CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19)
CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19)
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DOI：
10.1007/s00330-020-06817-6
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发表时间：
2020-03-25
影响因子：
5.9
通讯作者：
Li, Shaolin
中科院分区：
文献类型：
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作者：
Li, Kunwei;Fang, Yijie;Li, Shaolin
目的探讨新冠肺炎的影像表现与临床分型的关系。方法采用单中心回顾性研究方法，对2020年1月18日至2020年2月7日在珠海就诊的新冠肺炎患者进行调查。根据中国临床诊断标准将患者分为3种类型：轻度(症状轻微，CT阴性)、一般、重度(CT阳性，临床表现不同的患者)。CT视觉定量评价以累及各肺叶的急性炎性病变积分为基础，分别为0(0%)、1(1~25%)、2(26~50%)、3(51~75%)、4(76~100%)。总严重度评分(TSS)由五个肺叶评分相加得出。对两个观察员的一致性进行了评价。将TSS评分与临床分型进行比较。采用ROC量表检测TSS对重症危重病的诊断能力。结果78例患者，男38例，女40例。轻度24例(30.8%)，普通46例(59.0%)，重度8例(10.2%)。重型组的焦虑自评量表的中位数显著高于普通型(p<；0.001)。两个观察者的ICC值为0.976(95%可信区间为0.962~0.985)。ROC分析显示，TSS诊断重症危重型的曲线下面积为0.918。以TSS为7.5作为临界值，敏感性为82.6%，特异性为100%。结论新冠肺炎临床轻型者所占比例较高，CT不宜作为独立筛查工具。CT目视定量分析具有较高的一致性，能反映新冠肺炎的临床分型。
Objectives To explore the relationship between the imaging manifestations and clinical classification of COVID-19. Methods We conducted a retrospective single-center study on patients with COVID-19 from Jan. 18, 2020 to Feb. 7, 2020 in Zhuhai, China. Patients were divided into 3 types based on Chinese guideline: mild (patients with minimal symptoms and negative CT findings), common, and severe-critical (patients with positive CT findings and different extent of clinical manifestations). CT visual quantitative evaluation was based on summing up the acute lung inflammatory lesions involving each lobe, which was scored as 0 (0%), 1 (1-25%), 2 (26-50%), 3 (51-75%), or 4 (76-100%), respectively. The total severity score (TSS) was reached by summing the five lobe scores. The consistency of two observers was evaluated. The TSS was compared with the clinical classification. ROC was used to test the diagnosis ability of TSS for severe-critical type. Results This study included 78 patients, 38 males and 40 females. There were 24 mild (30.8%), 46 common (59.0%), and 8 severe-critical (10.2%) cases, respectively. The median TSS of severe-critical-type group was significantly higher than common type (p < 0.001). The ICC value of the two observers was 0.976 (95% CI 0.962-0.985). ROC analysis showed the area under the curve (AUC) of TSS for diagnosing severe-critical type was 0.918. The TSS cutoff of 7.5 had 82.6% sensitivity and 100% specificity. Conclusions The proportion of clinical mild-type patients with COVID-19 was relatively high; CT was not suitable for independent screening tool. The CT visual quantitative analysis has high consistency and can reflect the clinical classification of COVID-19.