Please wait a minute...
浙江大学学报(医学版)  2020, Vol. 49 Issue (2): 191-197    DOI: 10.3785/j.issn.1008-9292.2020.02.03
原著     
2019冠状病毒病(COVID-19)患者胸部CT影像学动态变化
王锦程(),刘锦鹏,王园园,刘伟,陈小群,孙超,沈晓勇,汪启东,吴亚平,梁文杰,阮凌翔*()
浙江大学医学院附属第一医院放射科, 浙江 杭州 310003
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
 全文: PDF(12251 KB)   HTML( 85 )
摘要:

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    
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 words: Coronavirus disease 2019    Severe acute respiratory syndrome coronavirus 2    Novel coronavirus infection    Diagnostic imaging    Tomography, X-ray computed
收稿日期: 2020-02-15 出版日期: 2020-02-24
:  R512.99  
基金资助: 国家重点研发计划(2016YFC0104510)
通讯作者: 阮凌翔     E-mail: 1517018@zju.edu.cn;1190026@zju.edu.cn
作者简介: 王锦程(1990-), 男, 硕士, 住院医师, 主要从事胸腹部影像学研究; E-mail:1517018@zju.edu.cn; https://orcid.org/0000-0003-4676-309X
服务  
把本文推荐给朋友
加入引用管理器
E-mail Alert
RSS
作者相关文章  
王锦程
刘锦鹏
王园园
刘伟
陈小群
孙超
沈晓勇
汪启东
吴亚平
梁文杰
阮凌翔

引用本文:

王锦程,刘锦鹏,王园园,刘伟,陈小群,孙超,沈晓勇,汪启东,吴亚平,梁文杰,阮凌翔. 2019冠状病毒病(COVID-19)患者胸部CT影像学动态变化[J]. 浙江大学学报(医学版), 2020, 49(2): 191-197.

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.

链接本文:

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

图 1  COVID-19患者实变病灶内出现空气支气管征
图 2  COVID-19患者CT显示大范围肺间质改变及纤维化演变
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)
表 1  COVID-19患者入院后不同时间段胸部CT影像学表现频次
图 3  COVID-19患者CT复查显示肺部实变进展
图 4  COVID-19患者病程后期CT复查肺纤维化明显
图 5  COVID-19患者CT复查显示肺部阴影进展和吸收(首次CT检查呈实变表现)
图 6  COVID-19患者CT复查显示肺部病灶进展和吸收(首次CT检查阴性)
图 7  COVID-19患者CT扫描横断位(A)和冠状位(B)图像显示病灶吸收首先从中心开始
图 8  COVID-19患者CT显示肺部病灶出现顺序及纤维化过程
1 LI Q , GUAN X , WU P et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia[J]. N Engl J Med, 2020, 382 1199- 1207
doi: 10.1056/NEJMoa2001316
2 FANG Y C , ZHANG H Q , XU Y Y et al. CT manifestations of two cases of 2019 novel coronavirus (2019-nCoV) pneumonia[J]. Radiology, 2020, 295 208- 209
doi: 10.1148/radiol.2020200280
3 金银华, 陈斌, 张景峰 et al. 胸部CT影像学在新型冠状病毒肺炎疫情防控中的价值[J]. 现代实用医学, 2020, 32 (2):
JIN Yinhua , CHEN Bin , ZHANG Jingfeng et al. Value of chest CT imaging in prevention and control of novel coronavirus pneumonia epidemic[J]. Modern Practical Medicine, 2020, 32 (2):
4 中华人民共和国国家卫生健康委员会办公厅, 国家中医药管理局办公室.新型冠状病毒感染的肺炎诊疗方案(试行第六版)[A/OL].国卫办医函[2020] 145号.(2020-02-18)[2020-02-23].http://www.nhc.gov.cn/yzygj/s7653p/202002/8334a8326dd94d329df351d7da8aefc2.shtml.
General Office of National Health Commission of the People's Republic of China, Office of National Administration of Traditional Chinese Medicine. Diagnosis and treatment of novel coronavirus pneumonia (trial version 6)[A/OL]. No.145[2020] of the General Office of the National Health Commission. (2020-02-18)[2020-02-23]. http://www.nhc.gov.cn/yzygj/s7653p/202002/8334a8326dd94d329df351d7da8aefc2.shtml. (in Chinese)
5 LIU Y , GAYLE A A , WILDER-SMITH A et al. The reproductive number of COVID-19 is higher compared to SARS coronavirus[J]. J Travel Med, 2020, 27 (2): taaa021
doi: 10.1093/jtm/taaa021
6 ZHU N , ZHANG D , WANG W et al. Anovel coronavirus from patients with pneumonia in China, 2019[J]. N Engl J Med, 2020, 382 727- 733
doi: 10.1056/NEJMoa2001017
7 GUPTA K K , KHAN M A , SINGH S K . Constitutive inflammatory cytokine storm:a major threat to human health[J]. J Interferon Cytokine Res, 2020, 40 (1): 19- 23
8 PAN Y , GUAN H , ZHOU S et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV):a study of 63 patients in Wuhan, China[J]. Eur Radiol, 2020,
doi: 10.1007/S00330-020-06731-X
9 YIN Y , WUNDERINK R G . MERS, SARS and other coronaviruses as causes of pneumonia[J]. Respirology, 2018, 23 (2): 130- 137
doi: 10.1111/resp.13196
10 OOI G C , DAQING M . SARS:radiological features[J]. Respirology, 2003, 8 (Suppl): S15- S19
doi: 10.1046/j.1440-1843.2003.00519.x
11 PAUL N S , ROBERTS H , BUTANY J et al. Radiologic pattern of disease in patients with severe acute respiratory syndrome:the Toronto experience[J]. Radiographics, 2004, 24 (2): 553- 563
doi: 10.1148/rg.242035193
12 杜湘珂, 郁万江, 王思伦 et al. SARS的临床与影像分析[J]. 中华放射学杂志, 2003, 37 (9): 780- 783
DU Xiangke , YU Wanjiang , WANG Silun et al. Preliminary analysis of clinical images of SARS[J]. Chinese Journal of Radiology, 2003, 37 (9): 780- 783
doi: 10.3760/j.issn:1005-1201.2003.09.003
13 王仁贵, 孙洪跃, 宋鲁新 et al. 112例SARS急性期的X线和CT表现特征分析[J]. 北京大学学报(医学版), 2003, 35 (1): 29- 33
WANG Rengui , SUN Hongyue , SONG Luxin et al. Plain radiograph and CT features of 112 patients with SARS in acute stage[J]. Journal of Peking University (Health Sciences), 2003, 35 (1): 29- 33
doi: 10.3321/j.issn:1671-167X.2003.z1.011
[1] 陈志敏,傅君芬,舒强,汪伟,陈英虎,华春珍,李甫棒,林茹,唐兰芳,汪天林,王颖硕,徐玮泽,杨子浩,叶盛,袁天明,张晨美,张园园. 儿童2019冠状病毒病(COVID-19)诊疗指南(第二版)[J]. 浙江大学学报(医学版), 2020, 49(2): 139-146.
[2] 徐凯进,蔡洪流,沈毅弘,倪勤,陈瑜,胡少华,李剑平,王华芬,俞亮,黄河,裘云庆,魏国庆,方强,周建英,盛吉芳,梁廷波,李兰娟. 2019冠状病毒病(COVID-19)诊疗浙江经验[J]. 浙江大学学报(医学版), 2020, 49(2): 147-157.
[3] 姜赛平,李璐,茹仁萍,张春红,饶跃峰,林彬,王融溶,陈娜,王小娟,蔡洪流,盛吉芳,周建英,卢晓阳,裘云庆. 2019冠状病毒病(COVID-19)重型、危重型患者用药管理经验[J]. 浙江大学学报(医学版), 2020, 49(2): 158-169.
[4] 李鑫,代甜,王虹,石军年,袁薇,栗静,陈利军,张天明,张珊珊,孔焱,岳宁,时慧,何玉苹,胡惠芳,柳芙蓉,杨彩霞. 2019冠状病毒病(COVID-19)疑似患者合并焦虑和抑郁的临床分析[J]. 浙江大学学报(医学版), 2020, 49(2): 203-208.
[5] 骆嵩,杨丽娟,王春,刘传苗,李殿明. 血浆置换和托珠单抗治疗六例2019冠状病毒病(COVID-19)重型患者临床分析[J]. 浙江大学学报(医学版), 2020, 49(2): 227-231.
[6] 洪东升,倪剑,单文雅,李璐,胡希,羊红玉,赵青威,张幸国. 基于监测数据的药物不良反应快速识别及R语言实现[J]. 浙江大学学报(医学版), 2020, 49(2): 253-259.
[7] 钟琦,李志,沈晓勇,徐凯进,沈毅弘,方强,陈峰,梁廷波. 2019冠状病毒病(COVID-19)不同临床分型患者胸部CT影像学特征[J]. 浙江大学学报(医学版), 2020, 49(2): 198-202.
[8] 康仙慧,张荣,何慧梁,姚永兴,郑跃英,温小红,祝胜美. 一例妊娠合并2019冠状病毒病(COVID-19)患者的剖宫产麻醉管理[J]. 浙江大学学报(医学版), 2020, 49(2): 249-252.
[9] 陈旭,李央,王金希,蔡洪流,曹红翠,盛吉芳. 三例妊娠合并2019冠状病毒病(COVID-19)患者诊治分析[J]. 浙江大学学报(医学版), 2020, 49(2): 240-244.
[10] 沈利华,黄菲,陈祥,熊钻,杨晓玉,李慧,程丰,郭健,龚国富. 严重急性呼吸综合征冠状病毒2(SARS-CoV-2)核酸检测试剂盒临床诊断效能评估[J]. 浙江大学学报(医学版), 2020, 49(2): 185-190.
[11] 张胜,李丹萍,陈华忠,郑丹,周益萍,陈葆国,石卫武,林荣海. 糖皮质激素治疗一例2019冠状病毒病(COVID-19)危重型患者炎症反应动态观察[J]. 浙江大学学报(医学版), 2020, 49(2): 220-226.
[12] 李游江,胡瑛瑛,张晓东,喻员员,李斌,吴建国,吴英萍,夏肖萍,徐键. 七例2019冠状病毒病(COVID-19)普通型患者出院后病毒核酸随访结果[J]. 浙江大学学报(医学版), 2020, 49(2): 270-274.
[13] 叶子奇,洪昀,吴秀华,洪东升,张燕芳,董曦浩,饶跃峰,卢晓阳. 一例肿瘤合并2019冠状病毒病(COVID-19)患者的治疗决策分析[J]. 浙江大学学报(医学版), 2020, 49(2): 245-248.
[14] 丁叔波,俞世安,陈海君,张德和,徐叶进,朱丹,陈琨. 2019冠状病毒病(COVID-19)疑似患者多学科协作诊治分析[J]. 浙江大学学报(医学版), 2020, 49(2): 209-214.
[15] 何国军,韩一骄,方强,周建英,盛吉芳,李彤,浦其斌,陈爱君,戚志洋,孙丽君,蔡洪流. 经鼻高流量氧疗应用于2019冠状病毒病(COVID-19)重型患者的临床经验[J]. 浙江大学学报(医学版), 2020, 49(2): 232-239.