CT征象及动态变化对COVID-19疑似病例鉴别诊断的价值

Value of CT signs and dynamic changes in the differential diagnosis of suspected COVID-19 cases

目的:探讨CT征象及动态变化对COVID-19疑似病例鉴别诊断的价值。方法:回顾性分析2020年1月20日至2020年2月25日收治的54例COVID-19疑似病例的资料。最终COVID-19确诊病例25例,患者年龄3~94岁,≤50岁16例(64%)。排除病例(非COVID-19)29例。54例均行CT平扫,首次检查后间隔3~6 d复查。结果:COVID-19病灶多分布于双肺胸膜下,主要征象为磨玻璃密度改变并小叶内间隔增厚,伴血管影增粗;进展期13例呈胸膜下融合改变,好转消散期15例密度增高,边缘平直及出现纤维条索。非COVID-19病灶多沿支气管血管束分布,树芽征及腺泡结节7例,均见于细菌性肺炎及支原体肺炎患者;进展期9例沿支气管血管束扩散,好转消散期27例表现为整体密度浅淡。两组以上征象检出率差异均有统计学意义(P<0.05)。结论:精准CT征象分析可以用于COVID-19和非COVID-19的鉴别,有助于缩小疑诊范围,减轻临床排查压力。

Aim:To investigate the value of CT signs and dynamic changes in the differential diagnosis of suspected COVID-19 cases.Methods:A total of 54 suspected COVID-19 cases from January 20,2020 to February 25,2020 were collected.Finally 25 cases were confirmed,aged 3-94 years,and 16 cases(64%)were≤50 years;29 cases were excluded.The 54 suspected cases received plain CT scan,and re-examination was conducted at an interval of 3-6 days after the first examination.Results:The lesions of COVID-19 patients were mainly located under the pleura of both lungs,and the main signs were ground glass density and thickening of the interval inside flocculus,accompanying vessels enlargement;in progress phase,13 patients had fusion change under the pleura of both lungs,in abreaction period 15 cases were with higher density,straight edge and fiber cords.The lesions of most non COVID-19 patients were distributed along the bronchovascular bundle;tree-in-bud and acini nodules appeared in 7 cases of bacterial pneumonia and mycoplasma pneumonia;in progress period the lesion of 9 cases spreaded along the bronchovascular bundle,the overall density of 27 cases in abreaction period became shallow light.There were statistical differences between the two groups in the signs mentioned above(P<0.05).Conclusion:Accurate CT signs analysis can be used in the differential daignosis of COVID-19 caces and non COVID-19 caces,narrow down the suspected diagnosis and reduce the pressure of clinical screening.