Chest CT Features of COVID-19 in Rome, Italy
Chest CT Features of COVID-19 in Rome, Italy
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DOI：
10.1148/radiol.2020201237
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发表时间：
2020-08-01
期刊：
影响因子：
19.7
通讯作者：
Laghi, Andrea
中科院分区：
文献类型：
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作者：
Caruso, Damiano;Zerunian, Marta;Laghi, Andrea
背景资料：诊断严重急性呼吸综合征冠状病毒2的标准是逆转录聚合酶链反应（RT-PCR）测试，但胸部CT可能在2019年冠状病毒病的早期检测中发挥补充作用目的：研究意大利罗马COVID-19肺炎患者的CT特征，并比较CT与RT-PCR的准确性。材料与方法：在这项前瞻性研究中，从2020年3月4日至2020年3月19日，连续招募了疑似患有COVID-19感染和呼吸道症状的患者。排除标准为因血管适应症而进行的造影剂增强胸部CT、拒绝胸部CT或住院的患者以及严重的CT运动伪影。所有患者均行RT-PCR和胸部CT检查。以RT-PCR为参考标准计算CT的诊断性能。计算RT-PCR和CT结果阳性的患者亚组的胸部CT特征。使用Pearson χ 2检验比较住院患者和居家隔离患者的CT特征。结果：研究人群包括158名连续参与者（83名男性，75名女性;平均年龄，57岁+/- 17 [标准差]）。在158名参与者中，97名（61%）观察到发热，88名（56%）观察到咳嗽，52名（33%）观察到呼吸困难，95名（60%）观察到淋巴细胞减少，139名（88%）观察到C反应蛋白水平升高，128名（81%）观察到乳酸脱氢酶水平升高。CT的敏感性、特异性和准确性分别为97%（95%置信区间[CI]：88%，99%）（60/62）、56%（95% CI：45%，66%）（54/96）和72%（95% CI：64%，78%）（114/158）。在58例RT-PCR和CT结果阳性的参与者中，所有58例（100%）均存在磨玻璃样阴影，54例（93%）同时存在多叶和后部受累，53例（91%）存在双侧肺炎，52例（89%）存在亚段血管扩大（>3 mm）。意大利罗马的COVID-19肺炎的典型模式是外周毛玻璃样阴影伴多叶和后部受累、双侧分布和亚段血管扩大（>3 mm）。胸部CT敏感性高（97%），特异性低（56%）。(C)RSNA，2020年
Background: The standard for diagnosis of severe acute respiratory syndrome coronavirus 2 is a reverse transcription polymerase chain reaction (RT-PCR) test, but chest CT may play a complimentary role in the early detection of Coronavirus Disease 2019 (COVID-19) pneumonia.Purpose: To investigate CT features of patients with COVID-19 in Rome, Italy, and to compare the accuracy of CT with that of RT-PCR.Materials and Methods: In this prospective study from March 4, 2020, until March 19, 2020, consecutive patients suspected of having COVID-19 infection and respiratory symptoms were enrolled. Exclusion criteria were contrast material-enhanced chest CT performed for vascular indications, patients who refused chest CT or hospitalization, and severe CT motion artifact. All patients underwent RT-PCR and chest CT. Diagnostic performance of CT was calculated using RT-PCR as the reference standard. Chest CT features were calculated in a subgroup of patients with positive RT-PCR and CT findings. CT features of hospitalized patients and patients in home isolation were compared using the Pearson chi(2) test.Results: The study population included 158 consecutive participants (83 male, 75 female; mean age, 57 years +/- 17 [standard deviation]). Of the 158 participants, fever was observed in 97 (61%), cough was observed in 88 (56%), dyspnea was observed in 52 (33%), lymphocytopenia was observed in 95 (60%), increased C-reactive protein level was observed in 139 (88%), and elevated lactate dehydrogenase level was observed in 128 (81%). Sensitivity, specificity, and accuracy of CT were 97% (95% confidence interval [CI]: 88%, 99%) (60 of 62), 56% (95% CI: 45%, 66%) (54 of 96), and 72% (95% CI: 64%, 78%) (114 of 158), respectively. In the subgroup of 58 participants with positive RT-PCR and CT findings, ground-glass opacities were present in all 58 (100%), both multilobe and posterior involvement were present in 54 (93%), bilateral pneumonia was present in 53 (91%), and subsegmental vessel enlargement (>3 mm) was present in 52 (89%).Conclusion: The typical pattern of COVID-19 pneumonia in Rome, Italy, was peripheral ground-glass opacities with multilobe and posterior involvement, bilateral distribution, and subsegmental vessel enlargement (>3 mm). Chest CT had high sensitivity (97%) but lower specificity (56%). (C) RSNA, 2020