Coronavirus disease 2019 (COVID-19): chest CT characteristics benefit to early disease recognition and patient classification-a single center experience
Coronavirus disease 2019 (COVID-19): chest CT characteristics benefit to early disease recognition and patient classification-a single center experience
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2019 年冠状病毒病 (COVID-19)：胸部 CT 特征有利于早期疾病识别和患者分类 - 单中心经验。
DOI：
10.21037/atm-20-2119a
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发表时间：
2020-06-01
影响因子：
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通讯作者：
Lou, Haiyan
中科院分区：
文献类型：
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作者：
Zhou, Hua;Xu, Kaijin;Lou, Haiyan
背景：当前以中国湖北省武汉市为中心的2019冠状病毒病（COVID-19）疫情已成为全球突发卫生事件。最近，中国的几项研究提供了COVID-19患者的流行病学、临床、实验室和结果的证据。在一个大的队列中，关于胸部CT在患者筛查和治疗过程中的作用的研究仍然很少。方法：基于2020年1月19日至2020年2月15日收集的数据，采用回顾性观察性研究。回顾了使用胸部CT和RT-PCR检测筛查疑似患者的临床工作流程。对临床资料进行评价，将患者分为轻度、普通、重度和危重症组。评估每位患者的胸部CT特征，并应用CT评分系统对肺部受累程度进行分级。结果：98例入组患者中，临床分为轻度组1例，普通组29例，重度组51例，危重组17例。胸部CT表现为毛玻璃样混浊83例（84.7%），实变76例（77.5%），疯狂铺路型18例（18.4%）。根据CT评分分为0级2例、1级35例、2级55例、3级6例，与临床分型有显著性一致（kappa = 0.638， P.0.05）。发热门诊入院29例，CT检查至出现症状平均间隔1.2天（范围0 ~ 4天）。其中3例患者初始RT-PCR结果为阴性，而初始胸部CT显示异常。结论：新冠肺炎胸部CT最常见的表现是周围肺分布的GGO和实变，无胸膜下保留。在COVID-19的早期阶段，即使RT-PCR检测呈阴性，胸部CT也可能出现异常，这可能有助于早期识别和快速诊断这种疾病。
Background: The current outbreak of coronavirus disease 2019 (COVID-19), epi-centered in Wuhan, Hubei Province of the China, has become a global health emergency. Several studies from China have recently provided the evidence of epidemiological, clinical, laboratory, and outcomes of COVID-19 patients. Investigation on the role of chest CT in patient screening and management course in a large cohort remains paucity.Methods: This was a retrospective observational study based on the data collected between January 19 and 2020 to February 15, 2020. A clinic workflow using chest CT and RT-PCR assay to screen suspected patient was reviewed. Clinical data were evaluated and patients were classified to mild, common, severe and critical group. Chest CT characteristics of each patient were evaluated and a CT scoring system was applied to grade the lung involvement.Results: Of 98 enrolled patients, 1, 29, 51 and 17 were clinically classified into mild, common, severe and critical group, respectively. Eighty-three patients (84.7%) demonstrated ground-glass opacity (GGO), 76 patients (77.5%) demonstrated consolidation and 18 patients (18.4%) demonstrated crazy-paving pattern on chest CT. Based on the CT scoring, 2, 35, 55 and 6 patients were categorized to grade 0, grade 1, grade 2 and grade 3, respectively, which significantly consistent with clinical classification (kappa = 0.638, P.0.05). Twenty-nine patients admitted from fever clinic, with an average interval of 1.2 days (range, 0-4 days) between CT examination and onset of symptom. Three of these patients had negative initial RT-PCR result while abnormalities displayed on the initial chest CT.Conclusions: Peripheral lung distributed GGO and consolidation, without subpleural sparing, are the most common manifestations on chest CT of COVID-19. Abnormalities on chest CT can occur in an early stage of COVID-19, even when RT-PCR assay negative, which may help to early recognition and rapid diagnosis of this disease.