SARS的X线平片与CT诊断

目的评价平片和CT检查在严重急性呼吸综合征(SARS)的诊断价值.方法回顾性分析29例临床诊断SARS的患者,对发病后的一系列胸片和CT影像进行分析.结果胸片显示SARS患者早期出现肺部局灶性斑片状模糊影,并进行性扩大,有82.8%(24/29)的患者最后病变累及两肺大部分区域.CT显示起病初期以肺实变为主的影像表现.中期表现为肺间质增厚,呈网格状,并肺实变影.恢复期肺间质增厚,呈细网状.部分患者遗留肺纤维化病灶.结论SARS同时存在急性肺炎和急性间质性肺炎的影像改变,在治疗过程中,一系列胸片检查有助于掌握病情的变化,CT检查能较准确的评价肺部病变.

Chest X - ray and CT in diagnosis of severe acute respiratory syndrome

Objective To evaluate characteristic change and diagnostic value of chest roentgenography and CT in severe acute respiratory syndrome (SARS). Methods Serial roentgenography and CT findings in 29 confirmed SARS patients were retrospectively analyzed. Results On roentgenography, the main abnormality was unilateral or bilateral localized patchy clouding opacity in the early phase of SARS(within one week) . The opacity progressed quickly into other parts of the lung field over time. In 24 out of 29 cases (82.8 % ) , the lesion developed into bilateral diffuse opacity involving most of the lungs in the fully advanced phase. Some lesions presented as diffuse small patches, while some other lesions as fused large patches with high density in the center and low density in the peripheral regions associated with air bronchium sign. According to the extent of the lesion involvement at the advanced phase, the lesion was classified into mild, moderate, and severe. The main CT findings in 4 cases were multiple patchy local consolidations in bilateral lungs with blurred margin and air bronchium in the early phase (1 to 10 days after onset). CT findings in 9 cases showed bilateral ground - glass changes and interstitial thickening together with mesh appearance and consolidation in the middle phase (10 to 30 days) . CT findings revealed interstitial thickening and fine mesh appearance in 17 cases and normal in 2 cases in the recovery phase ( after 30 days) . Local fibrosis of the lungs was found in some cases after recovery in the follow - up examination. Conclusion There were radiological changes of both acute pneumonia and acute interstitial inflammation in SARS. Serial chest roentgenography was useful in the diagnosis and for the severity assessment of SARS. CT scan could provide more accurate assessment of the pathology of the lungs.