新型冠状病毒感染影像学诊断标准

Criterion for imaging diagnosis of Corona Virus Disease 2019

新型冠状病毒感染(COVID-19)目前为全球性重大的公共卫生事件,诊断需有病原学或血清学证据,疫苗接种者和儿童COVID-19症状轻。影像评估是COVID-19临床诊断、鉴别诊断、疗效监测和预后随访的主要和常用手段,资源有限时影像学检查适用于中重度临床特征COVID-19疑似和高概率患者的医学分诊。推荐高分辨率CT评估COVID-19肺损伤及随访,重症患者使用便携式数字X线检查,孕妇和儿童可使用MRI检查评估疗效,COVID-19人工智能诊断可用于发热患者早期筛查。典型COVID-19影像学演变分为早期、进展期、重症期、恢复期四个阶段,早期为胸膜下局限分布的斑片状、亚段或节段性磨玻璃样影(GGO);进展期病灶范围增大、增多,累及多个肺叶;重症期双肺弥漫性实变或GGO,呈“白肺”表现;恢复期病变吸收。大部分非重患者病变可完全吸收。部分患者出现COVID-19后综合征,3个月后肺部见低密度区,GGO伴马赛克征、条索影、网状或蜂窝样改变、支气管扩张、肺气囊、肺纤维化等表现。临床中型以GGO病变为主,重型/危重型GGO范围增大、实变增多,双肺多叶受累多见。COVID-19肺炎需与其他病毒引起的肺炎、严重急性呼吸综合征、隐源性机化性肺炎、过敏性肺炎等鉴别。

Corona Virus Disease 2019(COVID-19),a novel acute respiratory infection,is sweeping across the globe,and has become a significant global public health event.Diagnosis of COVID-19 can be made if there is evidence of etiology or serology.Clinical symptoms of COVID-19 are generally mild in vaccinated individuals and children.Imaging assessment is the main and commonly used method for clinical diagnosis,differential diagnosis,treatment monitoring,and follow-up.When medical resources are constrained,images are appropriate for medical triage of patients with moderate to severe clinical characteristics that suspected or with high probability of COVID-19.High-resolution CT is generally used for the assessment of lung lesions with long-term follow-up.Chest X-ray is of great value in predicting the prognosis of COVID-19 and is helpful in the management of critical patients.MRI can be used for evaluating and monitoring the efficacy during treatment for pregnant women and children.AI diagnosis is expected for early screening of fever patients.Typical image manifestations of COVID-19 include four stages:early stage,progressive stage,severe stage,and recovery stage.In the early stage,patchy,subsegmental,or segmental ground glass opacities(GGOs)were mainly found in subpleural areas.In the progressive stage,the lesion area is enlarged and increased,and involves multiple lobes.In the severe stage,both lungs showed diffuse consolidation or GGOs,presenting as"white lung".In the recovery stage,the lesions are absorbed.In most non-severe patients,the lesions were completely absorbed after 3 months.Some patients developed post-COVID-19 syndrome,which showed low-density areas in one lobe or multiple lobes,GGOs with a mosaic sign,streak shadow,reticular or honeycomb-like changes,traction bronchiectasis,pulmonary bullae,and pulmonary fibrosis in images.Clinically,the moderate type is mainly shown as GGOs,while in severe/critical cases,increasing GGOs,consolidations,and multiple lobes involvement were found in both lungs.COVID-19 needs to be distinguished from pneumonia caused by other viruses,severe acute respiratory syndrome,cryptogenic organizing pneumonia,and allergic pneumonia.