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行业新闻:用低剂量ct进行covid-19pinggude效果很好

2020-07-01 2020-07-03  来源:




据auntminnie.com报道, 2020年4月21日发表于radiology: cardiothoracic imaging 一篇论文发现[1],剂量在1msv以下(亚msv)的胸部ct可以准确快速地评估急诊室患者的covid-19感染情况,特别是那些出现症状超过48小时的病人。这能够帮助临床医生快速诊断病人,同时避免不必要的辐射。鉴于目前胸部ct在covid-19检测中应用广泛,亚msv胸部ct照射剂量小(比tao等人[2] 使用的ct减少到1/5),使用亚msv胸部ct可以大幅度减少人群接受剂量。


dangis团队指出,实时聚合酶链反应(rt-pcr)测试是现在诊断covid-19的黄金标准,但是它的灵敏度可低至70%。而一些研究证明,胸部ct的灵敏度可超过90%,提供了诊断新冠肺炎的另一种工具。

为了确定剂量大小和诊断ct所需时间,dangis的团队对192名具有covid-19症状的急诊室患者进行研究。这些患者在3月14至24日期间接受了亚msv胸部ct照射以及rt-pcr测试,ct照射参数为100kvp、20mas、螺距1.2,治疗床旋转0.5秒。在192名病人中,43.2%的人covid-19检测呈阳性,其余56.8%的人检测呈阴性。病人的平均年龄是62岁,但患有covid-19的人平均年龄(67岁)高于不患病的人(57岁),并且有更大概率出现发热(68.7%和45.9%)。


小组发现亚msv胸部ct在各种测量数据中表现良好,特别是对出现症状超过48小时的病例(图1、表1)。亚msv胸部ct的平均有效剂量是0.56msv。获取ct图像和患者报告的中位时间是25分钟(13-49分钟)。ct测试中观察者内相关系数和观察者间相关系数分别是0.96和0.95,没有明显偏差。



图1 两个患有covid-19的病例的ct图像。图a和图b是一位呼吸困难、发烧的85岁女士的轴向(a)和冠向(b)ct图像。ct图像显示了典型的早期covid-19症状,双侧胸膜下出现磨玻璃影(箭头所示)。有效剂量是0.52msv。图c和图d是一位咳嗽、发烧14天的41岁女士的轴向(c)和冠向(d)ct图像。ct图像显示了典型的covid-19晚期症状,双侧胸膜下出现多灶性实变(jiantousuo示)。有效剂量是0.53msv。上述图片和标题由北美放射学会(radiological society of north america, rsna)提供。


因此dangis总结认为,对可能感染covid-19的患者进行早期诊断分类时,低剂量亚msv胸部ctkeyizuo为rt-pcr重要的补充手段


[1] anthony dangis, christopher gieraerts, yves de bruecker, lode janssen, hanne valgaeren, dagmar obbels, marc gillis, marc van ranst, johan frans, annick demeyere, rolf symons. accuracy and reproducibility of low-dose submillisievert chest ct for the diagnosis of covid-19. radiology. vol.2. no. 2 (apr 21 2020) http://doi.org/10.1148/ryct.0908730196. 

[2] ai, t., yang, z., hou, h., zhan, c., chen, c., lv, w., ... & xia, l. (2020). correlation of chest ct and rt-pcr testing in coronavirus disease 2019 (covid-19) in china: a report of 1014 c


 

以下为原文:

low-dose ct works well for covid-19 assessment


chest ct at a radiation dose under 1 msv can accurately and rapidly assess covid-19 infection in emergency room patients -- particularly those who have had symptoms longer than 48 hours, according to a study published april 21 in radiology: cardiothoracic imaging by dangis et al [1].

the results are good news for clinicians seeking to diagnose patients quickly while also avoiding undue radiation exposure, wrote a team led by dr. anthony dangis of imelda hospital in bonheiden, belgium.

"[we found] an estimated radiation dose reduction by a factor of five," the group wrote. "given the widespread use of chest ct for covid-19 detection, our results demonstrate the feasibility of using low-dose chest ct to achieve an important reduction in radiation dose on a population level during this pandemic."

real time polymerase chain reaction (rt-pcr) testing is currently the gold standard for diagnosing covid-19, but its sensitivity can be as low as 70%, the group noted. chest ct offers an additional diagnostic tool for the disease, with a sensitivity of more than 90%, according to some studies.