The Value of Digital DR Bedside Chest Radiography and Chest CT Scanning in the Diagnosis of Severe Novel Coronavirus Pneumonia
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摘要: 目的：探讨数字床旁胸部摄影（简称床旁胸片）与胸部CT扫描在重症新型冠状病毒肺炎中的影像学表现和临床诊断中的应用价值。方法：回顾性调取分析2022年12月10日至2023年1月10日首都医科大学附属北京世纪坛医院确诊收治的43例新型冠状病毒肺炎患者的影像学与临床资料；依据实验室诊断和临床划分新冠肺炎的标准，多学科专家联合诊断，入组43例患者均为重症新型冠状病毒肺炎感染患者；43例患者均进行床旁胸片摄影，其中6例患者在症状相对平缓的前提下进行胸部CT扫描；床旁胸片复查时间间隔1～5 d，复查次数1～4次；胸部CT扫描复查时间间隔1～4 d，复查次数2次；观察分析受检者胸片和胸部CT扫描的影像学图像表现。结果：43例重症新型冠状病毒肺炎患者首次床旁胸片示双肺斑片状实变影并累计两个肺野以上者25例，双肺胸腔积液6例，单侧肺部渗出实变影18例，单侧胸腔积液4例，心外形增大合并肺水肿7例，疑似肺内肿瘤团块影2例；6例接受胸部CT扫描患者双肺多发磨玻璃影6例，斑片影，网格状影，叶间隔增厚，病变区域内可见肺血管及亚支气管增粗；复查床旁胸片双肺斑片密度增高影面积扩大5例，新增胸腔积液2例；复查胸部CT扫描示磨玻璃影增多转变为不规则斑片状高密度影4例，新增肺不张1例，新增胸腔积液1例。结论：床旁胸片和胸部CT扫描是诊断新型冠状病毒肺炎首要的影像学检查手段，前者在重症患者不能进行胸部CT扫描时起到重要的辅助诊断作用，在后期复查和临床随访病情中提供较大帮助。
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关键词:
- 重症新型冠状病毒肺炎 /
- 数字床旁胸部摄影 /
- 胸部CT扫描
Abstract: Objective: To investigate the applicability of DR Bedside chest radiography and chest computed tomography (CT) scanning for the imaging and clinical diagnosis of severe novel coronavirus pneumonia. Methods: Imaging and clinical data of 43 patients with novel coronavirus pneumonia who were admitted to Beijing Shijitan Hospital Affiliated to Capital Medical University from December 10, 2022 to January 10, 2023 were retrospectively analyzed. Joint diagnoses by multidisciplinary experts according to the clinical and laboratory diagnosis criteria confirmed that all the 43 enrolled patients were severely infected with novel coronavirus pneumonia. All 43 patients underwent digital DR Bedside chest radiography; of these, 6 patients underwent chest CT scanning as they had relatively mild symptoms. The time interval for chest X-ray reexamination was 1~5 days, with 1~4 reexaminations. The chest CT scan review interval was 1~4 days, with 2 reviews. The imaging findings of chest radiography and chest CT scanning were observed and analyzed. Results: Among 43 patients with severe novel coronavirus pneumonia, 25 cases showed the first digital DR Bedside chest radiographs showing plaques and solid shadows in both lungs, 6 cases of pleural effusion in both lungs, 18 cases of unilateral lung exudation and solid shadows, 4 cases of unilateral pleural effusion, 7 cases of cardiac enlargement combined with pulmonary edema, and 2 cases of suspected pulmonary tumor mass shadows. There were multiple ground glass shadows in both lungs in 6 patients who underwent chest CT scanning. Spot shadows, grid shadows, thickened interlobular septum, and thickened pulmonary vessels and subbronchus were identified in the lesion area. Double lung spot density increased in the chest radiographs; the shadow area expanded in 5 cases and pleural effusion increased in 2 cases. Reexamination of chest CT images showed that 4 cases of increased ground-glass shadow transformed into irregular patchy high CT value shadow, 1 case of new atelectasis and 1 case of new pleural effusion. Conclusion: Digital DR Bedside chest radiography and chest CT scanning are the primary imaging methods for the diagnosis of novel coronavirus pneumonia. In particular, the former plays an important auxiliary diagnostic role when chest CT scan cannot be performed in patients with severe disease, and can greatly assist in the later review and clinical evaluation of the disease during active treatment. -
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图 1 重症新型冠状病毒肺炎数字床旁胸部摄影
（a）～（d）男，68岁，发热4 d，喘憋气短2 d。（a）为收治第1天床旁胸片，表现为右肺大面积斑片状实变影，中下肺叶显著。左下肺肋膈角小面积片状影。（b）和（c）为收治第2和第3天床旁胸片，较前无明显变化。图为第4天床旁胸片，示右肺片状实变影，密度较前增高，右肺胸腔积液。（e）～（h）女，72岁，发热1 d，咳嗽，呼吸急促1 d。（e）为收治第1天床旁胸片，示双肺散在不规则片状影，索条影，网格状影。（f）和（g）为收治第2第3天床旁胸片，较前一天片状实变影分布有所增加，双下肺炎性变密度增加。（h）为收治第4天床旁胸片，示右侧肺上中下肺野大面积片状实变影，右侧肋膈变钝胸腔积液。（i）～（k）男，70岁，发热3 d，胸闷气短，咳嗽咳痰，呼吸频率>30/分。（i）为收治第1天床旁胸片，示双肺散在斑片状实变影，左肺实变面积大，累及上中下肺野，（j）为收治第2天，较前一天胸片无明显变化。（k）为收治第3天，左侧肺炎性渗出面积进展迅速累及左侧全肺，大气管向右位移，左肺“大白肺”，左肺胸腔积液。（l）～（p）女，79岁，高热3天，喘憋咳痰2天，纳差1 d，（l）为收治第1天床旁胸片，示双肺肺野外带斑片状实变影以左肺野显著，心尖钝圆。左侧肋膈角模糊不清。（m）～（o）为第2～4天床旁胸片，斑片状实变影面积较前增大累及双肺中下野，双肺透过度持续性降低。（p）为第5天床旁胸片，示双肋膈角消失，双肺胸腔积液。
Figure 1. Digital Bedside chest X-ray for severe novel coronavirus pneumonia
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图 2 新型冠状病毒肺炎胸部CT扫描扫描三维重建
（a）～（e）胸部CT扫描冠状面多平面重组三维重建图像，清晰显示斑片状密度增高位置、分布、病变内部特征，病变形态与周围组织关系。（f）～（j）胸部CT扫描矢状面多平面重组三维重建图像，清晰显示病灶面积、分布情况，病灶与正常肺组织及纵膈的毗邻关系，新型冠状病毒肺炎多呈双肺背段及双肺外带分布，局部胸膜增厚。
Figure 2. Novel coronavirus pneumonia image chest CT scanning; 3D reconstruction in coronal and sagittal positions
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[1] LI Q, GUAN X, WU P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia[J]. The New England Journal of Medicine, 2020, 382(13): 1199−1207. DOI: 10.1056/nejmoa2001316.
[2] 陈淮, 邹玉坚, 蓝博文, 等. 重症和危重症新型冠状病毒肺炎患者床边胸部X平片表现及其在随访中的作用[J]. 中华放射学杂志, 2022,54(6): 539−543. DOI: 10.3760/cma.j.cn112149-20200213-540. CHEN H, ZOU Y J, LAN B W, et al. The effect of bedside chest radiograph in the diagnosis and follow-up of severe and critical COVID-19[J]. Chinese Journal of Radiology, 2022, 54(6): 539−543. DOI: 10.3760/cma.j.cn112149-20200213-540. (in Chinese).
[3] ZHU N, ZHANG D, WANG W, et al. A novel coronavirus from patients with pneumonia in china, 2019[J]. The New England Journal of Medicine, 2020, 382(8): 727−733. DOI: 10.1056/NEJMoa2001017.
[4] 靳英辉, 蔡林, 程真顺, 等. 新型冠状病毒(2019-nCoV)感染的肺炎诊疗快速建议指南(标准版)[J]. 解放军医学杂志, 2020,45(1): 1−20. [5] 马琼, 石秀东, 陆阳, 等. 新型冠状病毒肺炎临床及影像学研究进展[J/OL]. 中国临床医学, 2020. http://kns.cnki.net/kcms/detail/31.1794.r.20200225.1126.004.html. [6] 史河水, 韩小雨, 樊艳青, 等. 新型冠状病毒(2019-nCoV)感染的肺炎临床特征及影像学表现[J/OL]. 临床放射学杂志, 2020, 39(1): 8-11. http://doi.org/10.13437/j.cnki.jcr.20200206.002. SHI H S, HAN X Y, FAN Y Q, et al. Radiologic Features of Patients with 2019-nCoV Infection[J]. Journal of Clinical Radiology, 2020, 39(1): 8-11. http://doi.org/10.13437/j.cnki.jcr.20200206.002. (in Chinese).
[7] 薛国辉, 刘晓峰, 陈春辉, 等. 新型冠状病毒肺炎抗体及核酸检测和影像学诊断价值[J]. 中华医院感染学杂志, 2020,30(15): 2256−2260. DOI: 10.11816/cn.ni.2020-200690. XUE G H, LIU X F, CHEN C H, et al. Diagnostic value of COVID-19 IgM/IgG antibody detection, nucleic acid detection, and CT imaging detection[J]. Chinese Journal of Nosocomiology, 2020, 30(15): 2256−2260. DOI: 10.11816/cn.ni.2020-200690. (in Chinese).
[8] 张永县, 牛延涛, 刘丹丹, 等. 管电压联合器官剂量调制技术对胸部CT辐射剂量和图像质量影响的体模研究[J]. 中华放射医学与防护杂志, 2019,39(7): 529−533. doi: 10.3760/cma.j.issn.0254-5098.2019.07.009 [9] 阳建强. 胸部数字X射线摄影的质量保证与质量控制方法探讨[J]. 影像研究与医学应用, 2019,(5): 98−99. doi: 10.3969/j.issn.2096-3807.2019.05.063 [10] LEE K M, AI E Y, JAWDER S E, et al. Acute middle east respiratory syndrome dascoronavirus: Temporal lung changes observed on the chest radiographs of 55 patients[J]. American Journal of Roentgenology, 2015, 205(3): W267−W274. DOI: 10.2214/AJR/15.1444.
[11] 汪锴, 康嗣如, 田荣华, 等. 新型冠状病毒肺炎(COVID-19)的胸部CT影像学特征分析[J/OL]. 中国临床医学, 2020. DOI:10.12025/j.issn.1008-6358.2020.20200169. [12] 岑人丽, 钱元新, 李林, 等. 重症及危重症新型冠状病毒肺炎患者床旁DR图像质量控制[J]. 生物医学工程与临床, DOI:10.13339/j.cnki.sglc.20201023.022 [13] 徐俊贤, 田李均, 张素燕. 床边胸片的RALE评分与COVID-19病情严重程度相关性研究[J]. 交通医学, 2022,(3): 256−258. doi: 10.19767/j.cnri.32-1412.2022.03.01 [14] 周胜利, 徐磊, 刘菁, 等. HRCT在新型冠状病毒肺炎诊断中的应用[J]. 医学影像学杂志, 2020,(7): 1186−1189. ZHOU S L, XU L, LIU Q, et al. Clinical application of HRCT in novel coronavirus pneumonia[J]. Journal of Medical Imaging, 2020, (7): 1186−1189. (in Chinese).
[15] 聂军, 周伟, 汤天生. 三维重建在胸腔镜肺段手术的临床应用[J]. 赣南医学院学报, 2022,42(12): 1243−1246. DOI: 10.3969/j.issn.1001-5779.2022.12.004. NIE J, ZHOU W, TANG T S. The clinical application value of three-dimensional reconstruction technology in thoracoscopic lung segment surgery[J]. Journal of Gannan Medical University, 2022, 42(12): 1243−1246. DOI: 10.3969/j.issn.1001-5779.2022.12.004. (in Chinese).
[16] 庞景灼, 叶敏, 庞文广, 等. CT三维重建技术在解剖性肺段切除中的应用[J]. 解剖学研究, 2021,(4): 342−345. DOI: 10.3969/j.ISSN.1671-0770.2021.04.010. PANG J S, YE M, PANG W G, et al. Application of CT three-dimensional reconstruction technique in anatomical pulmonary segmental resection[J]. Anatomy Research, 2021, (4): 342−345. DOI: 10.3969/j.ISSN.1671-0770.2021.04.010. (in Chinese).
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