5%);lesions involving single,two,and three or more segments were detected in 18(12.6%),18(12.6%),and 107(74.8%)cases,respectively,with an average of(7.4±5.7)segments. ②number,shape and density:among 133(93.0%)patients with multiple lesions,round or patchy consolidation with little ground glass opacity(GGO) was the most common(37 cases,27.8%),followed by patchy GGO(28 cases,21.1%) and round or patchy GGO with little consolidation(26 cases,19.6%);10(7.0%)cases with single lesion included 5(50.0%)cases with round and 5(50.0%) cases with patchy GGO,respectively.③distribution:lesions in 87(60.8%)cases were mainly located in subpleural zone,in 7(4.9%) cases were mainly distributed around the bronchial vascular bundle,and in 49(34.3%)cases located in both areas or distributed diffusely. With the passage of time,patients with multiple lesions were common in different periods. The proportion of patients with GGO alone increased gradually,while that of patients with GGO and consolidation decreased gradually. Conclusion :The pulmonary lesions of COVID-19 patients in Chongqing are often multiple,mainly involving bilateral lung,multiple lobes and segments,and subpleural zones,round or patchy GGO with or without consolidation are the main CT manifestations. The proportion of cases with early stage disease increases gradually over time. The clinical data should be considered for diagnosing a few patients with localized lesions.