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浙江大学学报(医学版)  2020, Vol. 49 Issue (2): 198-202    DOI: 10.3785/j.issn.1008-9292.2020.03.05
原著     
2019冠状病毒病(COVID-19)不同临床分型患者胸部CT影像学特征
钟琦1,2(),李志1,沈晓勇1,徐凯进3,沈毅弘4,方强5,陈峰1,*(),梁廷波6
1. 浙江大学医学院附属第一医院放射科, 浙江 杭州 310003
2. 杭州市中医院放射科, 浙江 杭州 310007
3. 浙江大学医学院附属第一医院感染科, 浙江 杭州 310003
4. 浙江大学医学院附属第一医院呼吸内科, 浙江 杭州 310003
5. 浙江大学医学院附属第一医院重症医学科, 浙江 杭州 310003
6. 浙江大学医学院附属第一医院肝胆胰外科, 浙江 杭州 310003
CT imaging features of patients with different clinical types of COVID-19
ZHONG Qi1,2(),LI Zhi1,SHEN Xiaoyong1,XU Kaijin3,SHEN Yihong4,FANG Qiang5,CHEN Feng1,*(),LIANG Tingbo6
1. Department of Radiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
2. Department of Radiology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310007, China
3. Department of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
4. Department of Respiratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
5. Intensive Care Unit, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
6. Department of Hepatopancreatobiliary Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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摘要:

目的: 探讨2019冠状病毒病(COVID-19)不同临床分型患者的胸部CT影像学特征。方法: 收集经核酸检测确诊为COVID-19的患者67例,根据《新型冠状病毒感染肺炎诊疗方案(试行第六版)》对患者进行临床分型,其中轻型3例,普通型35例,重型22例,危重型7例。分析和比较不同临床分型患者的胸部CT影像学特征。结果: 轻型患者胸部CT影像学检查无明显异常。普通型患者中,单发病灶3例(8.6%),多发病灶32例(91.4%);重型患者中,单发病灶1例(4.5%),多发病灶21例(95.5%);危重型患者均为多发病灶。普通型患者胸部CT影像以实性斑片影伴晕征为主要表现(18/35,51.4%);重型患者以条索影伴磨玻璃影为主要表现(7/22,31.8%);以实变影为主要表现共7例,全部为重型或危重型患者。结论: COVID-19不同临床分型患者胸部CT影像学有特征性表现,以实变影为主要病灶的影像学特征可作为重型和危重型患者的指征之一。

关键词: 2019冠状病毒病严重急性呼吸综合征冠状病毒2新型冠状病毒肺炎影像诊断体层摄影术, X线计算机    
Abstract:

Objective: To investigate the CT findings of patients with different clinical types of coronavirus disease 2019 (COVID-19). Methods: A total of 67 patients diagnosed as COVID-19 by nucleic acid testing were collected and divided into 4 groups according to the clinical stages based on Diagnosis and treatment of novel coronavirus pneumonia (trial version 6). The CT imaging characteristics were analyzed among patients with different clinical types. Results: Among 67 patients, 3(4.5%) were mild, 35 (52.2%) were moderate, 22 (32.8%) were severe, and 7(10.4%) were critical ill. No significant abnormality in chest CT imaging in mild patients. The 35 cases of moderate type included 3 (8.6%) single lesions, the 22 cases of severe cases included 1 (4.5%) single lesion and the rest cases were with multiple lesions. CT images of moderate patients were mainly manifested by solid plaque shadow and halo sign (18/35, 51.4%); while fibrous strip shadow with ground glass shadow was more frequent in severe cases (7/22, 31.8%). Consolidation shadow as the main lesion was observed in 7 cases, and all of them were severe or critical ill patients. Conclusion: CT images of patients with different clinical types of COVID-19 have characteristic manifestations, and solid shadow may predict severe and critical illness.

Key words: Coronavirus disease 2019    Severe acute respiratory syndrome coronavirus 2    Novel coronavirus pneumonia    Diagnostic imaging    Tomography, X-ray computed
收稿日期: 2020-02-26 出版日期: 2020-03-11
:  R512.99  
通讯作者: 陈峰     E-mail: y215180184@zju.edu.cn;chenfenghz@zju.edu.cn
作者简介: 钟琦(1986-), 男, 硕士研究生, 主治医师, 主要从事胸腹部影像学研究; E-mail:y215180184@zju.edu.cn; https://orcid.org/0000-0003-0039-0048
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引用本文:

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.

ZHONG Qi,LI Zhi,SHEN Xiaoyong,XU Kaijin,SHEN Yihong,FANG Qiang,CHEN Feng,LIANG Tingbo. CT imaging features of patients with different clinical types of COVID-19. J Zhejiang Univ (Med Sci), 2020, 49(2): 198-202.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2020.03.05        http://www.zjujournals.com/med/CN/Y2020/V49/I2/198

分 型 n 胸膜下 支气管
血管束旁
胸膜下及支
气管血管束旁
弥漫性
  COVID-19:2019冠状病毒病.
普通型 35 15(42.9) 1(2.9) 19(54.3) 0(0.0)
重型 22 3(13.6) 0(0.0) 16(72.7) 3(13.6)
危重型 7 0(0.0) 0(0.0) 5(71.4) 2(28.6)
表 1  COVID-19不同临床分型患者胸部CT影像学病灶分布
分 型 n 实性斑片
影伴晕征
铺路石样
磨玻璃影
单纯斑片状
磨玻璃影
弥漫性磨
玻璃影
条索影伴
磨玻璃影
实变影为主 沿支气管血管束分布
的小结节(小于10mm)伴晕征
  COVID-19:2019冠状病毒病.
普通型 35 18(51.4) 5(14.3) 6(17.1) 0(0.0) 5(14.3) 0(0.0) 1(2.9)
重型 22 4(18.2) 4(18.2) 1(4.5) 1(4.5) 7(31.8) 5(22.7) 0(0.0)
危重型 7 0(0.0) 3(42.9) 0(0.0) 2(28.6) 0(0.0) 2(28.6) 0(0.0)
表 2  COVID-19不同临床分型患者胸部CT影像学特征
图 1  2019冠状病毒病患者胸部CT影像学表现
1 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].国卫办医涵[2020] 145号.(2020-02-18)[2020-02-28].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)[2020-02-28]. http://www.nhc.gov.cn/yzygj/s7653p/202002/8334a8326dd94d329df351d7da8aefc2.shtml. (in Chinese)
2 AI T , YANG Z L , ZHAN H Y et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019(COVID-19) in China:a report of 1014 cases[J]. Radiology, 2020,
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3 中华医学会放射学分会 . 新型冠状病毒肺炎的放射学诊断:中华医学会放射学分会专家推荐意见(第一版)[J]. 中华放射学杂志, 2020, 54
Chinese Society of Radiology . Radiological diagnosis of new coronavirus infected pneumonitis:expert recommendation from the chinese society of radiology (first edition)[J]. Chinese Journal of Radiology, 2020, 54
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