新型冠状病毒、细菌和病毒性肺炎患者胸部影像学特征分析

Analysis of chest imaging features of novel coronavirus pneumonia, bacterial pneumonia and viral pneumonia

目的:分析并总结新型冠状病毒肺炎(新冠肺炎)、细菌性肺炎及其他病毒性肺炎患者胸部CT影像学特点。方法:回顾性分析102例因不同病因引起肺部感染患者的胸部CT资料,其中包括2019年12月至2020年3月海南省人民医院及海南医学院附属第二医院收治的36例新冠肺炎患者,2018年1月至2020年2月海南省人民医院收治的16例其他病毒性肺炎患者,2018年4月至2020年5月中南大学湘雅医学院附属海口医院收治的50例细菌性肺炎患者。由2位高年资放射科医师及2位高年资重症医学科医师共同评估患者发病后首次胸部CT的病灶累及范围及影像学特点。结果:新冠肺炎及其他病毒性肺炎患者以双侧肺叶病变较多,其发生率明显高于细菌性肺炎(91.6%、75.0%比26.0%,P<0.05)。而与其他病毒性肺炎及新冠肺炎比较,细菌性肺炎患者以单肺多叶病变为主(62.0%比18.8%、5.6%,P<0.05),并伴有胸腔积液及淋巴结肿大。新冠肺炎患者肺组织磨玻璃影比例高达97.2%,其他病毒性肺炎患者达56.2%,而细菌性肺炎患者仅有2.0%(P<0.05)。新冠肺炎和其他病毒性肺炎患者肺组织实变影(25.0%、12.5%)、支气管充气征(13.9%、6.2%)、胸腔积液(16.7%、37.5%)的发生率明显少于细菌性肺炎患者(62.0%、32.0%、60.0%,均P<0.05),铺路石征(22.2%、37.5%)、细网格征(38.9%、31.2%)、晕征(11.1%,25.0%)、磨玻璃影伴小叶间隔增厚(30.6%、37.5%)、双肺斑片样/条索阴影(80.6%、50.0%)等指标的发生率显著高于细菌性肺炎患者(2.0%、4.0%、2.0%、0%、22.0%,均P<0.05)。新冠肺炎患者局部斑片影的发生率仅为8.3%,明显低于其他病毒性肺炎及细菌性肺炎患者(8.3%比68.8%、50.0%,P<0.05)。新冠肺炎、其他病毒性肺炎及细菌性肺炎患者病灶周围血管影增粗的发生率差异无统计学意义(27.8%、12.5%、30.0%,P>0.05)。结论:新冠肺炎患者胸部CT出现磨玻璃影、铺路石样和网格影样改变的概率明显高于细菌性肺炎,且以双下肺及外侧背段多见;其他病毒性肺炎患者肺部磨玻璃影在上下肺均有分布;细菌性肺炎患者常以单肺实变影多见,以小叶或大叶分布并伴有胸腔积液。

Objective To investigate and summarize the chest CT imaging features of patients with novel coronavirus pneumonia(COVID-19),bacterial pneumonia and other viral pneumonia.Methods Chest CT data of 102 patients with pulmonary infection due to different etiologies were retrospectively analyzed,including 36 patients with COVID-19 admitted to Hainan Provincial People's Hospital and the Second Affiliated Hospital of Hainan Medical University from December 2019 to March 2020,16 patients with other viral pneumonia admitted to Hainan Provincial People's Hospital from January 2018 to February 2020,and 50 patients with bacterial pneumonia admitted to Haikou Affiliated Hospital of Central South University Xiangya School of Medicine from April 2018 to May 2020.Two senior radiologists and two senior intensive care physicians were participated to evaluated the extent of lesions involvement and imaging features of the first chest CT after the onset of the disease.Results Bilateral pulmonary lesions were more common in patients with COVID-19 and other viral pneumonia,and the incidence was significantly higher than that of bacterial pneumonia(91.6%,75.0%vs.26.0%,P<0.05).Compared with other viral pneumonia and COVID-19,bacterial pneumonia was mainly characterized by single-lung and multi-lobed lesion(62.0%vs.18.8%,5.6%,P<0.05),accompanied by pleural effusion and lymph node enlargement.The proportion of ground-glass opacity in the lung tissues of patients with COVID-19 was 97.2%,that of patients with other viral pneumonia was 56.2%,and that of patients with bacterial pneumonia was only 2.0%(P<0.05).The incidence rate of lung tissue consolidation(25.0%,12.5%),air bronchial sign(13.9%,6.2%)and pleural effusion(16.7%,37.5%)in patients with COVID-19 and other viral pneumonia were significantly lower than those in patients with bacterial pneumonia(62.0%,32.0%,60.0%,all P<0.05),paving stone sign(22.2%,37.5%),fine mesh sign(38.9%,31.2%),halo sign(11.1%,25.0%),ground-glass opacity with interlobular septal thickening(30.6%,37.5%),bilateral patchy pattern/rope shadow(80.6%,50.0%)etc.were significantly higher than those of bacterial pneumonia(2.0%,4.0%,2.0%,0%,22.0%,all P<0.05).The incidence of local patchy shadow in patients with COVID-19 was only 8.3%,significantly lower than that in patients with other viral pneumonia and bacterial pneumonia(8.3%vs.68.8%,50.0%,P<0.05).There was no significant difference in the incidence of peripheral vascular shadow thickening in patients with COVID-19,other viral pneumonia and bacterial pneumonia(27.8%,12.5%,30.0%,P>0.05).Conclusions The probability of ground-glass opacity,paving stone and grid shadow in chest CT of patients with COVID-19 was significantly higher than those of bacterial pneumonia,and it was more common in the lower lungs and lateral dorsal segment.In other patients with viral pneumonia,ground-glass opacity was distributed in both upper and lower lungs.Bacterial pneumonia is usually characterized by single lung consolidation,distributed in lobules or large lobes and accompanied by pleural effusion.