新型冠状病毒肺炎胸部高分辨CT表现及演变规律  

HRCT feature and evolution rule of COVID⁃19

作　　者：姚庆东[1] 张呈兵[1] 付军 阳义[1] 张东友[1] YAO Qingdong;ZHANG Chengbing;FU Jun;YANG Yi;ZHANG Dongyou(Department of Radiology,Wuhan NO.1 Hospital,Wuhan 430030,China)

机构地区：[1]武汉市第一医院放射科,武汉430030

出　　处：《实用医学杂志》2020年第12期1552-1557,共6页The Journal of Practical Medicine

摘　　要：目的探讨新型冠状病毒肺炎(COVID⁃19)患者胸部高分辨CT(HRCT)表现及演变规律。方法回顾性分析我院经RT⁃PCR确诊COVID⁃19患者45例,男16例,女29例,年龄25~88岁,平均(47.7±18.2)岁,所有患者均于病程早期(病初1~7 d)、进展期(起病后8~14 d)、恢复期(起病后15~21 d)行HRCT检查,记录各病程期病变肺叶、相对位置、数量、大小、形态、密度、肺外病变及CT征象,比较影像学表现在各病程期有无差异,分析演变规律。结果45例患者中,全身及呼吸循环系统症状比其他症状更常见(χ2=96.3,P<0.05)。病变发生的肺叶、相对位置、数量、大小、密度在各病程期差异无统计学意义(P>0.05),同一病程期内主要分布在双肺下叶、肺野外周及外周+中心,以单发或多发常见;病变形态在各病程期存在差异(Z=12.782,P=0.002),其中斑片状vs.条索状、条索状vs.团块状(Z=-3.067,P<0.01;Z=-2.595,P=0.009),斑片状vs.团块状(Z=-1.280,P=0.201),条索状病变发生率在进展期及恢复期高于早期,呈上升趋势。胸膜增厚、胸腔积液及纵隔淋巴结增大、心包积液在各病程期差异无统计学意义(Z=2.912,P=0.088;Z=-1.291,P=0.197)。45例患者各病程期可见充气支气管征、铺路石征、晕征、胸膜下线、网格征。病变主要进展方式有:(1)病灶增大(31/45,68.9%);(2)病灶数量增多(33/45,72.5%);(3)密度改变(39/45,86.7%);(4)病灶局部增多、局部吸收(12/45,26.7%)。结论COVID⁃19患者肺部病变HRCT表现及演变复杂多样,条索状病变随着病程推进而增加可能是特征性表现之一。Objective To investigate the High Resolution CT(HRCT)feature and evolution rule of COVID⁃19.Methods Forty⁃five cases of COVID⁃19 confirmed by RT⁃PCR(reverse⁃transcriptase⁃polymerase⁃chain⁃reac⁃tion)were enrolled in this study,including 16 males and 29 females,aged from 25~88(47.7±18.2)years.All pa⁃tients were performed HRCT in early phase(1~7 d after symptoms onset),advanced phase(8~14 d)and recov⁃ery phase(15~21d).HRCT findings such as involved pulmonary lobe,lesion distribution,number,size,shape,and density in three phases were evaluated by two radiologists,and the difference was compared,then the evolution rule of COVID⁃19 was analyzed.CT signs of lesions and extrapulmonary changes were also recorded.Results Of this 45 cases,the symptoms of the whole body(such as fever)and respiratory circulatory system were more common than others(χ2=96.3,P<0.05).There was no significant difference in three phases in terms of involved pulmonary lobe,lesion distribution,number,size,and density(P<0.05).The lesions distributed predominantly in inferior lobes,peripheral and peripheral plus central zone in the same phase and either single or multifocal lesions were more common than diffuse lesions.However there was significant difference of lesions′shape in three phases(Z=12.782,P=0.002),mainly patch shadow vs fibrotic streaks(Z=-3.067,P=0.002),patch shadow vs mass⁃like(Z=-1.280,P=0.201)and fibrotic streaks vs mass⁃like(Z=-2.595,P=0.009),and the fibrotic streaks′rate increased gradually.The rate of pleural thickening and pleural effusion had no significant difference in three phases(Z=2.912,P=0.088),as well as the mediastinal lymphadenopathy and pericardial effusion(Z=-1.291,P=0.197).HRCT demonstrated air bronchogram sign,crazy⁃paving sign,halo sign,subpleural line,and reticular sign in three phases.The lesions aggravated in the following four ways:(1)enlargement of lesions(31/45,68.9%),(2)in⁃creased lesions′number(33/45,72.5%),(3)density changed(39/45,86.7%)and(4)partial aggravation and par

关 键 词：新型冠状病毒肺炎 体层摄影术 X线计算机 

分 类 号：R445.4[医药卫生—影像医学与核医学] R512.99[医药卫生—诊断学]