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【摘要】目的:探讨胸部CT特征评估普通型新型冠状病毒肺炎(COVID-19)患者转归情况的价值。方法:搜集入院时为普通型COVID-19的患者158例,根据入院后2~7天内是否发展为重症肺炎分为普通型组和转重症组;记录其临床资料、血清学指标以及胸部CT表现。利用多因素Logistic回归筛选普通型COVID-19转重症肺炎的独立影响因素。利用列线图预测普通型COVID-19患者的预后。结果:淋巴细胞计数减少(P=0.032)、病灶累及右肺中叶(P=0.020)、病灶累及肺叶数(P=0.021)以及病灶占整肺体积百分比(P=0.013)是影响普通型COVID-19转重症的独立影响因素。列线图模型拟合度为0.85,提示模型预测结果与实际一致性较好。结论:胸部CT的特征表现对普通型COVID-19患者临床分型的转变具有较好的预测能力,列线图可以方便地预测出每例普通型COVID-19患者转为重症肺炎的概率。 相似文献
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《医学影像学杂志》2021,(6)
目的探讨深度学习模型在新型冠状病毒肺炎的诊断、病情评估及与非新型冠状病毒肺炎的鉴别诊断价值。方法选取并分析南京大学医学院附属鼓楼医院确诊的9例普通型新型冠状病毒肺炎(coronavirus disease-2019 pneumonia,COVID-19)患者(COVID-19组,新冠组)及25例非新型冠状病毒肺炎(community-acquired pneumonia,CAP)患者(CAP组,非新冠组)的胸部CT扫描图像和临床资料,通过深度学习分割方法进行图像分割,分割内容包括感染肺叶数、感染体积及其在肺部总体积中的占比等参数。分析两组患者的临床表现和实验室结果,比较两组患者的深度学习分割结果的差异。感染体积在肺部体积总占比及其在位置上的分布情况以平均值以及95%置信区间显示;两组之间感染肺叶数的比较采用Fisher确切概率法,两组之间肺炎病灶占整肺体积百分比之间的比较采用Mann-Whitney U检验(非正态分布)。结果采用深度学习分割方法可以对两组所有肺炎患者进行快速图像分割,平均分割时间为10s/例。新冠组与非新冠组在白细胞及淋巴细胞计数差异有统计学意义(P 0.05)。与非新冠组相比,普通型COVID-19组中的感染肺叶数显著少于CAP组(2.11 vs. 3.24,P 0.05),感染肺叶数与感染病变的分布及位置无显著差异;感染总体积占比在两组间无显著性差异。结论深度学习分割的方法能够迅速进行肺炎整体病灶的自动分割,定量评估病变范围,与CAP组也具有一定的鉴别诊断价值,为探究COVID-19提供了一种CT的定量方法。 相似文献
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【摘要】目的:分析新型冠状病毒肺炎(COVID-19)恢复期多层螺旋CT(MSCT)表现特点及新型冠状病毒核酸检测非复阳患者与复阳患者的MSCT表现差异。方法:回顾性分析深圳市萨米医疗中心收治的131例恢复期COVID-19患者的一般资料及MSCT图像,并将病例分为非复阳组 (93例)及复阳组(38例),采用t检验、Mann-Whitney U检验、χ2检验或Fisher确切概率法进行统计分析。结果:恢复期COVID-19患者男女比例为61:70,平均发病年龄(48.6±16.3)岁。非复阳组和复阳组性别比例差异无统计学意义[(45∶48) vs. (16∶22),χ2=0.428,P=0.513],非复阳组较复阳组平均发病年龄大[(51.3±14.9) vs. (42.7±18.0),t=2.836,P=0.005]。恢复期COVID-19患者肺叶病灶受累情况如下:右肺下叶(143分)、左肺下叶(140分)、右肺上叶(93分)、右肺中叶(90 分)、左肺上叶舌段(84分)、左肺固有上叶(70分)。非复阳组总肺叶、右肺上叶、右肺中叶、右肺下叶及左肺下叶受累情况计分均高于复阳组,差异有统计学意义(P<0.05)。恢复期患者病灶主要位于肺外带,其次弥漫分布。非复阳组病灶外带和中内带分布比例均低于复阳组,差异有统计学意义(χ2=6.711,P=0.035)。恢复期COVID-19患者MSCT主要征象为:磨玻璃样密度影(GGO)及索条状影,其次是GGO合并实变影,少数征象依次有钙化灶、小结节灶、树芽征、支气管扩张、肺气肿/肺大泡、胸膜增厚伴/不伴钙化、铺石路征、肺不张。其中支气管扩张均为柱状及囊状,支气管扩张主要位于双肺下叶。两组病例MSCT征象出现率无显著差异(χ2=10.196,P=0.423),GGO与GGO合并实变征象差异无统计学意义(χ2=0.011,P=0.915)。两组病例支气管扩张位置、数量差异均无统计学意义。结论:COVID-19恢复期MSCT表现有其特征性,新型冠状病毒核酸检测非复阳与复阳患者年龄及MSCT病灶的累及程度、分布范围均有差异,MSCT可以反映COVID-19的进展情况,对疾病的诊断、预防起到积极作用。 相似文献
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【摘要】目的:探讨儿童新型冠状病毒肺炎(COVID-19)的临床及影像学特征。方法:搜集在指定就诊医院经实验室核酸检测(RT-PCR)确诊为COVID-19的30例14岁及以下患儿的临床资料,其中男18例,女12例,年龄0~14岁,中位年龄6岁。由2名经验丰富的儿科放射诊断医师双盲阅片,分析儿童COVID-19胸部CT影像学表现。结果:入组的30例儿童COVID-19患者有12例合并其他细菌和病毒感染。临床主要症状为发热(n=25),咳嗽(n=20),乏力(n=2),流涕(n=2),腹泻(n=2),呕吐(n=2)。胸部CT表现呈多样性:病灶多发为主,7例病灶呈弥漫性分布,23例(76.7%)累及左肺下叶。病变主要累及外周近胸膜部分,仅仅累及内带少。病变以实变及磨玻璃影为主,其中部分病例表现为支气管肺炎。所有病例均未见明显淋巴结肿大和胸腔积液。结论:儿童COVID-19患儿易合并其他病原体感染,结合流行病学史、CT影像学表现和实验室检查可协助早期治疗。 相似文献
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【摘要】目的:探讨妊娠晚期合并新型冠状病毒肺炎(COVID-19)的影像及临床特征。方法:回顾性分析12例经临床及核酸检测确诊为COVID-19妊娠晚期患者的临床及影像资料,包括患者的基本孕产资料、就诊症状、实验室检查、肺部影像学特征及转归。结果:患者年龄为26~33岁(中位年龄28岁),孕35+4~40周,因临产或先兆临产入院;12例均于本院足月分娩,3例为阴道产,9例为剖宫产,均未出现严重产后并发症,分娩结局良好。7例(7/12)伴有低热、咳嗽为主的呼吸道感染症状,5例(5/12)无明显产内科症状。实验室检查以白细胞计数正常、淋巴细胞计数降低及C-反应蛋白增高为主要特征。首次CT检查2例为阴性,余10例阳性者中3例为单肺叶单病灶,1例为单肺叶多病灶,6例为多肺叶多病灶;病灶主要分布于下叶胸膜下,以磨玻璃密度影(4/10)合并铺路石征及部分实变(6/10)为主。进展期CT病变范围增大、数目增多、密度增高,部分实变,吸收期病灶总体吸收,部分病灶纤维化,吸收早期可出现病灶缓解与进展交替发生。肺外表现:早期3例出现少量心包积液,2例出现单侧少量胸腔积液;进展期胸腔积液例数明显增多(11/12),吸收期减少。结论:妊娠晚期合并COVID-19患者的呼吸道感染症状较轻,分娩结局良好;胸部CT提示肺内病变特征与普通人群相似,但胸腔积液发生率较高,具有一定特征性。 相似文献
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《医学影像学杂志》2020,(9)
目的探讨新型冠状病毒肺炎(COVID-19)患者的胸部CT表现及动态变化特征,以帮助诊断,评估疗效以及转归。方法回顾性分析22例我院治愈出院的COVID-19患者的影像资料,动态观察患者的早期、进展期和转归期胸部CT表现,并对病变分布、形态、密度进行记录和统计分析,应用SPSS17.0统计软件对肺叶受累程度在三期之间的差异进行分析。结果早期(初次就诊时):病变多位于外周或者胸膜下,以双侧肺受累多灶性磨玻璃影为主。进展期(入院4~6天):病变多以外周向中央进展,以双肺受累为主,病变形态多呈多叶多灶性,密度主要为磨玻璃影合并实变的混合型。转归期(入院≥10天):肺部病变范围均较前缩小,形态上仍以多叶多灶为主,实变明显减少,索条影明显增多。肺部病灶范围占全部肺叶比重进行评分显示各期差异均具有统计学意义(P0.05)。本组病例中均无胸腔积液及淋巴结肿大。结论 COVID-19胸部CT表现为分布多发、胸膜下多见,磨玻璃影、实变影为主,各期的病变分布、形态和密度会有不同变化,不同分期的肺部病变范围占肺叶比重评分有差异。CT能够帮助COVID-19的诊断、观察肺内病变的动态变化,对临床诊疗具有重要价值。 相似文献
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【摘要】目的:探讨能谱CT单能量图像对改善胸部CT扫描增强效果和成像质量的应用价值。方法:回顾性收集进行胸部宝石能谱CT扫描、且肺动脉增强效果不佳(70keV单能图像肺动脉主干CT值<200HU)的49例患者的CT图像资料,通过改变单能量图像的keV值,使图像肺动脉主干CT值达到200HU。计算调整前(70keV)和调整keV值后的肺动脉主干CT值、图像信噪比(SNR)、对比噪声比(CNR);由2名放射科医师以5分法对调整前后的图像质量进行主观评分。采用配对样本t检验比较调整前后的图像肺动脉主干CT值、同层肌肉CT值、SNR和CNR,将调整前后的图像质量主观评分进行Wilcoxon秩和检验。同时将图像按调整前肺动脉主干CT值分为A、B、C、D四组,四组图像调整前后的SNR、CNR分别进行配对样本t检验;采用单因素方差分析,对A、B、C、D四组图像调整后的SNR、CNR进行两两比较。结果:调整前后图像的SNR差异无统计学意义(t=0.539,P>0.05),而调整后图像CNR(t=-8.961,P=0.000)和主观评分(Z=-3.400,P=0.001)均较调整前有所提高。A、B、C、D四组调整前后SNR均无统计学差异(P均>0.05),而CNR均具有统计学差异(P均≤0.05)。A组(肺动脉主干CT值<140HU)调整后SNR均低于B组(P=0.014)、C组(P=0.009)、D组(P=0.020);A组调整后CNR均低于B组(P=0.017)、C组(P=0.004)、D组(P=0.011);B组、C组、D组间SNR、CNR两两比较均无统计学差异(P均> 0.05)。结论:对于胸部能谱CT扫描增强效果不佳的患者,在一定范围内降低单能量图像的KeV值能够改善增强效果,且能在一定程度上提高成像质量。 相似文献
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《Journal of the American College of Radiology》2020,17(6):701-709
PurposeTo date, considerable knowledge gaps remain regarding the chest CT imaging features of coronavirus disease 2019 (COVID-19). We performed a systematic review and meta-analysis of results from published studies to date to provide a summary of evidence on detection of COVID-19 by chest CT and the expected CT imaging manifestations.MethodsStudies were identified by searching PubMed database for articles published between December 2019 and February 2020. Pooled CT positive rate of COVID-19 and pooled incidence of CT imaging findings were estimated using a random-effect model.ResultsA total of 13 studies met inclusion criteria. The pooled positive rate of the CT imaging was 89.76% and 90.35% when only including thin-section chest CT. Typical CT signs were ground glass opacities (83.31%), ground glass opacities with mixed consolidation (58.42%), adjacent pleura thickening (52.46%), interlobular septal thickening (48.46%), and air bronchograms (46.46%). Other CT signs included crazy paving pattern (14.81%), pleural effusion (5.88%), bronchiectasis (5.42%), pericardial effusion (4.55%), and lymphadenopathy (3.38%). The most anatomic distributions were bilateral lung infection (78.2%) and peripheral distribution (76.95%). The incidences were highest in the right lower lobe (87.21%), left lower lobe (81.41%), and bilateral lower lobes (65.22%). The right upper lobe (65.22%), right middle lobe (54.95%), and left upper lobe (69.43%) were also commonly involved. The incidence of bilateral upper lobes was 60.87%. A considerable proportion of patients had three or more lobes involved (70.81%).ConclusionsThe detection of COVID-19 chest CT imaging is very high among symptomatic individuals at high risk, especially using thin-section chest CT. The most common CT features in patients affected by COVID-19 included ground glass opacities and consolidation involving the bilateral lungs in a peripheral distribution. 相似文献
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S. Ashtari A. Vahedian-Azimi S. Shojaee M.A. Pourhoseingholi R. Jafari F.R. Bashar M.R. Zali 《Radiologia》2021,63(4):314-323
Introduction and ObjectivesThe pivotal role of chest computed tomographic (CT) to diagnosis and prognosis coronavirus disease-2019 (COVID-19) is still an open field to be explored. This study was conducted to assess the CT features in confirmed cases with COVID-19.Materials and MethodsRetrospectively, initial chest CT data of 363 confirmed cases with COVID-19 were reviewed. All subjects were stratified into three groups based on patients’ clinical outcomes; non-critical group (n=194), critical group (n=65), and death group (n=104). The detailed of CT findings were collected from patients’ medical records and then evaluated for each group. In addition, multinomial logistic regression was used to analyze risk factors according to CT findings in three groups of patients with COVID-19.ResultsCompared with the non-critical group, mixed ground-glass opacities (GGO) and consolidation lesion, pleural effusion lesion, presence of diffuse opacity in cases, more than 2 lobes involved and opacity scores were significantly higher in the critical and death groups (P<0.05). Having more mixed GGO with consolidation, pleural effusion, lack of pure GGO, more diffuse opacity, involvement of more than 2 lobes and high opacity score identified as independent risk factors of critical and death groups.ConclusionCT images of non-critical, critical and death groups with COVID-19 had definite characteristics. CT examination plays a vital role in managing the current COVID-19 outbreak, for early detection of COVID-19 pneumonia. In addition, initial CT findings may be useful to stratify patients, which have a potentially important utility in the current global medical situation. 相似文献