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Chest CT features of 105 patients with COVID-19: a multicenter retrospective study in Shandong Province
- CHENG Zhaoping, DUAN Yanhua, YAO Jinkun, LI Yan, GU Hui, YUAN Xianshun, LIU Bin, BI Wanli, SONG Zhaoliang, NIE Pei, CHEN Yueqin, SUN Zhanguo, LIU Shanping, WANG Luguang, TANG Zhongren, WEI Xianglei, DONG Liang, WANG Chunting, WANG Ximing
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Journal of Shandong University (Health Sciences). 2020, 58(5):
38-45.
doi:10.6040/j.issn.1671-7554.0.2020.541
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Objective To explore the chest CT features of patients with coronavirus disease 19(COVID-19)and the clinical application value. Methods The epidemiological, clinical and chest CT data of 105 COVID-19 cases confirmed by nucleic acid test in accordance with Diagnosis and Treatment of Novel Coronavirus Pneumonia(trial version sixth)who were treated and cured(or died)during Jan. and Mar. 2020 were retrospectively analyzed. The patients included 92 common cases and 13 severe or critical cases, averaged 48±14(21-88)years old. The basic and dynamic characteristics of chest CT images were analyzed and compared between the two groups. Results All patients had a clear epidemiological history. The main initial clinical symptoms were fever(85%, 90/105), cough and expectoration(72%, 75/105). Both leucocyte count(11%, 12/105)and lymphocyte count(38%, 40/105)were decreased. Chest CT showed that in the early stage, multiple ground glass opacity(GGO, 98%)was observed in bilateral lungs involving 3 lobes(2, 5)in average, mainly distributed in the middle and outer zone of the lung under pleura; in the progressive stage, GGO consolidated(96%), with interlobular septal thickening(64%), paving stone sign(42%), reactive pleura thickening(23%), pleural effusion(3 cases), pneumothorax(1 case); in the recovery stage, fibrous streak sign was observed(49%). Another important feature was typical air bronchogram sign(ABS, 41%)and microvascular dilation sign(MVDS, 40%)in the extrapulmonary zone. Compared with the common cases, the severe cases had more lobes involved (P<0.001), higher semi-quantitative score (P<0.001), and higher incidences of paving stone sign(85% vs 34%, P=0.001), interlobular septal thickening(92% vs 61%, P=0.029), pleural thickening(69% vs 16%, P<0.001), and fibrous streak sign(85% vs 43%, P=0.007). Dynamic image analysis showed that in the initial stage, positive image manifested later than clinical symptoms: chest CT showed positive signs of the disease on day 5(5, 6), the disease progressed on day 5(5, 7)until day 11(10, 14), and showed possible outcome after another 12(11, 15)days. The span between progression and outcome was related to the severity of disease, and CT outcome was delayed after nucleic acid test was negative. Conclusion COVID-19 shows some specific manifestations on chest CT, characterized by GGO, dynamic evolution, ABS and MVDS. The above manifestations and semi-quantitative evaluation can provide reliable basis for the early diagnosis, clinical classification and prognosis evaluation of COVID-19.
