早期无症状新冠肺炎HRCT特征与重症化预警研究

HRCT imaging characteristics of early asymptomatic novel coronavirus pneumonia and their values in warning of progression to severe illness

目的探讨早期无症状新冠肺炎患者高分辨率CT(HRCT)影像特征及其重症化风险预警价值。方法回顾性分析2020年2月15日至4月6日由我院支援的武汉泰康同济医院收治的4252例住院患者的病例资料。结果有45例患者发现肺炎时无发热和呼吸道症状,HRCT检查均有磨玻璃结节影,以胸膜下为主;出现胸膜平行征40例,铺路石征39例。共检出197个磨玻璃病灶,其中右肺下叶、中叶和上叶分别为76个、21个和6个,左肺下叶61个、左肺上叶33个。8例“晕征”大于5 mm的患者,第3周至第4周复查,4例进展为重症,2例进展为危重症,2例无明显进展;其余37例患者无危重症化发生。结论早期无症状新冠肺炎HRCT特征性表现为双下肺胸膜下多发磨玻璃结节影伴胸膜平行征和铺路石征,伴有宽大晕征提示病情存在进一步进展的风险。

Objective To explore the high resolution CT(HRCT)imaging characteristics of early asymptomatic novel coronavirus pneumonia(COVID-19)and their value in warning of progression to severe illness.Methods The clinical data of 4252 inpatients admitted to Wuhan Taikang Tongji Hospital from February 15 to April 6,2020 were retrospectively analyzed.Results Forty-five patients had no fever or respiratory symptoms when pneumonia were found on the first CT examination.HRCT examination of the patients showed ground-glass nodules in 45 patients(mainly under the pleura),pleural parallel signs in 40 patients,and paving stone signs in 39 patients.A total of 197 ground-glass lesions were detected,including 76 in the right lower lobe,21 in the right middle lung,6 in the right upper lobe,61 in the left lower lobe,and 33 in the left upper lobe.From the 3rdto the 4thweek,among the 8 patients with a halo sign greater than 5 mm,4progressed to severe illness,2 progressed to critical illness,and 2 had no significant progression.There were no critically ill patients during the follow-up of the remaining 37 patients.Conclusion HRCT of early asymptomatic novel coronavirus pneumonia is characterized by multiple ground-glass nodules under the pleura with parallel pleural signs and paving stone signs.The ground-glass shadow in the lungs with a halo sign greater than 5 mm may indicate the risk of further progression to critical illness.