基于定量CT对新型冠状病毒肺炎肺部改变的纵向研究  

Longitudinal study of lung changes induced by COVID-19 based on quantitative CT

作　　者：陈静 于勇 段海峰 金晨望[2] 沈聪 于楠 CHEN Jing;YU Yong;DUAN Haifeng;JIN Chenwang;SHEN Cong;YU Nan(Department ofRadiology,Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang 712000,China;Department ofRadiology,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]陕西中医药大学附属医院医学影像科,陕西咸阳712000 [2]西安交通大学第一附属医院医学影像科,陕西西安710061

出　　处：《中国医学物理学杂志》2020年第4期445-449,共5页Chinese Journal of Medical Physics

基　　金：国家自然科学基金(81701691);陕西中医药大学创新团队(2019-QN09)。

摘　　要：目的:探讨新型冠状病毒感染引起肺部改变的CT定量参数变化,为新型冠状病毒肺炎患者提供影像定量依据。方法:回顾性分析已确诊新型冠状病毒感染者17例,对其初次及随访胸部CT图像进行定量分析。CT定量评价指标包括肺总体积(TV)、病变总体积(TLV)、病变占总肺体积百分比(TLV/TL%)、最高密度区(HLD)、最低密度区(LLD)、磨玻璃密度百分比(GGO%)。结果:17例确诊患者共进行42次胸部CT扫描,平均间隔时间为(4±1)d。按照发病时间将病程分为4个阶段:第1阶段第0~3天,第2阶段第4~7天,第3阶段第8~14天和第4阶段第15~21天。其中第2阶段(第4~7天)和第3阶段(第8~14天)的患者TLV和TLV/TL%最高,而TV和GGO%最低(P=0.001)。TLV/TL%在第4~7天进展最快。快速进展患者(2次随访CT发现TLV进展超过50%)具有高龄(P<0.05)、淋巴细胞计数降低(P<0.001),首次CT扫描GGO%更低而TLV/TL%较高(P<0.05)的特点。结论:胸部定量CT相关指标提示,病变在第4~7天进展最快;高龄、淋巴细胞减低,初检时胸部CT病灶范围大且密度高的患者更容易出现病变的快速进展。Objective To investigate the changes in CT quantitative parameters because of the lung changes induced by 2019 novel coronavirus(COVID-19) for providing quantitative imaging basis for patients with COVID-19. Methods A retrospective analysis of 17 patients with confirmed COVID-19 was carried out. The initial and follow-up chest CT images were analyzed quantitatively.The quantitative CT indexes included total lung volume(TV), total lesion volume(TLV), the percentage of lesion volume in total lung volume(TLV/T%), the highest lesion density region(HLD), the lowest lesion density region(LLD), percentage of ground glass opacity(GGO%). Results A total of 42 chest CT scans were conducted in 17 patients with confirmed COVID-19, and the average interval was(4±1) days. According to the time of onset, the course of disease was divided into 4 stages, namely day 0-3(stage 1), day 4-7(stage 2), day 8-14(stage 3) and day 15-21(stage 4). TLV and TLV/TL% reached the highest in stage 2(day4-7) and stage 3(day 8-14), while TV and GGO% were the lowest(P=0.001). The fastest progression of TLV/TL% was found in stage 2(day 4-7). Patients with rapid disease progression(with more than 50% TLV progression in 2 follow-up CT scans) had the characteristics of elder age(P<0.05), decreased lymphocyte count(P<0.001), and lower GGO% but higher TLV/TL% in the first CT scan(P<0.05). Conclusion Chest quantitative CT related indicators suggest that the fastest disease progression is on day4-7. The patients with elder age, low leukocyte count, large lesion volume and high lesion density in initial CT are more likely to have rapid disease progression.

关 键 词：新型冠状病毒 肺炎 定量CT 磨玻璃密度 

分 类 号：R814.42[医药卫生—影像医学与核医学] R563.1[医药卫生—放射医学]