Typical and atypical HRCT manifestations of COVID-19
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摘要:
目的探讨COVID-19患者典型与不典型的高分辨率CT（HRCT）表现及HRCT在临床诊疗中的价值。 方法分析连云港地区28例经临床及核酸检测确诊的COVID-19患者胸部HRCT的表现，其中男16例，女12例，年龄25~71岁（46±14.9岁）。观察分析病变的分布、范围、形态、密度，以及纵隔、肺门有无淋巴结，胸腔及胸膜有无异常。按照50岁及发热后行首次胸部HRCT检查的时间间隔4 d为界限，进行年龄及时间间隔分组，统计比较不同组别COVID-19患者累及肺段的数目。 结果COVID-19患者典型的HRCT表现：胸膜下或多中心分布20例，单发或多发斑片状或节段性磨玻璃密度影（GGO）11例；GGO伴小叶间隔增厚14例，其中5例可见典型的“铺路石征”；实变伴GGO 8例；实变5例，内部可见空气支气管征。不典型表现：5例呈弥漫性小叶中心磨玻璃样结节分布；5例病变可见网格状及蜂窝样纤维索条影；3例沿支气管周围节段性分布。胸膜及纵隔表现：1例胸膜增厚；本组病例无胸腔积液及淋巴结肿大。发热后行首次胸部HRCT检查的时间间隔4 d以上的患者累及3个以上肺段的例数明显多余4 d及以下的患者（P=0.002）；年龄50岁以上累及3个以上肺段的例数多于50岁及以下患者的患者（P=0.003）。 结论连云港地区COVID-19患者的胸部HRCT典型表现具有一定的特征，不典型表现具有多样性，胸部HRCT不仅成为COVID-19患者早期的筛查与诊断的主要手段，同时对胸部HRCT不典型表现的高度疑似患者作出控制及早期治疗，而且还能评估患者的临床病程、病情严重程度及预后，从而控制疫情及提高治愈率。 Abstract:ObjectiveTo explore the typical and atypical HRCT manifestations of novel coronavirus and its value in clinical diagnosis and treatment. MethodsThe chest HRCT manifestations of 28 COVID-19 patients diagnosed by clinical and nucleic acid testing were collected and analyzed. There were 16 males and 12 females, with age of 25-71 years(46±14.9 years). The distribution, range, shape and density of the lesion, the presence of lymph nodes in the mediastinum and hilum, and the presence of abnormalities in the thorax and pleura were analyzed. According to the 4-day interval between the first chest HRCT examination at the age of 50 and after fever, the age and time interval were divided into groups. The number of lung segments involved by COVID-19 in different groups was compared. ResultsTypical HRCT manifestations of COVID-19: Subpleural or multicentric distribution in 20 cases, single or multiple patchy or segmental ground glass density shadow (GGO) in 11 cases. GGO was associated with septal thickening in 14 cases, of which 5 showed typical "paving signs". Eight cases of solid change with GGO. Consolidation was observed in 5 cases with internal air bronchus. Atypical manifestations: 5 cases presented diffuse hyaline nodules in the center of lobule. In 5 cases, there were meshes and honeycomb fiber strip shadows. In 3 cases, the distribution was segmental around the bronchus. Pleural and mediastinal manifestations: pleural thickening in 1 case. There was no pleural effusion and lymph node enlargement in this group. Patients who underwent HRCT for the first time after fever at a time interval of more than 4 days involved more than 3 pulmonary segments (P=0.002). Patients over 50 years of age with more than 3 lung segments were more likely to be involved than patients under 50 years of age (P=0.003) ConclusionsThe chest HRCT manifestations of COVID-19 have certain characteristics, which not only become the main means of early screening and diagnosis of COVID-19, but also control and early treatment of highly suspected patients.It can evaluate the clinical course, severity, efficacy and prognosis of patients, so as to control the epidemic situation and improve the cure rate. -
Key words:
- COVID-19 /
- pneumonia /
- high resolution /
- computed tomography
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图 1 COVID-19患者典型的CT表现
A:女，47岁，发热伴乏力2 d, CT示右肺下叶沿胸膜下分布片状磨玻璃影, 呈云雾状, 形态不规则; B:女，32岁，发热伴咳嗽, 乏力4 d, 表现为中心实变周围伴有磨玻璃影, 呈晕征; C:女, 39岁, 发热伴咳嗽, 乏力5 d, 双肺弥漫性网格状小叶间隔增厚, 呈蝶翼状分布, 形成典型的"铺路石征", 内部见支气管壁增厚; D-F:女，44岁, 发热6 d.胸部HRCT平扫轴位(D)、矢状位(E)、冠状位图(F)示双肺胸膜下及内中带片状分布磨玻璃密度影伴小叶间隔增厚（黑色箭头）, 形态不规则.
Figure 1. Typical CT findings in COVID-19 patients.
图 2 COVID-19患者不典型的CT表现
A:男, 26岁, 发热伴咳嗽3 d, 左肺上叶沿支气管分布实变伴磨玻璃影; B:男, 60岁, 发热伴咳嗽3 d.双肺弥漫性分布小叶中心磨玻璃样结节（白色箭头）; C:女, 63岁, 发热5 d，双肺多发中心实变，周围见磨玻璃影; D:女, 75岁, 发热伴咳嗽7 d, 双肺弥漫性网格或蜂窝样间质改变, 提示小叶间隔增厚伴纤维化, 内部见支气管管壁增厚.
Figure 2. Atypical CT findings in COVID-19 patients.
图 3 不同组别之间二维柱状图比较
Figure 3. Comparison of two-dimensional bar charts between different groups.
图 4 COVID-19患者转归后CT表现
女, 34岁, 发热6 d; A: CT示双肺下叶实变, 密度较高, 内部可见空气支气管征, 周围见晕征; B:入院治疗4 d后复查CT, 病变范围缩小, 密度减低, 肺实变灶吸收, 见残留索条影; C:纵隔窗示双侧胸膜轻度增厚(白色箭头).
Figure 4. CT findings of COVID-19 patients after outcome.
表 1 COVID-19患者CT影像学分布特点
Table 1. CT imaging characteristics of COVID-19 patients
[n(%)] 分布特点 构成比 单侧肺 3 (11) 双侧肺 25 (89) 上叶 14 (50) 中叶 5 (18) 下叶 27 (96) 病变累及肺段 ≤3个肺段 16 (57) 3~10个肺段 11 (39) ≥10个肺段 1 (4) 胸膜下或多中心分布 20 (71) 支气管周围分布 3 (11) 多发弥漫性病变 5 (18) 
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表 2 COVID-19患者CT影像学表现
Table 2. CT imaging findings of COVID-19 patients
[n(%)] CT影像学表现 构成比 磨玻璃斑片或结节 11 (39) 磨玻璃伴小叶间隔增厚 14 (50) 磨玻璃伴实变 8 (29) 实变 5 (18) 网格状及蜂窝样纤维索条 5 (18) 胸膜增厚 1 (4) 胸腔积液 0 (0) 纵隔淋巴结肿大 0 (0)
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表 3 不同分组之间COVID-19累及肺段数目的比较
Table 3. Comparison of the number of pulmonary segments involved by COVID-19 between different groups
年龄(岁) 累及肺段（段） P 间隔(d) 累及肺段（段） P ≤3 > 3 ≤3 > 3 ≤50 14 4 0.003 ≤4 12 2 0.002 > 50 2 8 > 4 4 10 注:不同组别之间COVID-19累及肺段数目的比较采用Fisher确切概率法检验.
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