湖南首诊新型冠状病毒感染者的肺部CT表现

Lung CT findings of first visit patients with 2019-nCoV in Hunan province

目的:回顾性分析三家医院首次确诊2019-nCoV感染患者的肺部薄层CT图像,总结其影像学表现,以提高对本病的认识及诊断的准确率。方法:评估2020年1月24日~2月15日三家医院发热门诊2019-nCoV核酸阳性患者66例的临床资料,分析主要CT征象、分布及出现频率。结果:女性患者32例(48.5%),男性34例(51.5%),年龄(44.7±16.6)岁,所有患者均有明确的流行病学史及典型临床症状,约半数患者体温及实验室检查正常。60名肺部CT患者中,12名(20.0%)阴性,48名(80.0%)阳性,肺部病灶胸膜下分布30例(50.0%)和弥散分布18例(30.0%),共累及145个肺叶,上肺及下肺分别占37.2%及50.3%,病灶多发为主,累及1个肺叶9例(18.8%),累及2个及以上肺叶39例(81.2%)。肺部CT阳性患者多可见磨玻璃影,仅1例以实变为主,伴发的主要是征象是病灶内血管影增粗31例(64.6%)、临近脏层胸膜及叶间裂增厚18例(37.5%)、小叶间隔增厚17例(35.4%)、实变14例(29.2%),少见征象包括结节伴晕征、反晕征及蜂窝征,没有发现小气道壁增厚及胸腔积液。低龄患者肺部CT阴性多见,老年人蜂窝征常见。结论:初诊COVID-19患者CT征象以胸膜下分布的磨玻璃影为主要特点,病灶内血管影增粗、小叶间隔增厚及实变为主要伴发征象,肺部薄层CT是评估新型冠状病毒感染的重要工具,可以为及时甄别疑似病例提供一定的价值。

Objective To retrospectively analyze the lung thin-section CT findings of first visit patients with 2019-nCoV,summarize the imaging findings in order to improve the recognition and diagnostic accuracy of the disease.Methods 66 patients with 2019-nCoV positive in the fever clinic of three hospital from January 24 to February 15,2020 were evaluated,the main CT features,distribution and frequency were analyzed.Results There were 32 females(48.5%)and 34 males(51.5%),with an average age of 44.7±16.6 years,and a median age of 41.All the patients had a history of epidemiology and typical clinical symptoms,about half of the patients had normal body temperature and laboratory tests.Of the 60 patients with pulmonary CT,12(20.0%)were negative and,48(80.0%)were positive,the pulmonary lesions in 30 case(50.0%)were subpleurally distributed,18(30.0%)cases were scattered.Involving 145 lobes,the upper and lower lungs accounted for 37.2%and 50.3%,respectively,involving one lobe of the lung accounted for 9(18.8%),and involving more than 2 lobes accounted for 39(81.2%).Ground-glass opacities were seen in the most of patients with positive lung CT,only one case was dominated by consolidation,the main concomitant signs was thickening of blood vessels in the lesion,31 cases(64.6%),and adjacent visceral pleura and interlobar fissure thickening,18 cases(37.5%),and interlobular septal thickening,17 cases(35.4%),and consolidation,14cases(29.2%).Rare signs included nodule with halo sign,anti-halo sign and honeycomb sign,no small airway wall thickening and pleural effusion were found.Conclusion The CT features of first visit patients with COVID-19 are mainly characterized by ground glass opacities distributed subpleurally,thickened blood vessels,interlobular septum and consolidation as the main concomitant signs.Lung thin-section CT is an important tool to evaluate 2019-nCoV infection and can provide some value for the timely identification of suspected cases.