Multistage CT features of coronavirus disease 2019

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2020 Mar 28;45(3):250-256. doi: 10.11817/j.issn.1672-7347.2020.200144.
[Article in English, Chinese]


Objectives: To determine imaging features of coronavirus disease 2019 (COVID-19) in different stages, and to provide foundations for early diagnosis and treatment.

Methods: CT image data of 187 COVID-19 patients were analyzed in the period of hospitalization. CT scanning was performed on admission and repeated every 3 days. The improvement time of clinical symptoms and the image changes of follow-up CT were statistically analyzed.

Results: All 187 patients' nucleic acid test were positive to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The early CT images of lung in 187 cases (100%) showed multiple patchy and ground-glass opacities with fine mesh and consolidation shade, which mainly distributed in pulmonary band or under the pleura. In the progressive stage, the pulmonary lesions in 146 cases (78.1%) were mainly consolidation, accompanied by air bronchogram, thickening of blood vessels, and interstitial changes. Severe pulmonary CT images in 15 cases (8%) showed diffuse lesions in both lungs, displaying consolidation, or "white lung". The CT imaging features in 185 cases (98.9%) at the absorptive period showed that the lesions diminished and fibrogenesis. The imaging features of 6 times of lung CT examination in one case showed continuous progress. The original lesion in one case was obviously absorbed, but new lesions appeared under the pleura of both lungs at the third review of CT scanning. The changes of CT imaging lesions during follow-up were significantly different in different clinical symptoms improvement time (P< 0.01).

Conclusions: Images of COVID-19 in various stages have special characteristics. The change of clinical symptoms is synchronous with the change of reexamination CT. Follow-up CT can reflect the trend of clinical changes. Repeat CT examination plays an important role in the early clinical diagnosis and the evaluation for the therapeutic effect on COVID-19 patient.

目的: 通过多阶段观察2019冠状病毒病(coronavirus disease 2019,COVID-19)患者的CT影像学表现,研究COVID-19各期CT影像学特征,为临床早期诊断和治疗提供依据。方法: 回顾性分析经病原学确诊的187例COVID-19患者入院时及住院期间每3 d复查1次肺部CT的影像学资料,并对临床症状改善时间与随访CT的病灶变化时间进行统计学分析。结果: 187例患者核酸检测均为严重急性呼吸综合征冠状病毒2阳性,肺部CT均出现肺部炎性改变。187例(100%)的患者早期肺部CT影像学表现为多发斑片状、片状磨玻璃影伴细小网格影及实变影,病灶主要分布在肺外带或胸膜下。146例(78.1%)进展期患者的肺部CT影像学表现以实变为主,伴支气管充气征、局部血管增粗、间质改变。15例(8%)重症期患者的肺部CT影像学表现双肺弥漫性病变呈现实变表现,少数呈“白肺”表现。185例(98.9%)消散期患者肺部CT影像学表现为病变范围缩小、纤维灶形成;1例连续复查6次肺部CT提示病变持续进展;1例原病变明显吸收,第3次复查时双肺胸膜下出现新发病变。随访时CT影像学变化时间与不同的临床症状改善时间比较,差异具有统计学意义(P<0.01)。结论: COVID-19各期的CT影像学表现具有一定的特征;临床症状变化与复查CT影像学变化同步,随访CT能够反映临床变化的趋势,因此对患者进行多阶段CT影像学表现的观察在临床COVID-19的早期诊断和治疗评估中有重要作用。.

Keywords: computer tomography; corona virus disease 2019; severe acute respiratory syndrome coronavirus 2.

MeSH terms

  • Betacoronavirus*
  • COVID-19
  • Coronavirus Infections / diagnostic imaging*
  • Humans
  • Pandemics
  • Pneumonia, Viral / diagnostic imaging*
  • SARS-CoV-2
  • Tomography, X-Ray Computed