新型冠状病毒肺炎胸部高分辨率CT影像分期与鉴别

目的探讨新型冠状病毒肺炎(COVID-19)胸部高分辨率CT(HRCT)影像分期与鉴别。方法回顾性分析50例临床确诊为COVID-19患者的临床资料及胸部HRCT图像,HRCT图像分析内容包括:病灶分布、范围、形态、密度、实变、磨玻璃影、支气管血管束增厚等。结果 COVID-19胸部HRCT主要表现可分为早期、进展期、重症期、恢复期:1)早期双肺散在、多发斑片状、节段或亚段性磨玻璃密度影(GGO),以肺外周或胸膜下分布为主,可见空气支气管征及血管增粗穿行;2)进展期病灶范围融合增大,累及多个肺段、肺叶呈"反蝶翼"征,可见小叶间隔增厚呈"铺路石"征;少数出现胸膜增厚、胸腔积液、淋巴结肿大或小空洞;3)重症期:双肺弥漫GGO合并实变影,见支气管充气征,可至"白肺";4)恢复期病灶范围缩小,实变灶逐渐消失,部分残留纤维条索影。结论 COVID-19患者胸部HRCT具有特征性表现,其中以双肺外周、胸膜下散在磨玻璃影(GGO)最具特征,可进展至双肺实变或"白肺",治疗后病灶可吸收或残留条索影。     

75例新型冠状病毒肺炎病人首诊CT表现与检验结果分析

目的探讨新型冠状病毒肺炎(COVID-19)病人首诊胸部CT特征性表现,评价CT评分与临床检验结果的相关性。方法回顾性分析75例确诊COVID-19病人首诊胸部CT、发病时间及临床检验结果。由2名高年资影像诊断医师进行阅片,CT异常表现包括单发或多发磨玻璃影(GGO)或实变影,单肺或双肺受累,分布以胸膜下为主或肺中央为主。同时对COVID-19胸部CT表现进行半定量CT评分,采用Spearman相关分析比较CT评分与发病时间、淋巴细胞计数、中性粒细胞计数及C反应蛋白(CRP)的相关性。结果75例COVID-19首诊胸部CT正常者4例(5.33%),异常者71例(94.67%)。影像表现为多发GGO(26例,36.62%)、多发实变为主伴GGO(25例,35.21%)、多发GGO为主伴部分实变(12例,16.90%)、单发或散在GGO(8例,11.27%)。多数病人双肺受累(65例,91.55%),少数为单肺受累(6例,8.45%)。病变多位于胸膜下(66例,92.96%),少数位于肺内(5例,7.04%)。首诊CT评分与发病时间(rs=0.701,P<0.05)和CRP呈正相关(rs=0.522,P<0.05),与淋巴细胞计数呈负相关(rs=-0.303,P<0.05),与中性粒细胞计数无明显相关性(P>0.05)。结论COVID-19首诊胸部CT表现具有一定特征性,且与淋巴细胞计数、CRP有一定相关性,可能对临床预后有提示作用。     

新型冠状病毒肺炎(COVID-19)的HRCT影像诊断价值

目的探讨新型冠状病毒肺炎(COVID-19)病人临床特点及胸部高分辨CT(HRCT)影像特征,提高放射科医生对该疾病的认识。方法回顾性分析单中心24例确诊COVID-19病人的病史、临床症状及影像特点。男15例,女9例,年龄17~74岁。所有病例均行胸部HRCT检查,并由2位影像科高年资医师对其影像征象进行归纳、总结。结果24例COVID病人中18例有临床呼吸道感染症状,2例有呼吸道以外症状,无症状者4例。白细胞计数增高6例(25%)、正常6例(25%)、减少12例(50%);淋巴细胞计数增高5例(21%)、减少19例(79%);中性粒细胞增高10例(42%)、正常9例(37%)、减少5例(21%);全部病人均有C反应蛋白升高(100%)。胸部HRCT表现以两肺外带及胸膜下弥漫性分布磨玻璃影(GGO)为主,可出现肺间质改变、支气管空气征、支气管血管束增粗、铺路石征及“白肺”改变,少数病例有淋巴结肿大及少量胸腔积液。结论COVID-19病人胸部HRCT具有一定特征表现,结合临床呼吸道感染症状及流行病史,可以发挥临床早期诊断的作用。     

新型冠状病毒肺炎的多层螺旋CT表现及动态观察

目的探讨新型冠状病毒肺炎(COVID-19)的胸部影像学征象及治疗前后动态变化。方法回顾性分析18例COVID-19患者的胸部MSCT表现,观察病变的影像学特点及治疗前后动态变化。结果胸部MSCT表现及动态变化特点1)18例患者中胸部影像表现阴性2例;2)双肺分布12例(67%),累及多个肺叶9例(50%),呈外周及中心同时分布8例(44%),病灶多处13例(72%);3)病灶形态多样磨玻璃影15例(83%),实变影5例(28%),网格影5例(28%),两者以上5例(28%);4)病灶内部形态支气管血管束增粗3例(17%),血管穿行6例(33%),空气支气管征5例(28%);5)治疗前后对比观察确诊患者治疗后3天内复查实变影变淡8例(44%),磨玻璃影局部密度变实9例(50%),单发磨玻璃结节影边界变清晰、密度增高1例(6%),多发磨玻璃结节影范围增大、呈簇状改变1例(6%),网格影密度增高、范围略减小5例(28%),另有新发斑片影2例(11%);6天内复查,实变影进一步吸收、可见反晕征8例(44%),实变区域增多10例(56%),单发实性结节形成1例(6%),磨玻璃影密度进一步减低、其内血管影明显9例(50%),网格影范围减小、呈条状改变,边界清晰5例(28%),部分新发斑片影融合2例(11%),胸腔积液较前减少1例(6%);10天以上复查,肺内斑片影完全吸收18例(100%),实变影范围减小,呈纤维化改变16例(89%),实变结节密度变淡,周围见晕征1例(6%)。结论COVID-19胸部MSCT表现有一定特征性,影像学检查与诊断仍是其临床诊断、疗效评价、预后分析的重要方法。     

普通型COVID-19与轻症甲型H1N1流感肺炎病人的临床特征和CT表现比较

目的分析普通型新型冠状病毒肺炎(COVID-19)和轻症甲型H1N1流感病人临床特征和CT表现的异同。方法回顾性分析25例普通型COVID-19病人(COVID-19组)[平均(36.44±14.68)岁]和20例轻症甲型H1N1流感肺炎病人(H1N1组)[平均(51.45±22.72)岁]的临床和CT影像特征,包括病变密度、直径、部位及受累肺叶,以及病变内部特征、肺外表现的发生率及数量。采用卡方检验或Fisher确切概率法或t检验比较2组间临床资料和CT影像特征的发生率;采用Mann-Whitney U检验比较2组间不同特征的病灶数量。结果 COVID-19组病人首次CT检查时间较H1N1组短(分别为2.52±2.40、4.20±3.14 d,P0.05),平均年龄、体温、外周血中性粒细胞计数及C反应蛋白(CRP)均低于H1N1组(均P0.05)。2组病人CT影像均以GGO或GGO伴实变影表现为主,COVID-19胸部CT显示肺内实变影发生率及数量均低于H1N1组(均P0.05),但外周混合磨玻璃影、直径为1～3 cm的病灶数量多于H1N1组(均P0.05)。2组病人其他临床及CT影像特征的差异均无统计学意义(均P0.05)。结论普通型COVID-19和甲型轻症H1N1流感病人的发病年龄和发热温度有一定差异,普通型COVID-19的CT影像上更多见1～3 cm的病变,多见分布于肺野外周的混合GGO,实变影少见。     

不同人群患COVID-19的胸部CT征象：Meta分析

目的采用Meta分析评价患新型冠状病毒肺炎(COVID-19)的各类人群的CT征象,首次为COVID-19的影像诊断提供不同人群的荟萃分析。方法检索PubMed、Cochrane Library、Elsevier、CNKI中国期刊全文数据库,检索时间限定为2019年12月1日—2020年4月21日。搜集国内外关于普通成人、儿童及妊娠期确诊COVID-19者的胸部CT影像表现的文献并进行筛选。采用STATA 11软件进行Meta分析,采用Cochrane's Q检验对纳入研究的各文献进行异质性检验,并根据I2评估研究之间的异质性。计算纳入研究中各CT征象的发生率及95%置信区间(CI),绘制森林图。采用Egger's漏斗图分析发表偏倚。结果纳入60项研究共3 822例COVID-19病人。普通成人病人主要有16个征象,最多见的3个CT征象为肺磨玻璃影(GGO)(60.5%,95%CI:0.515～0.694)、血管增粗影(55.5%,95%CI:0.333～0.777)和胸膜增厚(49.7%,95%CI:0.323～0.672),肺部病灶分布特征以外带及胸膜下(67.1%,95%CI:0.589～0.752)、双肺分布(77.6%)最多见。其他少见胸部影像表现包括胸腔积液(4.9%)和淋巴结肿大(10.7%)。儿童病人主要有8个征象,最多见的3个征象为GGO合并实变(71.2%,95%CI:0.580～0.844)、GGO(39.2%,95%CI:0.270～0.513)和结节(39.1%,95%CI:-0.115～0.896),肺部病灶分布特征以外带及胸膜下(58.0%,95%CI:0.287～0.873)、双肺分布(35.4%)最多见。少见胸部影像表现为胸腔积液(6.2%,95%CI:-0.008～0.132)。妊娠期病人主要有5个征象,最多见的征象为GGO(71.0%,95%CI:0.510～0.910),其余为GGO合并实变、网格影、实变影及胸膜增厚,少见胸部影像表现为胸腔积液(38.0%)。部分CT表现漏斗图提示存在发表偏倚。结论 COVID-19的CT征象有一定的特征,普通成人及妊娠期病人的胸部CT表现比较典型,儿童病人胸部CT表现不典型并且其胸部CT改变可能早于临床症状。     

新型冠状病毒肺炎儿童高分辨率CT表现

目的 探讨儿童新型冠状病毒肺炎(COVID-19)患者高分辨率CT(HRCT)表现。方法 回顾性分析2020年1月25日至2月5日华中科技大学同济医学院附属武汉儿童医院22例经临床及核酸检测确诊为COVID-19患儿的胸部HRCT表现。其中男12例,女10例,年龄2个月~14岁,中位年龄4岁,5岁以下患儿14例。由2名放射科医师共同观察肺部病变分布、形态、密度等特征及有无肺门、纵隔淋巴结肿大及胸膜改变。结果 22例患儿中,3例(3/22)肺部CT正常,19例(19/22)肺部HRCT见病灶浸润,其中单侧肺病变7例,双侧肺病变12例。HRCT表现为:磨玻璃影6例,其中淡磨玻璃影4例、典型铺路石征磨玻璃影2例;4例呈肺实变改变,表现为局限性条索影、斑片状高密度影;6例表现为实变影与磨玻璃影共存,呈斑片状致密影夹杂周围磨玻璃影改变,其中1例呈右侧白肺表现;3例呈类支气管肺炎改变,表现为肺叶内散在点状或斑片状密度不均高密度影。下叶病灶较上叶为重,肺外后带较肺尖部、中央区多见。全部患儿均未见肺门淋巴结增大和胸腔积液,1例见叶间胸膜增厚。结论 儿童COVID-19的HRCT表现多样化,需结合流行病学资料、临床表现及实验室检测综合判断,但肺部CT表现可作为临床早期诊断和防控干预的重要依据。     

甲型H1N1流感胸部高分辨率CT表现

目的 探讨甲型H1N1流感胸部HRCT表现.方法 回顾性分析163例临床确诊为甲型H1N1流感患者的172次胸部HRCT扫描(复查9例)资料,采用标准肺窗和纵隔窗观察图像,分析胸部HRCT影像表现.结果 97例胸部HRCT未见异常,其余66例HRCT主要表现为:(1)肺实质和间质同时受累,磨玻璃密度影35例(53.0%),小叶中心结节30例(45.5%),小叶内间质及小叶间隔增厚31例(47.0%),网状结节影8例(12.1%),单小叶炎症19例(28.8%),实变15例(22.7%),肺不张3例(4.5%),条索影2例(3.0%).(2)胸膜炎症:右侧胸膜炎症8例,左侧胸膜炎症5例,双侧胸膜炎症19例.(3)纵隔淋巴结和腋窝淋巴结肿大7例.(4)抗病毒治疗后病灶吸收快.结论 甲型H1N1流感患者胸部HRCT影像表现多样,类似病毒性肺炎表现,可见肺实质和肺间质炎症、胸膜炎症和纵隔淋巴结肿大.     

艾滋病合并马红球菌肺部感染影像学表现

目的探讨获得性免疫缺陷综合征(AIDS)合并马红球菌肺部感染的影像学表现.资料与方法回顾性分析6例临床确诊的 AIDS 合并马红球菌肺部感染患者的影像资料,其中5例行胸部 CT 平扫,1例加做胸部增强扫描;1例行 DR 胸部正侧位摄片.结果6例患者影像学表现呈多样性,其中2例表现为单一结节肿块影,1例为斑片渗出影,3例合并浸润实变影、斑片状模糊影.6例中出现结节及团块实变影4例,空洞2例;斑片状渗出影4例,间质样改变2例,支气管扩张3例,纵隔淋巴结肿大2例,肺门淋巴结肿大1例,胸膜腔积液3例.结论结节肿块影、浸润实变影伴空洞、斑片状模糊影是 AIDS合并马红球菌肺部感染的常见影像表现.     

儿童甲型H1N1流感患者胸部影像表现

目的:分析儿童甲型H1N1流感患者胸部影像特点,为临床合理诊断和评价病情提供依据。方法:回顾性分析80例确诊甲型H1N1流感患者胸部影像资料及特点。患者图像资料由两位高年资医师独立阅片并达成一致意见。结果:甲型H1N1流感患者肺部影像特点8例X线表现正常;50例肺部X线表现为两肺下野斑片状影(10例病灶有融合);6例患者表现为大叶性肺炎;16例重症患者行胸部X线检查,均表现为两肺弥漫性大片状实变影,其中6例行CT平扫,表现为两肺弥漫性大片状实变影和肺间质改变;5例表现为两肺弥漫性大片状实变影者,3个月后HRCT复查显示小叶间隔增厚。结论:儿童甲型H1N1流感患者胸部影像多表现为两肺下斑片状阴影,其次为两肺弥漫大片状实变影,影像表现为正常或大叶状实质变性相对较少。     

Características en tomografía computarizada de la neumonía por coronavirus-2019 (COVID-19) en tres grupos de pacientes iraníes: estudio de un solo centro

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.     

Bronchiolitis obliterans organizing pneumonia after bone marrow transplantation: high-resolution computed tomography findings in 4 patients

OBJECTIVE: To assess the high-resolution computed tomography (HRCT) appearances of bronchiolitis obliterans organizing pneumonia (BOOP) after bone marrow transplantation (BMT). METHODS: The HRCT scans obtained in 4 patients (2 men and 2 women, age range: 20-50 years, mean age = 36 years) with biopsy-proven BOOP after BMT were reviewed retrospectively by 2 observers for the presence, extent, and distribution of parenchymal abnormalities. RESULTS: All patients demonstrated consolidation and ground-glass opacity. The consolidation was bilateral, patchy, and asymmetric in all patients and was predominantly peribronchovascular in 3 patients and subpleural and peribronchovascular in 1 patient. Ground-glass opacity was patchy and asymmetric in all patients and was bilateral in 3 patients and unilateral in 1 patient. No zonal predominance of either feature could be identified. CONCLUSIONS: The predominant HRCT features of BOOP after BMT are bilateral, patchy, and asymmetric consolidation in a predominantly peribronchovascular distribution with associated ground-glass opacity.     

Cytomegalovirus Pneumonia: High-Resolution CT Findings in Ten Non-AIDS Immunocompromised Patients

Objective

To describe the HRCT findings of cytomegalovirus (CMV) pneumonia in non-AIDS immunocompromised patients.

Materials and Methods

This retrospective study involved the ten all non-AIDS immunocompromised patients with biopsy-proven CMV pneumonia and without other pulmonary infection encountered at our Medical Center between January 1997 and May 1999. HRCT scans were retrospectively analysed by two chest radiologists and decisions regarding the findings were reached by consensus.

Results

The most frequent CT pattern was ground-glass opacity, seen in all patients, with bilateral patchy (n = 8) and diffuse (n = 2) distribution. Other findings included poorly-defined small nodules (n = 9) and consolidation (n = 7). There was no zonal predominance. The small nodules, bilateral in eight cases and unilateral in one, were all located in the centrilobular region. Consolidation (n = 7), with patchy distribution, was bilateral in five of seven patients (71%). Pleural effusion and bilateral areas of thickened interlobular septa were seen in six patients (60%).

Conclusion

CMV pneumonia in non-AIDS immunocompromised patients appears on HRCT scans as bilateral mixed areas of ground-glass opacity, poorly-defined centrilobular small nodules, and consolidation. Interlobular septal thickening and pleural effusion are frequently associated.     

Typical chest CT features can determine the severity of COVID-19: A systematic review and meta-analysis of the observational studies

BackgroundIt remains unclear whether a specific chest CT characteristic is associated with the clinical severity of COVID-19. This meta-analysis was performed to assess the relationship between different chest CT features and severity of clinical presentation in COVID-19.MethodsPubMed, Embase, Scopus, web of science databases (WOS), Cochrane library, and Google scholar were searched up to May 19, 2020 for observational studies that assessed the relationship of different chest CT manifestations and the severity of clinical presentation in COVID-19 infection. Risk of bias assessment was evaluated applying the Newcastle-Ottawa Scale. A random-effects model or fixed-effects model, as appropriately, were used to pool results. Heterogeneity was assessed using Forest plot, Cochran's Q test, and I2. Publication bias was assessed applying Egger's test.ResultsA total of 18 studies involving 3323 patients were included. Bronchial wall thickening (OR 11.64, 95% CI 1.81–74.66) was more likely to be associated with severe cases of COVID-19 infection, followed by crazy paving (OR 7.60, 95% CI 3.82–15.14), linear opacity (OR 3.27, 95% CI 1.10–9.70), and GGO (OR 1.37, 95% CI 1.08–1.73). However, there was no significant association between the presence of consolidation and severity of clinical presentation (OR 2.33, 95% CI 0.85–6.36). Considering the lesion distribution bilateral lung involvement was more frequently associated with severe clinical presentation (OR 3.44, 95% CI 1.74–6.79).ConclusionsOur meta-analysis of observational studies indicates some specific chest CT features are associated with clinical severity of COVID-19.     

High-Resolution CT Findings of Re-Expansion Pulmonary Edema

Objective

To describe the high-resolution CT (HRCT) findings of re-expansion pulmonary edema (REPE) following a thoracentesis for a spontaneous pneumothorax.

Materials and Methods

HRCT scans from 43 patients who developed REPE immediately after a thoracentesis for treatment of pneumothorax were retrospectively analyzed. The study group consisted of 41 men and two women with a mean age of 34 years. The average time interval between insertion of the drainage tube and HRCT was 8.5 hours (range, 1-24 hours). The patterns and distribution of the lung lesions were analyzed and were assigned one of the following classifications: consolidation, ground-glass opacity (GGO), intralobular interstitial thickening, interlobular septal thickening, thickening of bronchovascular bundles, and nodules. The presence of pleural effusion and contralateral lung involvement was also assessed.

Results

Patchy areas of GGO were observed in all 43 patients examined. Consolidation was noted in 22 patients (51%). The geographic distribution of GGO and consolidation was noted in 25 patients (58%). Interlobular septal thickening and intralobular interstitial thickening was noted in 28 patients (65%), respectively. Bronchovascular bundle thickening was seen in 13 patients (30%), whereas ill-defined centrilobular GGO nodules were observed in five patients (12%). The lesions were predominantly peripheral in 38 patients (88%). Of these lesions, gravity-dependent distribution was noted in 23 cases (53%). Bilateral lung involvement was noted in four patients (9%), and a small amount of pleural effusion was seen in seven patients (16%).

Conclusion

The HRCT findings of REPE were peripheral patchy areas of GGO that were frequently combined with consolidation as well as interlobular septal and intralobular interstitial thickening.