表现为磨玻璃影的新型冠状病毒肺炎和早期肺肿瘤的CT影像学对比研究

目的回顾性分析以磨玻璃影(GGO)为表现的新型冠状病毒(2019-nCoV,SARS-CoV-2)肺炎(COVID-19)与早期肺肿瘤的CT影像学特点,以指导抗疫防治工作。方法回顾性纳入华中科技大学同济医学院附属同济医院2020年1月17日至2月13日收治的CT表现为GGO的COVID-19临床诊断71例患者,作为COVID-19组;以2017年9月至2019年5月收治的CT表现为GGO并行手术切除、术后病理证实为早期肺肿瘤患者80例作对照,为早期肺肿瘤组。分析两组患者性别、年龄、就诊症状(发热、咳嗽、乏力、肌痛、呼吸困难)、流行病学史、SARS-CoV-2核酸检测结果、肺肿瘤术后病理结果的临床特征及包括病灶数量、病灶位置、最大直径的CT影像特征。结果相比早期肺肿瘤组,COVID-19组具有特异性临床症状和流行病学史(P<0.001),而在高分辨率CT(high resolution CT,HRCT)上多表现为2个以上病灶(61例,85.92%,P<0.001),主要分布在双肺的外周1/2带(69例,97.18%,P<0.001),病灶形态多为最大径>1 cm的较大片状(65例,91.55%,P<0.001)。COVID-19组在病程初期与早期肺肿瘤组形态相似,但随着病程进展则出现融合实变,可能出现GGO样的COVID-19和早期肺肿瘤共存的现象。结论以GGO为表现的COVID-19与早期肺肿瘤在CT影像上具有既相似又独立的特征。充分了解两者的影像特点并结合患者病史、实验室检验和确诊金标准、短期复查CT协助评估,有利于实现应收尽收、减少交叉感染,打赢疫情防控阻击战。

Chest CT comparison of ground glass opacity-like 2019 novel coronavirus pneumonia and early-stage lung carcinoma

Objective To investigate CT image features of ground glass opacity(GGO)-like 2019 novel coronavirus(2019-nCoV,SARS-CoV-2)pneumonia(COVID-19)and early-stage lung carcinoma for control and therapy of this acute severe respiratory disease.Methods We retrospectively analyzed the clinical data of 71 GGO-like COVID-19 patients who received therapy in Tongji Hospital of Huazhong University of Science and Technology between January17 th and February 13 th,2020.These 71 GGO-like COVID-19 patients were as a COVID-19 group.And 80 GGO-like earlystage lung carcinoma patients who underwent resection were as a lung carcinoma group.Clinical features such as sex,age,symptoms including fever,cough,fatigue,myalgia and dyspnea,detailed exposure history,confirmatory test(SARS-CoV-2 quantitative RT-PCR)and pathologic diagnosis were analyzed.Results Significantly different symptoms and exposure history between the two groups were detected(P<0.001).More lesions(61 patients at percentage of 85.92%,P<0.001),relative peripheral locations(69 patients at percentage of 97.18%,P<0.001)and larger opacities(65 patients at percentage of 91.55%,P<0.001)were found in chest radiographs of GGO-like COVID-19 compared with GGO-like early-stage lung carcinoma.Similar features appeared in early-stage of COVID-19 and lung carcinoma,while pneumonia developed into more extensive and basal predominant lung consolidation.Coexistence of GGO-like COVID-19 and early-stage lung carcinoma might occur.Conclusion Considering these similar and unique features of GGO-like COVID-19 and earlystage lung carcinoma,it is necessary to understand short time re-examination of chest radiographs and other diagnostic methods of these two diseases.We believe that the findings reported here are important for diagnosis and control of COVID-19 in China.