Coronavirus Disease 2019 (COVID-19): Role of Chest CT in Diagnosis and Management
Coronavirus Disease 2019 (COVID-19): Role of Chest CT in Diagnosis and Management
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DOI：
10.2214/ajr.20.22954
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发表时间：
2020-06-01
影响因子：
5
通讯作者：
Xia, Liming
中科院分区：
文献类型：
--
作者：
Li, Yan;Xia, Liming
OBJECTIVE.我们的研究旨在确定放射科医生对2019冠状病毒病（COVID-19）的误诊率，并评估胸部CT在COVID-19诊断和管理中的性能。报告COVID-19的CT特征，并与其他病毒的CT特征进行比较，以使放射科医生熟悉可能的CT模式。材料和方法。该研究包括首批51名经核酸检测确诊为COVID-19感染的患者（23名女性和28名男性;年龄范围，26-83岁）和2名腺病毒患者（1名女性和1名男性;年龄，58岁和66岁）。我们回顾了这53例患者的临床资料、CT图像和相应的影像学报告。CT图像包括来自99次胸部CT检查的图像，包括初始和随访CT研究。我们将最初CT研究的影像报告与实验室检查结果进行了比较，并确定了提示病毒感染的CT模式。在两名患有基础疾病和COVID-19的住院患者的初始CT研究中，COVID-19被误诊为常见感染。其余49名COVID-19患者和2名腺病毒患者在初始CT研究中正确诊断为病毒性肺炎。这些患者被隔离并接受治疗。磨玻璃影（甘精蛋白）和实变伴或不伴血管增大、小叶间隔增厚和支气管充气征是COVID-19的常见CT特征。“反晕”征和肺结节伴晕征是少见的CT表现。COVID-19的CT表现与腺病毒感染的CT表现重叠。COVID-19与SARS的CT表现有相似之处，也有不同之处。我们发现，胸部CT对COVID-19的漏诊率较低（3.9%，2/51），可作为快速诊断COVID-19的标准方法，以优化患者的管理。然而，CT在识别特定病毒和区分病毒方面仍然有限。
OBJECTIVE. The objective of our study was to determine the misdiagnosis rate of radiologists for coronavirus disease 2019 (COVID-19) and evaluate the performance of chest CT in the diagnosis and management of COVID-19. The CT features of COVID-19 are reported and compared with the CT features of other viruses to familiarize radiologists with possible CT patterns.MATERIALS AND METHODS. This study included the first 51 patients with a diagnosis of COVID-19 infection confirmed by nucleic acid testing (23 women and 28 men; age range, 26-83 years) and two patients with adenovirus (one woman and one man; ages, 58 and 66 years). We reviewed the clinical information, CT images, and corresponding image reports of these 53 patients. The CT images included images from 99 chest CT examinations, including initial and follow-up CT studies. We compared the image reports of the initial CT study with the laboratory test results and identified CT patterns suggestive of viral infection.RESULTS. COVID-19 was misdiagnosed as a common infection at the initial CT study in two inpatients with underlying disease and COVID-19. Viral pneumonia was correctly diagnosed at the initial CT study in the remaining 49 patients with COVID-19 and two patients with adenovirus. These patients were isolated and obtained treatment. Ground-glass opacities (GGOs) and consolidation with or without vascular enlargement, interlobular septal thickening, and air bronchogram sign are common CT features of COVID-19. The The "reversed halo" sign and pulmonary nodules with a halo sign are uncommon CT features. The CT findings of COVID-19 overlap with the CT findings of adenovirus infection. There are differences as well as similarities in the CT features of COVID-19 compared with those of the severe acute respiratory syndrome.CONCLUSION. We found that chest CT had a low rate of missed diagnosis of COVID-19 (3.9%, 2/51) and may be useful as a standard method for the rapid diagnosis of COVID-19 to optimize the management of patients. However, CT is still limited for identifying specific viruses and distinguishing between viruses.