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基于CO-RADS评分及临床特征诊断新型冠状病毒肺炎的价值

Investigation of the diagnostic value of CO-RADS scores and clinical features for COVID-19 pneumonia
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摘要 目的:探讨新型冠状病毒肺炎(COVID-19)报告与数据系统(CO-RADS)评分及临床特征诊断COVID-19的价值。方法:回顾性分析本院COVID-19疫情期间就诊的169例患者的临床及影像资料,其中男68例,女101例,年龄15~98岁,平均(58.0±15.5)岁,入院后均行胸部CT、核酸及抗体检测。由两位影像医师独立进行CO-RADS评分,评价结果一致性,最终评分结果由两者协商确定。以核酸及抗体结果为金标准,分析CO-RADS评分的诊断效能,采用二元logistics回归分析评分预测COVID-19发生的风险。结果:169例患者中共139例确诊为COVID-19,临床症状以发热、咳嗽较常见(59.7%,51.8%),COVID-19患者CRP升高(χ^2=15.93,P=0.000)及淋巴细胞百分比降低(χ^2=4.11,P=0.043)较非COVID-19患者发生率高。COVID-19患者CT主要表现为病变多发(115/139,82.7%),下叶受累常见(102/139,73.4%),多位于外周或胸膜下(125/139,89.9%),磨玻璃密度(109/139,78.4%)伴铺路石征(83/139,59.7%)是特征表现之一。两位医生对169例患者CO-RADS评分具有较好一致性,线性加权Kappa分析系数值为0.84(95%CI:0.78~0.89)。COVID-19患者评分较非COVID-19患者高(Z=-7.473,P=0.000)。CO-RADS评分诊断COVID-19的ROC曲线下面积(AUC)为0.91(95%CI:0.85~0.95,Z=13.71,P<0.0001),最佳截断值为3,其敏感度、特异度分别为88.5%、83.3%。单因素二元logistics回归分析显示CO-RADS评分是诊断COVID-19的危险因素,评分为2~5分时其风险是1分的3.43、4.67、45.00、312.00倍。结论:不同医师的CO-RADS评分一致性好,诊断效能高,评分越高COVID-19的风险越大。 Objective:To investigate the diagnostic value of CO-RADS scores and clinical characteristics for coronavirus disease 2019(COVID-19)pneumonia.Methods:A retrospective analysis was performed on 169 patients(mean age,58.0 years±15.5;range,15~98 years)admitted to our hospital during the epidemic period,including 68 males and 101 females.All patients underwent chest CT and RT-PCR/serum anti-SARS-CoV-2 IgM/IgG tests,and the clinical and imaging data were respectively analyzed.The CO-RADS scores were conducted by two radiologists independently,when the inconsistency was happened,the final result was obtained through consultation by two radiologists.The diagnostic value of CO-RADS scores were evaluated based on the gold standard(RT-PCR/serum anti-SARS-CoV-2 IgM/IgG tests).The risk of suffering from COVID-19 pneumonia was predicted by binary logistic regression.Results:A total of 139 of the 169 patients were diagnosed with COVID-19 pneumonia,and most of them had fever and cough(59.7%,51.8%,respectively).The patients with COVID-19 pneumonia had a higher incidence of CRP(χ^2=15.93,P=0.000)and lower lymphocyte percentage(χ^2=4.11,P=0.043)than those without.Patients with COVID-19 pneumonia were more likely to have multiple lesions(115/139,82.7%),which were distribute in inferior lobes(102/139,73.4%)and involved peripheral and subpleural(125/139,89.9%).Ground-glass opacity(GGO)(109/139,78.4%)with crazy paving stone sign(83/139,59.7%)were the typic imaging feature on chest CT.The consistency for evaluating CO-RADS scores of 169 patients between the two radiologists was good with a linearly weighted Kappa coefficient of 0.84(95%CI:0.78~0.89).The scores of patients with COVID-19 pneumonia were higher than those without(Z=-7.473,P=0.000).The area under the curve(AUC)of the CO-RADS scores for the diagnosis of COVID-19 pneumonia was 0.91(95%CI:0.85~0.95,Z=13.71,P<0.0001),and the optimal cut-off value was 3.The sensitivity and specificity were 88.5%and 83.3%,respectively.Univariate binary logistic regression analysis showed that the CO-RADS score was a risk factor for diagnosing COVID-19 pneumonia,and the odds ratio was 3.43,4.67,45.00,and 312.00 when the score was 2 to 5(reference:score 1).Conclusion:The CO-RADS scores have excellent consistency of evaluation for different radiologists and diagnostic value for COVID-19 pneumonia.The higher the CO-RADS scores,the greater the risk of COVID-19 pneumonia will be.
作者 姚庆东 张呈兵 付军 张东友 刘海峰 YAO Qing-dong;ZHANG Cheng-bing;FU Jun(Department of Radiology,Wuhan NO.1 Hospital,Wuhan 430022,China)
出处 《放射学实践》 北大核心 2020年第11期1362-1368,共7页 Radiologic Practice
关键词 新型冠状病毒肺炎 肺炎 病毒性 评分 诊断效能 体层摄影术 X线计算机 COVID-19 Pneumonia,viral Score Diagnositic performance Tomography,X-ray computed
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