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J Zhejiang Univ (Med Sci)  2020, Vol. 49 Issue (2): 191-197    DOI: 10.3785/j.issn.1008-9292.2020.02.03
    
Dynamic changes of chest CT imaging in patients with COVID-19
WANG Jincheng(),LIU Jinpeng,WANG Yuanyuan,LIU Wei,CHEN Xiaoqun,SUN Chao,SHEN Xiaoyong,WANG Qidong,WU Yaping,LIANG Wenjie,RUAN Lingxiang*()
Radiology Department, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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Abstract  

Objective: To analyze the dynamic changes of chest CT images of patients with coronavirus disease 2019 (COVID-19). Methods: Fifty-two cases of COVID-19 were admitted in the First Affiliated Hospital of Zhejiang University School of Medicine. The consecutive chest CT scans were followed up for all patients with an average of 4 scans performed per patient during the hospitalization. The shortest interval between each scan was 2 days and the longest was 7 days. The shape, number and distribution of lung shadows, as well as the characteristics of the lesions on the CT images were reviewed. Results: The obvious shadows infiltrating the lungs were shown on CT images in 50 cases, for other 2 cases there was no abnormal changes in the lungs during the first CT examination. Ground-glass opacities (GGO) were found in 48 cases (92.3%), and 19 cases (36.5%) had patchy consolidation and sub-consolidation, which were accompanied with air bronchi sign in 17 cases (32.7%). Forty one cases (78.8%) showed a thickened leaflet interval, 4 cases (7.6%) had a small number of fibrous stripes. During hospitalization, GGO lesions in COVID-19 patients gradually became rare, the fibrous strip shadows increased and it became the most common imaging manifestation. The lesions rapidly progressed in 39 cases (75.0%) within 6-9 days after admission. On days 10-14 of admission, the lesions distinctly resolved in 40 cases (76.9%). Conclusion: The chest CT images of patients with COVID-19 have certain characteristics with dynamic changes, which are of value for monitoring disease progress and clinical treatment.



Key wordsCoronavirus disease 2019      Severe acute respiratory syndrome coronavirus 2      Novel coronavirus infection      Diagnostic imaging      Tomography, X-ray computed     
Received: 15 February 2020      Published: 24 February 2020
CLC:  R512.99  
  R814.42  
Corresponding Authors: RUAN Lingxiang     E-mail: 1517018@zju.edu.cn;1190026@zju.edu.cn
Cite this article:

WANG Jincheng,LIU Jinpeng,WANG Yuanyuan,LIU Wei,CHEN Xiaoqun,SUN Chao,SHEN Xiaoyong,WANG Qidong,WU Yaping,LIANG Wenjie,RUAN Lingxiang. Dynamic changes of chest CT imaging in patients with COVID-19. J Zhejiang Univ (Med Sci), 2020, 49(2): 191-197.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2020.02.03     OR     http://www.zjujournals.com/med/Y2020/V49/I2/191


2019冠状病毒病(COVID-19)患者胸部CT影像学动态变化

目的: 探讨2019冠状病毒病(COVID-19)患者病程中胸部CT影像学表现的变化规律。方法: 收集在浙江大学医学院附属第一医院集中收治的COVID-19确诊患者52例。所有患者病程中持续胸部CT复查,人均共行4次胸部CT检查,每次检查间隔时间2~7 d。回顾性分析诊疗过程中患者CT影像学特点及随时间变化的特点。结果: 除2例患者首次胸部CT影像无异常,其余50例患者均发现肺部有不同程度的阴影。其中,表现为磨玻璃样密度影(GGO)48例(92.3%),斑片状实变、亚实变19例(36.5%),17例(32.7%)伴随出现空气支气管征,小叶间隔增粗41例(78.8%)。病程中COVID-19患者肺部GGO病变逐渐减少,纤维索条影逐渐增多,成为最常见的影像学表现。39例患者(75.0%)在入院第6~9天肺部病灶变化最明显,在入院第10~14天40例(76.9%)患者肺部病灶明显吸收。结论: COVID-19患者的胸部CT影像学表现具有一定的特征和变化规律,这在疫情防控和临床治疗决策中具有较大价值。


关键词: 2019冠状病毒病,  严重急性呼吸综合征冠状病毒2,  新型冠状病毒感染,  影像诊断,  体层摄影术, X线计算机 
Fig 1 Air bronchus signs in consolidation lesions of COVID-19 patient
Fig 2 COVID-19 patient has extensive pulmonary interstitial changes and gradual fibrosis in the lungs
距离首次CT检查时间(d) n 磨玻璃样密度影 斑片状实变、亚实变 小叶间隔增厚 纤维索条影
  COVID-19:2019冠状病毒病.
2~<6 32 27(84.4) 21(65.6) 23(71.9) 2(6.3)
6~<10 71 39(54.9) 59(83.1) 55(77.5) 23(32.4)
10~<14 77 31(40.3) 66(85.7) 68(88.3) 35(45.5)
≥14 25 9(36.0) 16(64.0) 21(84.0) 24(96.0)
Tab 1 A summary of imaging findings in COVID-19 patients at different time periods after admission [n(%)]
Fig 3 Progressive lung consolidation lesions in a COVID-19 patient
Fig 4 Dynamic CT showed pulmonary fibrosis became apparent later in hospitalization in COVID-19 patient
Fig 5 Dynamic CT showed the progression and absorption of lesion in a COVID-19 patient (the first CT examination showed consolidation)
Fig 6 Dynamic CT showed the progression and absorption of lesion in a COVID-19 patient (negative at the first CT scan)
Fig 7 The absorption begun firstly in the center of the COVID-19 lesion
Fig 8 Dynamic CT showed the sequence of lung lesion absorption and gradual pulmonary fibrosis in a COVID-19 patient
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