COVID-19病人首诊胸部CT 的临床价值分析

Clinical analysis on clinical value of initial chest CT findings in patients with COVID-19

目的:探讨新型冠状病毒肺炎(COVID-19)病人首诊胸部CT的临床价值。方法:回顾性分析164例COVID-19和疑似COVID-19病人首诊胸部CT表现及COVID-19病人的临床总病程。由两名高年资影像诊断医师进行阅片,分析病灶密度(GGO、GGO伴胸膜下条索影、实变影)、病灶内部特征(网格影、血管增粗、空气支气管征)、病灶分布(胸膜下且与长轴平行、非胸膜下沿血管束),并对COVID-19患者的胸部CT进行半定量评分。以核酸检测结果为金标准,评价CT筛查的灵敏度、特异度和漏诊率;比较COVID-19组与疑似COVID-19组之间CT征象的差异性,并分析COVID-19组CT评分与总病程的相关性。结果:COVID-19核酸检测阳性79例(48.17%),阴性85例(51.83%),CT筛查COVID-19的灵敏度为94.94%,特异度为35.29%,漏诊率为5.06%。COVID-19组中GGO、GGO伴胸膜下条索影、网格影、胸膜下且与长轴平行高于疑似COVID-19组(P<0.05),COVID-19组中实变影、非胸膜下沿血管束低于疑似COVID-19组(P<0.05),两组间病灶内血管增粗、空气支气管征差异无统计学意义(P>0.05)。首诊CT评分与临床总病程呈正相关(R=0.321,P<0.05)。结论:胸部CT在COVID-19筛查、鉴别诊断及临床预后方面均有较高的价值。

Objective:To assess the clinical value of initial chest CT findings in patients with COVID-19.Methods:Retrospective analysis was performed in 164 cases of confirmed or suspected COVID-19 regarding the initial chest CT findings and total disease duration in clinic.The CT images were evaluated by two experienced radiologists,and abnormalities on CT were categorized into single density of the lesion(GGO,GGO with subpleural cable shadow,consolidation),internal features of the lesion(mesh shadow,intrapleural vascular thickening,aiRbronchogram),and distribution of the lesion(subpleural and parallel to the long axis,along the non-subpleural vascular bundle).The chest CT of patients with COVID-19 was semi-quantitatively scored.The sensitivity,specificity,and missed diagnosis rate of CT screening were calculated by the nucleic acid test results as the gold standard.Chi-square test was used to compare the differences in CT signs between the COVID-19 group and the suspected COVID-19 group.Pearson correlation analysis was performed to compare the correlation between CT score and total disease duration in the COVID-19 group.Results:Seventy-nine cases(48.17%)were positive for COVID-19 and 85(51.83%)were negative for COVID-19 by nucleic acid test.The sensitivity,specificity and missed diagnosis rate of CT screening for COVID-19 was 94.94%,35.29%and 5.06%,respectively.GGO,GGO with subpleural cable shadow,mesh shadow,subpleural and parallel to the long axis were higher than in the COVID-19 group than in the suspected COVID-19 group(P<0.05),and patients in the COVID-19 group had lower imaging of consolidation,along the non-subpleural vascular bundle than those in the suspected COVID-19 group(P<0.05).There was no significant difference in intrapleural vascular thickening and aiRbronchogram between the two groups(P>0.05).The CT scoring at the first diagnosis was positively correlated with the total clinical course(R=0.321,P<0.05).Conclusion:Chest CT has higher value in screening,differential diagnosis and estimation of the clinical prognosis in patients with COVID-19.