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。

Value of HRCT in diagnosis of COVID-19

Objective To investigate the clinical features and imaging characteristics on chest high-resolution CT(HRCT)of COVID-19,so as to improve the radiologists’understanding of the disease.Methods The medical history,clinical symptoms and imaging characteristics of 24 confirmed COVID-19 patients from a single center were retrospectively analyzed.There were 15 males and 9 females,aged 17 to 74 years.All cases underwent chest HRCT examination,and their imaging signs were summarized by 2 senior radiologists.Results Of the 24 patients,18 had clinical symptoms of respiratory tract infection,2 had symptoms other than respiratory tract,and 4 had asymptomatic.Increased white blood cell count in 6 cases(25%),normal in 6 cases(25%),decreased in 12 cases(50%);increased lymphocyte count in 5 cases(21%),decreased in 19 cases(79%);increased neutrophils in 10 patients(42%),normal in 9 patients(37%),and decreased in 5 patients(21%);all patients had elevated C-reactive protein(100%).The main chest HRCT manifestation was diffuse ground glass opacity(GGO)in the peripheral zone of the lungs and under the pleura.Pulmonary interstitial changes,bronchial air signs,bronchial vascular bundle thickening,paving stone signs,and“white lung”changes appeared in some cases.A few cases have enlarged lymph nodes and a small amount of pleural effusion.Conclusion The COVID-19 has certain characteristics on chest HRCT.Combined with clinical symptoms and epidemiological history of respiratory infections,chest HRCT has early clinical diagnosis value.