多参数定量CT评估新型冠状病毒肺炎预后的价值  

Value of multiparameter quantitative CT in evaluating the prognosis of COVID-19

作　　者：胡元楠 邓明 胡金香[1] 张在鹏[1] 徐国斌[1] 梅列军[1] 徐海波[1] HU Yuannan;DENG Ming;HU Jinxiang;ZHANG Zaipeng;XU Guobin;MEI Liejun;XU Haibo(Dept.of Radiology,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China)

机构地区：[1]武汉大学中南医院医学影像科,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2021年第2期237-241,共5页Medical Journal of Wuhan University

摘　　要：目的:探讨基于肺部高分辨率CT(HRCT)的多参数定量CT在评估新型冠状病毒肺炎(COVID-19)预后中的应用价值。方法:回顾性分析69例初诊临床分型为普通型COVID-19患者的临床资料和影像资料,按照临床预后和影像变化,分为3组:A组(普通型伴影像好转组)21例、B组(普通型伴影像进展组)25例、C组(普通型转重型组)23例。分析多定量CT参数与临床预后的相关性。结果:与基线CT比较,随访CT中3组间病灶总体积变化、磨玻璃病灶体积(GGO)变化、实变灶体积变化及平均肺密度(MLA)变化差异有统计学意义(P<0.01),两组内比较均有统计学差异。以病灶总体积增加231.46 cm^(3)为界值,诊断普通型转重型的灵敏度(95.7%)和特异度(91.3%)最高,曲线下面积(AUC)为0.961。以GGO体积增加168.58 cm^(3)为界值,诊断普通型转重型的灵敏度(82.6%)和特异度(91.3%)最高,AUC为0.914。以实变灶体积增加74.46 cm^(3)为界值,诊断普通型转重型的灵敏度(73.9%)和特异度(93.5%)最高,AUC为0.885。以MLA增加57 Hu为界值,诊断普通型转重型的灵敏度(78.3%)和特异度(87%)最高,AUC为0.885。结论:病灶总体积变化、GGO病灶变化、实变灶体积变化及MLA变化是普通型COVID-19的重要预后因素。病灶总体积增加231.46 cm^(3)、GGO体积增加168.58 cm^(3)、实变灶体积增加74.46 cm^(3)、MLA增加57 Hu以上的患者更易由普通型转变为重型。多参数定量CT结果客观,可预测COVID-19患者的预后情况。Objective: To investigate the value of multi-parameter quantitative CT combining with HRCT in evaluating the prognosis of coronavirus disease 2019(COVID-19).Methods: Sixty-nine cases were included in this retrospective study. All of the cases were primarily diagnosed with common type of COVID-19 when admitted to hospital. According to the clinical prognosis and the changes of image appearance, three groups were divided. Group A with decreasing extent of lesions(21 cases) and group B with increasing extent of lesions(25 cases) were both common type of COVID-19 without converting into severe type. Group C(23 cases) converted common type into severe type during hospitalization. Multiple CT parameters among the groups were compared.Results: The changes of the multiple parameters of CT after treatment, such as the total volume of lesions, GGO volume, and the volume of the consolidation and MLA, had a significant difference among the three groups. When the cut-off values for the increasing total volume, GGO volume, consolidation volume, and MLA were determined to be 231. 46 cm^(3), 168. 58 cm^(3), 74. 46 cm^(3), and 57 Hu, the sensitivity(95. 7%, 82. 6%,73. 9%, and 78. 3%) and specificity(91. 3%, 91. 3%, 93. 5%, and 87%) of the diagnosis of common type converting into severe type were optimal and the areas under ROC curve were 0. 961,0. 914, 0. 885, and 0. 885.Conclusion: The changes of the volumes of total lesions, GGO and consolidation and the change of MLA between follow-up CT and first CT are important prognostic factors in patients with COVID-19. Common type COVID-19 patients with total volume of lesions increasing >231. 46 cm^(3), GGO volume increasing >168. 58 cm^(3), consolidation volume increasing >74. 46 cm^(3), or MLA increasing >57 Hu are more likely to convert into severe type. The multiparameter quantitative CT combined with HRCT has an effect on evaluating the prognosis of COVID-19.

关 键 词：新型冠状病毒肺炎 定量CT 高分辨率CT 

分 类 号：R563.1[医药卫生—呼吸系统] R445.3[医药卫生—内科学]