新型冠状病毒肺炎亚临床期CT影像特征及短期演变

目的 探讨新型冠状病毒肺炎(COVID-19)亚临床期高分辨率CT(HRCT)特征及短期演变规律。方法 回顾性分析2020年1月15日至31日在华中科技大学同济医学院附属协和医院及武汉市金银潭医院确诊的17例亚临床期COVID-19患者的HRCT影像资料,男4例,女13例,年龄25.0~51.0(39.8±7.5)岁,均为与确诊COVID-19患者的密切接触者。所有患者首次CT检查后3~6 d再次行CT复查,其中6例患者复查前接受抗炎抗病毒及对症治疗,11例患者未进行任何治疗。分析亚临床期和短期随访的CT影像学征象,总结其短期随访CT图像演变规律。结果 17例COVID-19患者亚临床期及短期随访CT病变主要位于双肺下叶,亚临床期左肺下叶9例,右肺下叶10例;短期随访左肺下叶9例,右肺下叶11例;病变累及肺段由亚临床期的46个增加至90个肺段。亚临床期病变以多发为主(13例),短期复查多发病例减少(7例),局灶性(6例)及弥漫分布(4例)增多。病变主要分布于胸膜下(13例)和沿支气管血管束走行(10例),短期随访1例病变分布由胸膜下进展为胸膜下及沿支气管血管束走行。病变主要有3种形态:磨玻璃密度结节影、斑片状/片状/团片状磨玻璃影和铺路石征。亚临床期及短期复查均可见磨玻璃影,随访复查显示磨玻璃结节减少4例,铺路石征增加4例。6例患者治疗后短期复查,3例由多发磨玻璃结节变为单发磨玻璃结节,3例多发磨玻璃影部分范围变小。11例未治疗患者病变范围增大。结论 亚临床期COVID-19患者肺部CT具有一定特征,多为胸膜下或沿支气管血管束走行的小磨玻璃密度结节或磨玻璃影,短期随访病变变化较大。

CT appearances and short-term changes of COVID-19 in subclinical period

Objective To explore the characteristics and short-term changes of high resolution CT(HRCT)in subclinical stage of COVID-19.Methods The HRCT images of 17 COVID-19 patients in subclinical stage were analyzed retrospectively in Union Hospital,Tongji Medical College,Huazhong University of Science and Technology and Wuhan Jinyintan Hospital from January 15 to 31,2020.There were 4 males and 13 females,age ranged from 25.0 to 51.0(39.8±7.5)years,who were closely contacted with other COVID-19 patients.The follow-up CT examination was performed within 3 to 6 days after the initial CT examination in all patients.Six patients were treated using anti-virus,anti-inflammation and symptomatic therapy,while the other 11 patients were untreated.The subclinical CT findings and short-term follow-up were analyzed,and the CT changes of short-term follow-up were summarized.Results The lesions of 17 COVID-19 patients were mainly located at the lower lobes of bilateral lungs(at the left lower lobe in 9 cases and at the right lower lobe in 10 cases in the subclinical stage,at the left lower lobe in 9 cases and at the right lower lobe in 11 cases in the short-term follow-up).The number of involved lung segments increased from 46 in the subclinical stage to 90 in the short-term follow-up.In the subclinical stage,the multiple lesions were found in 13 cases,while in the short-term follow-up,the number of cases with multiple lesions decreased by 7,however the cases with focal lesions increased by 6 and diffuse lesions by 4.The lesions were mainly distributed under the pleura(13 cases)or along the bronchovascular bundle(10 cases).In the short-term follow-up,the lesion in 1 case expanded from the subpleural area to neighbouring bronchovascular bundle.There were 3 main types of the lesions,including ground glass nodule,ground glass opacity and crazy-paving pattern.In the subclinical stage and short-term follow-up,the ground glass opacities were seen in all the 17 cases.In the short-term follow-up,the number of cases with ground glass nodules decreased by 4 and crazy-paving pattern increased by 4.In 6 patients after treatment,the multiple ground glass nodules became single one in 3 cases,and in other 3 cases the multiple ground glass opacities were getting smaller.However,the scope of lesions in 11 patients without treatment enlarged.Conclusion The HRCT features of the COVID-19 in subcilincal stage have some charicteristics,such as small ground glass nodule,ground glass opacity along the subpleural area or along the bronchovascular bundle,and the great changes can be seen in the short-term follow-up.