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目的 回顾性分析一组 (2 0例 )严重急性呼吸综合征 (SARS)死亡患者的影像表现 ,探讨特征性影像表现及其与临床进展的关系。方法 评价 2 0例死亡SARS患者的动态胸部平片和CT影像 ,分析病变分布、形式、面积和密度的特点 ,探讨死亡患者胸部平片进展类型 ,分析影像变化和临床病程关系。结果 2 0例患者入院时胸片均可见明显的肺部病灶 ,表现为边缘不清的渗出影 ,病灶面积占全肺的百分比平均值为 4 9.6 % (1.4 %～ 85 .4 % ) ,病灶相对密度比平均值为 0 .79(0 .6 0～ 1.10 ) ;患者死亡前胸片显示病灶明显扩大 ,均累及双肺 ,病灶面积占全肺的百分比上升为 77.8% (5 2 .2 %～ 10 0 % ) ,与入院时胸片面积相比 ,差异有显著性 (P <0 .0 1) ;死亡前密度增高 ,病变相对密度比平均值为 0 .88(0 .6 0～ 1.10 ) ,与入院时病灶密度相比 ,差异有显著性 (P <0 .0 1) ,8例患者胸片显示空洞、胸腔积液、纵隔气肿等征象 ;胸片进展状况可分为两种类型 ,Ⅰ型表现为病变面积扩展但无继发改变 ,Ⅱ型表现为病变面积扩展伴密度增高、空洞、胸腔积液等继发改变征象。结论 SARS病灶迅速进展 ,面积占据全肺组织 75 %以上 ,为死亡患者的影像特征 ;病灶密度明显升高 ,出现空洞和胸腔积液为病变出现继发改变的影像特点 ,可加重SARS?
Objective To retrospectively analyze the imaging manifestations of a group of 20 death patients with severe acute respiratory syndrome (SARS) and discuss the relationship between the imaging features and the clinical progress. Methods The dynamic chest and CT images of 20 death SARS patients were evaluated. The distribution, form, area and density of the lesions were analyzed. The progress of the chest radiographs was analyzed. The relationship between the changes of the images and the clinical course was analyzed. Results Twenty cases of patients were found to have obvious lung lesions on admission, which showed marginal effusion. The average percentage of lesions in total lung was 44.6% (1.4% -85.4%), The average relative density of lesions was 0.79 (0.600-1.10). The anteroposterior X-ray showed significant enlargement of lesions, both involved the lungs and the percentage of lesions in the whole lung increased to 77.8% (52.2 % ~ 100%). Compared with the area of chest X-ray on admission, the difference was significant (P <0.01); the density before death increased and the relative density of lesions was 0.88 (0.6 ~ 1.10). Compared with the density at admission, the difference was significant (P <0.01). The chest radiographs of 8 patients showed signs of empyema, pleural effusion and emphysema. The progress of chest radiography could be divided into two groups Type, type Ⅰ showed lesions expanded but no secondary changes, type Ⅱ showed lesions with increased density, cavities, pleural effusion secondary signs of change. CONCLUSIONS SARS lesions develop rapidly with an area accounting for more than 75% of total lung tissue, which is an imaging feature of patients with death. The density of lesions is obviously increased. The appearance of cavities and pleural effusion is secondary to the appearance of lesions and may aggravate SARS.