南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (03): 327-332.doi: 10.12122/j.issn.1673-4254.2020.03.03

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COVID-19患者胸部CT表现及动态演变

向 颖,杨全新,孙泓泓,秦幸茹,李晓会,张秋娟   

  • 出版日期:2020-04-08 发布日期:2020-03-20
  • 基金资助:

Chest CT findings and their dynamic changes in patients with COVID-19

  

  • Online:2020-04-08 Published:2020-03-20

摘要: 目的 明确新型冠状病毒肺炎(COVID-19)患者从发病到治愈的胸部CT表现动态变化。方法 回顾性分析我院收治的6例确诊COVID-19患者的临床及胸部CT表现。6例患者从入院到治愈出院进行胸部CT检查共计30次,以发病到治愈的时间 及发病到每次CT检查的时间,将胸部CT检查分为4期,一期:0~4 d;二期:5~9 d;三期10~14 d;四期:>14 d。同时采用半定量评分法对CT各期肺叶病变累及程度进行CT评分。比较各期胸部CT征象及CT上肺损伤程度的差别。结果 病程早期(一期),病变多呈胸膜下分布的磨玻璃密度,CT评分最低(4.00±0.40分);随着时间的推移,病变密度逐渐升高呈混合密度(铺路石样改变)并出现实变(二期),CT评分达到峰值(7.38±3.34分),一期与二期CT评分差异有统计学意义(P<0.05)。三期实变范围扩大,病变内出现索条灶,CT评分为6.86±2.91分;发病14 d后(四期),病变密度以混合型为主,实变范围较前缩小,同时伴有多的索条灶形成,CT评分为6.21±1.56分。三~四期肺损伤CT评分中,下肺叶评分高于中上肺叶(P<0.05)。结论 胸部CT检查可以动态观察不同时期病变的分布、密度和范围,反映病变随病程的变化规律,以更好地指导临床治疗。

Abstract: Objective To define chest CT findings and their dynamic changes in patients with coronavirus disease 2019 (COVID- 19) from disease onset to the cure. Method We analyzed the clinical and chest CT data of 6 patients with RT-PCR-confirmed COVID-19. According to the time from the disease onset to the cure or from the onset to each CT scan, the total of 30 chest CT scans were divided into 4 stages, namely stage 1 (0-4 days), stage 2 (5-9 days), stage 3 (10-14 days), and stage 4 (over 14 days). A semi-quantitative scoring system was used to quantitatively assess the pulmonary involvement on the basis of the involved area. The differences in chest CT signs and the lung injury scores based on CT findings were compared among the 4 stages. Results In stage 1, ground-glass opacities (GGO) was found frequently in the subpleura, and the CT score was the lowest at 4.00±0.40. Stage 2 was characterized by an increased and mixed density (crazy-paving pattern) with mild consolidation of the lungs, and the CT score reached its peak level of 7.38±3.34 (P<0.05). In stage 3, an expanded range of consolidation and linear lesions were found in the lungs, and the total CT score averaged 6.86±2.91. In stage 4, a gradual resolution of the consolidation occurred with more linear lesions in the lungs, and the total CT score was 6.21±1.56. The CT scores of the lower lobes were significantly higher compared with those of the middle/upper lobes (P<0.05) in stage 3 and stage 4. Conclusion Chest CT scans allows dynamic monitoring of the changes in the distribution, density and extent of the pulmonary lesions in the 4 stages, which are closely correlated with the evolution of the disease course of COVID-19.