INTRODUCTION A 56-year-old Chinese female patient with A （H1N1） influenza pneumonia accompanied by acute disseminated encephalomyelitis （ADEM） of the Central Nervous System （CNS） is described in this article. Th...INTRODUCTION A 56-year-old Chinese female patient with A （H1N1） influenza pneumonia accompanied by acute disseminated encephalomyelitis （ADEM） of the Central Nervous System （CNS） is described in this article. The patient had typical clinical manifestation, and the diagnosis was reached after MRI and other examinations. From this case, we can conclude that the virus of A （H1N1） influenza can infect CNS, and we should pay more attention to patients of A （H1N1） influenza pneumonia with neurological complications.展开更多
Objective Coronavirus disease 2019(COVID-19)is currently the most serious infectious disease in the world.An accurate diagnosis of this disease in the clinic is very important.This study aims to improve the differenti...Objective Coronavirus disease 2019(COVID-19)is currently the most serious infectious disease in the world.An accurate diagnosis of this disease in the clinic is very important.This study aims to improve the differential ability of computed tomography(CT)to diagnose COVID-19 and other community-acquired pneumonias(CAPs)and evaluate the short-term prognosis of these patients.Methods The clinical and imaging data of 165 COVID-19 and 118 CAP patients diagnosed in seven hospitals in Anhui Province,China from January 21 to February 28,2020 were retrospectively analysed.The CT manifestations of the two groups were recorded and compared.A correlation analysis was used to examine the relationship between COVID-19 and age,size of lung lesions,number of involved lobes,and CT findings of patients.The factors that were helpful in diagnosing the two groups of patients were identified based on specificity and sensitivity.Results The typical CT findings of COVID-19 are simple ground-glass opacities(GGO),GGO with consolidation or grid-like changes.The sensitivity and specificity of the combination of age,white blood cell count,and ground-glass opacity in the diagnosis of COVID-19 were 92.7 and 66.1%,respectively.Pulmonary consolidation,fibrous cords,and bronchial wall thickening were used as indicators to exclude COVID-19.The sensitivity and specificity of the combination of these findings were 78.0 and 63.6%,respectively.The follow-up results showed that 67.8%(112/165)of COVID-19 patients had abnormal changes in their lung parameters,and the severity of the pulmonary sequelae of patients over 60 years of age worsened with age.Conclusions Age,white blood cell count and ground-glass opacity have high accuracy in the early diagnosis of COVID-19 and the differential diagnosis from CAP.Patients aged over 60 years with COVID-19 have a poor prognosis.This result provides certain significant guidance for the diagnosis and treatment of new coronavirus pneumonia.展开更多
The purpose of this study is to review the published literature for the range ofradiographic findings present in patients suffering from coronavirus disease 2019infection. This novel corona virus is currently the caus...The purpose of this study is to review the published literature for the range ofradiographic findings present in patients suffering from coronavirus disease 2019infection. This novel corona virus is currently the cause of a worldwide pandemic.Pulmonary symptoms and signs dominate the clinical picture and radiologists arecalled upon to evaluate chest radiographs (CXR) and computed tomography (CT)images to assess for infiltrates and to define their extent, distribution andprogression. Multiple studies attempt to characterize the disease course bylooking at the timing of imaging relative to the onset of symptoms. In general,plain CXR show bilateral disease with a tendency toward the lung periphery andhave an appearance most consistent with viral pneumonia. Chest CT images aremost notable for showing bilateral and peripheral ground glass and consolidatedopacities and are marked by an absence of concomitant pulmonary nodules,cavitation, adenopathy and pleural effusions. Published literature mentioningorgan systems aside from pulmonary manifestations are relatively less common,yet present and are addressed in this review. Similarly, publications focusing onimaging modalities aside from CXR and chest CT are sparse in this evolving crisisand are likewise addressed in this review. The role of imaging is examined as it iscurrently being debated in the medical community, which is not at all surprisingconsidering the highly infectious nature of Severe Acute Respiratory Syndromecoronavirus 2.展开更多
The current gold standard for the diagnosis of coronavirus disease-19(COVID-19)is a positive reverse transcriptase polymerase chain reaction(RT-PCR)test,on the background of clinical suspicion.However,RT-PCR has its l...The current gold standard for the diagnosis of coronavirus disease-19(COVID-19)is a positive reverse transcriptase polymerase chain reaction(RT-PCR)test,on the background of clinical suspicion.However,RT-PCR has its limitations;this includes issues of low sensitivity,sampling errors and appropriate timing of specimen collection.As pulmonary involvement is the most common manifestation of severe COVID-19,early and appropriate lung imaging is important to aid diagnosis.However,gross discrepancies can occur between the clinical and imaging findings in patients with COVID-19,which can mislead clinicians in their decision making.Although chest X-ray(CXR)has a low sensitivity for the diagnosis of COVID-19 associated lung disease,especially in the earlier stages,a positive CXR increases the pre-test probability of COVID-19.CXR scoring systems have shown to be useful,such as the COVID-19 opacification rating score which helps to predict the need of tracheal intubation.Furthermore,artificial intelligence-based algorithms have also shown promise in differentiating COVID-19 pneumonia on CXR from other lung diseases.Although costlier than CXR,unenhanced computed tomographic(CT)chest scans have a higher sensitivity,but lesser specificity compared to RT-PCR for the diagnosis of COVID-19 pneumonia.A semi-quantitative CT scoring system has been shown to predict short-term mortality.The routine use of CT pulmonary angiography as a first-line imaging modality in patients with suspected COVID-19 is not justifiable due to the risk of contrast nephropathy.Scoring systems similar to those pioneered in CXR and CT can be used to effectively plan and manage hospital resources such as ventilators.Lung ultrasound is useful in the assessment of critically ill COVID-19 patients in the hands of an experienced operator.Moreover,it is a convenient tool to monitor disease progression,as it is cheap,non-invasive,easily accessible and easy to sterilise.Newer lung imaging modalities such as magnetic resonance imaging(MRI)for safe imaging among children,adolescents and pregnant women are rapidly evolving.Imaging modalities are also essential for evaluating the extra-pulmonary manifestations of COVID-19:these include cranial imaging with CT or MRI;cardiac imaging with ultrasonography(US),CT and MRI;and abdominal imaging with US or CT.This review critically analyses the utility of each imaging modality to empower clinicians to use them appropriately in the management of patients with COVID-19 infection.展开更多
Background In early April 2009, cases of human infection with 2009 pandemic influenza A （H1N1） virus were identified in Mexico. The virus then spread rapidly to other regions of the world. From October 2009, sporadi...Background In early April 2009, cases of human infection with 2009 pandemic influenza A （H1N1） virus were identified in Mexico. The virus then spread rapidly to other regions of the world. From October 2009, sporadic imported cases of novel influenza A （HIN1） were continuously confirmed in Suzhou. The aim of the study was to review the chest CT findings in 63 patients with laboratory-confirmed novel swine-origin influenza A （H1N1） virus （S-OIV） infection. Methods Chest CT examinations were collected from 63 S-OIV infected patients during their hospital stay. Three experienced radiologists inspected images to qualitatively and quantitatively characterize S-OIV induced image changes. CT scores of lesion severity were calculated based on the percentage of affected area to determine severity of infectious lesions. Patients were divided into two groups based on the leukocyte counts. Lesion patterns, local distributions, and quantitative measures were investigated and compared between the two groups. Results Various degrees of bilateral multifocal lesions of ground-glass opacities were found with or without consolidations on the chest CT images. The lesions were both bronchocentric and centrilobular. Patients with elevated leukocyte counts had more extensive lesions, in terms of severity and affected area, than the patients with normal leukocyte counts. The lesion severity scores of patients in the elevated leukocyte group were significantly higher than those of the normal leukocyte group in terms of the entire lung area （P 〈0.01）, and upper （P 〈0.05） and lower （P 〈0.01） lobes as well. There were changes in the CT characteristics seen at follow-up as demonstrated by lesions absorption （P 〈0.01）, especially in the upper lobe of the lung （P〈0.01）, but less so in the middle lobe/lingual and lower lobe of the lung （m〉o.o5）. Conclusions The most common CT findings in S-OIV infection patients were bilateral multifocal distributed ground-glass opacities and consolidations. The lesions were located dominantly at bronchocentric and centrilobular areas. Lung lesions were more obviously absorbed in upper lobes between two examinations. The observations and analysis from this study provide information that may be useful in image understanding and patient management for future pandemic influenza.展开更多
基金supported by the fund of "Clinical Study on Traditional Chinese Medicine for Severe A (H1N1) Influenza Cases 200907001-2A"
文摘INTRODUCTION A 56-year-old Chinese female patient with A （H1N1） influenza pneumonia accompanied by acute disseminated encephalomyelitis （ADEM） of the Central Nervous System （CNS） is described in this article. The patient had typical clinical manifestation, and the diagnosis was reached after MRI and other examinations. From this case, we can conclude that the virus of A （H1N1） influenza can infect CNS, and we should pay more attention to patients of A （H1N1） influenza pneumonia with neurological complications.
文摘Objective Coronavirus disease 2019(COVID-19)is currently the most serious infectious disease in the world.An accurate diagnosis of this disease in the clinic is very important.This study aims to improve the differential ability of computed tomography(CT)to diagnose COVID-19 and other community-acquired pneumonias(CAPs)and evaluate the short-term prognosis of these patients.Methods The clinical and imaging data of 165 COVID-19 and 118 CAP patients diagnosed in seven hospitals in Anhui Province,China from January 21 to February 28,2020 were retrospectively analysed.The CT manifestations of the two groups were recorded and compared.A correlation analysis was used to examine the relationship between COVID-19 and age,size of lung lesions,number of involved lobes,and CT findings of patients.The factors that were helpful in diagnosing the two groups of patients were identified based on specificity and sensitivity.Results The typical CT findings of COVID-19 are simple ground-glass opacities(GGO),GGO with consolidation or grid-like changes.The sensitivity and specificity of the combination of age,white blood cell count,and ground-glass opacity in the diagnosis of COVID-19 were 92.7 and 66.1%,respectively.Pulmonary consolidation,fibrous cords,and bronchial wall thickening were used as indicators to exclude COVID-19.The sensitivity and specificity of the combination of these findings were 78.0 and 63.6%,respectively.The follow-up results showed that 67.8%(112/165)of COVID-19 patients had abnormal changes in their lung parameters,and the severity of the pulmonary sequelae of patients over 60 years of age worsened with age.Conclusions Age,white blood cell count and ground-glass opacity have high accuracy in the early diagnosis of COVID-19 and the differential diagnosis from CAP.Patients aged over 60 years with COVID-19 have a poor prognosis.This result provides certain significant guidance for the diagnosis and treatment of new coronavirus pneumonia.
文摘The purpose of this study is to review the published literature for the range ofradiographic findings present in patients suffering from coronavirus disease 2019infection. This novel corona virus is currently the cause of a worldwide pandemic.Pulmonary symptoms and signs dominate the clinical picture and radiologists arecalled upon to evaluate chest radiographs (CXR) and computed tomography (CT)images to assess for infiltrates and to define their extent, distribution andprogression. Multiple studies attempt to characterize the disease course bylooking at the timing of imaging relative to the onset of symptoms. In general,plain CXR show bilateral disease with a tendency toward the lung periphery andhave an appearance most consistent with viral pneumonia. Chest CT images aremost notable for showing bilateral and peripheral ground glass and consolidatedopacities and are marked by an absence of concomitant pulmonary nodules,cavitation, adenopathy and pleural effusions. Published literature mentioningorgan systems aside from pulmonary manifestations are relatively less common,yet present and are addressed in this review. Similarly, publications focusing onimaging modalities aside from CXR and chest CT are sparse in this evolving crisisand are likewise addressed in this review. The role of imaging is examined as it iscurrently being debated in the medical community, which is not at all surprisingconsidering the highly infectious nature of Severe Acute Respiratory Syndromecoronavirus 2.
文摘The current gold standard for the diagnosis of coronavirus disease-19(COVID-19)is a positive reverse transcriptase polymerase chain reaction(RT-PCR)test,on the background of clinical suspicion.However,RT-PCR has its limitations;this includes issues of low sensitivity,sampling errors and appropriate timing of specimen collection.As pulmonary involvement is the most common manifestation of severe COVID-19,early and appropriate lung imaging is important to aid diagnosis.However,gross discrepancies can occur between the clinical and imaging findings in patients with COVID-19,which can mislead clinicians in their decision making.Although chest X-ray(CXR)has a low sensitivity for the diagnosis of COVID-19 associated lung disease,especially in the earlier stages,a positive CXR increases the pre-test probability of COVID-19.CXR scoring systems have shown to be useful,such as the COVID-19 opacification rating score which helps to predict the need of tracheal intubation.Furthermore,artificial intelligence-based algorithms have also shown promise in differentiating COVID-19 pneumonia on CXR from other lung diseases.Although costlier than CXR,unenhanced computed tomographic(CT)chest scans have a higher sensitivity,but lesser specificity compared to RT-PCR for the diagnosis of COVID-19 pneumonia.A semi-quantitative CT scoring system has been shown to predict short-term mortality.The routine use of CT pulmonary angiography as a first-line imaging modality in patients with suspected COVID-19 is not justifiable due to the risk of contrast nephropathy.Scoring systems similar to those pioneered in CXR and CT can be used to effectively plan and manage hospital resources such as ventilators.Lung ultrasound is useful in the assessment of critically ill COVID-19 patients in the hands of an experienced operator.Moreover,it is a convenient tool to monitor disease progression,as it is cheap,non-invasive,easily accessible and easy to sterilise.Newer lung imaging modalities such as magnetic resonance imaging(MRI)for safe imaging among children,adolescents and pregnant women are rapidly evolving.Imaging modalities are also essential for evaluating the extra-pulmonary manifestations of COVID-19:these include cranial imaging with CT or MRI;cardiac imaging with ultrasonography(US),CT and MRI;and abdominal imaging with US or CT.This review critically analyses the utility of each imaging modality to empower clinicians to use them appropriately in the management of patients with COVID-19 infection.
文摘Background In early April 2009, cases of human infection with 2009 pandemic influenza A （H1N1） virus were identified in Mexico. The virus then spread rapidly to other regions of the world. From October 2009, sporadic imported cases of novel influenza A （HIN1） were continuously confirmed in Suzhou. The aim of the study was to review the chest CT findings in 63 patients with laboratory-confirmed novel swine-origin influenza A （H1N1） virus （S-OIV） infection. Methods Chest CT examinations were collected from 63 S-OIV infected patients during their hospital stay. Three experienced radiologists inspected images to qualitatively and quantitatively characterize S-OIV induced image changes. CT scores of lesion severity were calculated based on the percentage of affected area to determine severity of infectious lesions. Patients were divided into two groups based on the leukocyte counts. Lesion patterns, local distributions, and quantitative measures were investigated and compared between the two groups. Results Various degrees of bilateral multifocal lesions of ground-glass opacities were found with or without consolidations on the chest CT images. The lesions were both bronchocentric and centrilobular. Patients with elevated leukocyte counts had more extensive lesions, in terms of severity and affected area, than the patients with normal leukocyte counts. The lesion severity scores of patients in the elevated leukocyte group were significantly higher than those of the normal leukocyte group in terms of the entire lung area （P 〈0.01）, and upper （P 〈0.05） and lower （P 〈0.01） lobes as well. There were changes in the CT characteristics seen at follow-up as demonstrated by lesions absorption （P 〈0.01）, especially in the upper lobe of the lung （P〈0.01）, but less so in the middle lobe/lingual and lower lobe of the lung （m〉o.o5）. Conclusions The most common CT findings in S-OIV infection patients were bilateral multifocal distributed ground-glass opacities and consolidations. The lesions were located dominantly at bronchocentric and centrilobular areas. Lung lesions were more obviously absorbed in upper lobes between two examinations. The observations and analysis from this study provide information that may be useful in image understanding and patient management for future pandemic influenza.
