Radiology:胸部CT研究发现COVID-19肺炎纤维化改变的预测因子

2021-07-30 MedSci原创 MedSci原创

男性、咳嗽、淋巴细胞增多和QCCT通气良好的肺是6个月时纤维化样改变的重要预测因素,并呈反相关(AUC.92)。

有研究对COVID-2019肺炎的胸部CT定性表现以及定量胸部CT(QCCT)方法和半定量肺部严重程度评分(LSS)进行了深入研究。新冠肺炎典型的胸部CT表现包括双侧和多叶磨玻璃影(GGOs),伴有后侧和外周分布,伴有实变,小叶间隔增厚和亚段肺血管扩张(>3 mm)。新冠肺炎患者的短期和中期胸部CT结果已经在一些研究中报道,包括定性和半定量方法;纤维化是一个常见的发现在几周后的症状开始。新冠肺炎的长期急性肺后遗症仍不清楚。

Andrea Laghi等评价了新冠肺炎患者6个月随访时肺损伤与基线胸部CT的比较。

2020年3月19日至2020年5月24日,对中重型新冠肺炎患者进行前瞻性随访,随访期为6个月。分析CT定性表现、半定量肺严重程度评分(LSS)和充气肺定量胸部CT(QCCT)。在6个月的胸部CT随访中,LSS和QCCT在预测纤维化样改变(网状结构和/或蜂窝状)方面的基线性能用接收器操作特征曲线进行测试。采用单变量和多变量logistic回归分析来检验预测纤维化样改变的临床和放射学特征。采用单纯临床参数(临床模型)、单纯放射学参数(放射模型)和临床与放射学参数结合(联合模型)进行多变量分析。

118例患者(62例女性,平均年龄65±12岁)均有基线和6个月的胸部CT随访。随访胸部CT时,85/118(72%)表现为纤维化样改变,49/118(42%)表现为GGOS。基线LSS(>14)和QCCT(≤3.75L和≤80%)在预测胸部CT随访时纤维化样改变方面表现良好。在多变量分析中,临床模型的AUC为0.89(95%CI.77-0.96),放射模型为0.81(95%CI.68-0.9),联合模型为0.92(95%CI.81-0.98)。

COVID-19患者基线与随访胸部CT表现比较

基线和随访时肺严重程度评分的比较

(a)ROC曲线测试了基线肺严重程度评分预测6个月随访胸部CT纤维化样改变的性能,显示曲线下面积(AUC)为0.91,95%CI.8-0.97,当截止值>14时敏感性为88%,特异性为80%。(b,c)ROC曲线测试了基线定量胸部CT(QCCT)分析在6个月随访时预测纤维化样改变的性能,以百分比(b)和公升(c)表示:(b)截断≤3.8L的AUC为0.88,95%CI.77-0.96,敏感性为86%,特异性为80%;(c)截断≤80%的AUC为0.88,95%CI.76-0.95,敏感性为74%,CI.100%。

ROC曲线测试临床(蓝线)、放射学(绿线)和联合模型(橙线)在6个月随访胸部CT时预测纤维化样改变存在的性能。临床模型的AUC值为0.89(95%CI.77-0.96,敏感性82%,特异性93%),放射模型的AUC值为0.81(95%CI.68-0.9,敏感性84%,特异性67%),联合模型的AUC值为0.92(95%CI.81-0.97,敏感性100%,特异性73%)。

在6个月的胸部CT随访中,72%的患者表现为晚期后遗症:纤维化样改变是最常见的残留表现(72%),其次是磨玻璃密度影(42%)。在6个月的胸部CT(AUC>.88)中,通气良好的肺基线LSS和QCCT显示出极好的预测纤维化样改变的性能。男性、咳嗽、淋巴细胞增多和QCCT通气良好的肺是6个月时纤维化样改变的重要预测因素,并呈反相关(AUC.92)

原文出处

Postacute Sequelae of COVID-19 Pneumonia: 6-month Chest CT Follow-up.

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    2021-07-31 zhouqu_8
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    2021-07-30 ms1000001920226686

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