health education

1. ШИНЭ ТӨРЛИЙН КОРОНА (COVID 19)
ВИРҮСИЙН ХАЛДВАРЫН ҮЕИЙН ДҮРСЛЭЛ
ОНОШИЛГОО
Дүрс оношилгооны хэсэг

2. ХЭВЛЭЛИЙН МАТЕРИАЛУУД:
1. PUBMED
Novel Coronavirus 19 – 479 илэрц
Covid 19 Radiology – 120 илэрц
Covid 19 CT – 109 илэрц
2. Google Scholar
Novel Coronavirus 19 – 71400 илэрц
Covid 19 Radiology – 1160 илэрц
Covid 19 CT – 1840 илэрц

3. Radiology: Volume 295: Number 1-April 2020 radiology.rsna.org
• From January 18, 2020, until January 27, 2020, 21 patients admitted to three
hospitals in three provinces in China with confirmed 2019-nCoV underwent chest CT.
• All CT images were reviewed by two fellowship-trained cardiothoracic radiologists with
approximately 5 years of experience each reviewed independently, and final decisions
were reached by consensus.
• For disagreement between the two primary radiologist interpretations, a third
fellowship-trained cardiothoracic radiologist with 10 years of experience adjudicated a
final decision.

5. a 36-year-old man with history of recent travel to Wuhan who presented with fever, fatigue, and myalgias.
Coronal thin-section unenhanced CT image shows ground-glass opacities with a rounded morphology in
both upper lobes (arrows).

6. a 43-year-old woman with a history of travel to Wuhan who presented with fever. (a) Axial thin-section
unenhanced CT image obtained January 18, 2020, shows normal lung. (b) Follow-up CT image
obtained January 21, 2020, shows a new solitary, rounded, peripheral ground-glass lesion in the right
lower lobe (arrow).

7. • Shanghai Public Health Clinical Center approved this retrospective study.
• We reviewed the clinical and laboratory data and CT images of the 51
patients (25 men and 26 women; age range 16–76 years) with 2019-nCoV
pneumonia from January 20, 2020, to January 27, 2020.
• All patients were confirmed as having positive results by using real-time RT-
PCR nucleic acid assay for 2019-nCoV.

10. https://pubs.rsna.org/doi/pdf/10.1148/radiol.2020200642
Correlation of Chest CT and RT-PCR Testing in Coronavirus
Disease 2019 (COVID-19) in China: A Report of 1014 Cases
Tao Ai MD, PhD1, Zhenlu Yang MD, PhD1, Hongyan Hou, MD2 , Chenao Zhan MD1, Chong Chen MD1, Wenzhi L3, Qian Tao, PhD4, Ziyong Sun MD2 ,
Liming Xia MD, PhD1
1Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
2Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
3Department of Artificial Intelligence, Julei Technology Company, Wuhan, 430030, China
METHODS: From January 6 to February 6, 2020, 1014 patients in Wuhan, China
who underwent both chest CT and RT-PCR tests were included.
RESULTS: Of 1014 patients, 59% (601/1014) had positive RT-PCR results, and 88%
(888/1014) had positive chest CT scans. The sensitivity of chest CT in suggesting
COVID-19 was 97% (95-98%, 580/601 patients) based on positive RT-PCR results. In
patients with negative RT-PCR results, 75% (308/413) had positive chest CT findings;
of 308, 48% were considered as highly likely cases, with 33% as probable cases.

12. Chest CT images of a 29-year-old man with fever for 6 days. RT-PCR assay for the SARS-CoV-2 using a swab sample
was performed on February 5, 2020, with a positive result. (A) Normal chest CT with axial and coronal planes was
obtained at the onset. (B) Chest CT with axial and coronal planes shows minimal GGO in the bilateral LL (yellow arrows).
(C) Chest CT with axial and coronal planes shows increased GGO (yellow arrowheads). (D) Chest CT with axial and
coronal planes shows the progression of pneumonia with mixed GGO and linear opacities in the subpleural area.
(E) Chest CT with axial and coronal planes shows the absorption of both GGO and organizing pneumonia.

13. Chest CT images of a 34-year-old man with fever for 4 days. Positive result of RT-PCR assay for the
SARS-CoV-2 using a swab sample was obtained on February 8, 2020. (row A) Chest CT with lesion
magnified coronal and sagittal planes shows a nodule with reversed halo sign in the left lower lobe (yellow
box) at the early stage of the pneumonia. (row B) Chest CT with different axial planes and coronal
reconstruction shows bilateral multifocal ground-glass opacities. The nodular opacity resolved.

14. A 36-year-old man presented to the hospital with
a 2-day history of fever, sore throat, and fatigue
5 days after visiting Wuhan, China.
His temperature on admission was 37.8°C.
Pulmonary auscultation normal.
Laboratory studies showed a normal white blood
cell count (4.6×109 /L)
The blood procalcitonin level was normal.
Chest CT showed multipleperipheral ground-glass
opacities in both lungs with more involvement of the left
upper lobe, lingular segment.
• At admission, RT-PCR assay of the sputum was
negative for the 2019 novel coronavirus (2019-nCoV)
nucleic acid.
• 3 day after RT-PCR 2019-nCoV negative at this time.
• 6 days after admission, the third RT-PCR 2019-nCoV
nucleic acid assay was finally found to be positive.

15. (a, b) Chest CT scans obtained at presentation show GGO(red box) in the RUL and
the lingular segment and LLL.
(d, e) CT scans obtained 3 days after admission show progression of ground-glass opacities to an atoll sign
in the right upper lobe (red boxes in d) and left lower lobe consolidation (red boxes in e).

16. THE CLINICAL AND CHEST CT FEATURES ASSOCIATED WITH
SEVERE AND CRITICAL COVID 19 PNEUMONIA
Kunhua Li MSMS1, Jiong Wu MS2, Faqi Wu MS3 Dajing Guo MD1, Linli Chen MS1, Zheng Fang MS1, Chuanming Li MD1
1Department of Radiology, theSecond Affiliated Hospital of Chongqing Medical University, Chongqing, China
2Department of Radiology, Chongqing Three Gorges Central Hospital, Chongqing, China
3Department ofMedical Service, Yanzhuang Central Hospital of Gangcheng District, Jinan, China
Materials and Methods: Eighty three patients with COVID 19 pneumonia
including 25 severe/critical cases and 58 ordinary cases were enrolled. The
chest CT images and clinical data of them were reviewed and compared The
risk factors associated with disease severity were analyzed.
Study Population: Ninety patients were diagnosed as COVID-19 according to
the Diagnosis and Treatment of Novel Coronavirus Pneumonia (trial version
fifth) of China in our hospitals from January 2020 to February 2020 in this study.

17. THE INCLUSION CRITERIA WERE AS FOLLOWS:
A)having an epidemiological history;
B)having one of the following etiological evidences:
1. real-time reverse-transcriptase polymerase-chain-reaction detection of
SARS-CoV-2 nucleic acid positive in throat swabs or lower respiratory
tract
2. the virus gene sequencing of respiratory or blood samples was highly
homologous with SARS-CoV-2.
C) having underwent thin-section CT at least one time. The ordinary patients
all had fever or other respiratory symptoms with CT manifestations of
pneumonia.

18. The severe/critical patients met any of the following condition:
1) respiratory rate ≥30 breaths per minute
2) finger of oxygen saturation≤93% in a resting state
3) arteria oxygen tension (PaO2)/inspiratory oxygen fraction (FiO2) ≤300 mmHg
(1mmHg=0.133kPa)
4) respiratory failure occurred and mechanical ventilation required
5) shock occurred
6) patients with other organ failure needed intensive care unit monitoring and
treatment.
The exclusion criteria were COVID-19 patients without abnormal manifestations
on CT. Finally, seven patients were excluded because of no abnormal
manifestations on CT and 83 patients were included.

20. Each lobe was assigned a score that
was based on the following:
• score 0, 0% involvement;
• score 1, less than 5% involvement;
• score 2, 5% to 25% involvement;
• score 3, 26% to 49% involvement;
• score 4, 50% to 75% involvement;
• score 5, greater than 75%
involvement.
When the cutoff value of CT score 7,
the sensitivity and specificity were
80.0% and 82.8% respectively.

21.  25 (30.1%) of them were severe/critical cases, and 58 (69.9%) of them were
ordinary cases.
 No difference was observed in the proportion of men and women between the two
groups.
 The median time from illness onset to hospital admission in severe/critical patients (8
days [6-12]) was significantly longer than those of the ordinary patients (6 days [3-
8.5]) (P = 0.006).
 Compared with the ordinary patients, severe/critical patients had higher body
temperature and higher incidences of cough, expectoration, dyspnea and chest pain.
No significant differences of heart rate, respiratory rate and arterial pressure were
found between the two groups.
 Compared with the ordinary patients, the severe/critical patients have poor prognosis
and high mortality.

22.  Compared with ordinary groups, consolidation was significantly more frequent
in severe/critical patients, which indicates that the alveoli are completely filled
by inflammatory exudation. This usually means that the virus diffuses into the
respiratory epithelium, leading to necrotizing bronchitis and diffuse alveolar
damage.
 Severe/critical patients showed more lymph node enlargement, pericardial
effusion and pleural effusion. These extrapulmonary lesions may indicate the
occurrence of severe inflammation.
 Although GGO is the most common CT feature of COVID-19 pneumonia, no
statistical incidence difference was observed between our two groups.

23.  The clinical factors of age > 50 years old, dyspnea, chest pain, cough,
expectoration, decreased lymphocytes and increased inflammation indicators
were risk factors for severe/critical COVID-19 pneumonia.
 CT findings of consolidation, linear opacities, crazy-paving pattern, bronchial
wall thickening, high CT scores (>7) and extrapulmonary lesions were
imaging features of severe/critical COVID-19 pneumonia.
CT plays an important role in the diagnosis and disease
severity evaluation of this disease.

24. Chest CT of a 44 year old man with ordinary COVID 19 pneumonia CT score 5.
(A) An axial CT image showed multiple small regions of subpleural GGO with superimposed
inter and intralobular septal thickening.
(B) 3D visualization of CT VRT showed the extent of GGO with scattered pattern.

25. Chest CT findings of severe/critical COVID 19 pneumonia (CT score 18),
a 60 year old man with dyspnea and pleural effusion.
(A) An axial CT image showed diffuse large regions of crazy paving pattern (GGO with superimposed inter
and intralobular septal thickening) with partial consolidation and bronchial wall thickening
(B) 3D visualization of CT VRT showed the diffuse extent of GGO and consolidation.

26. Компьютер томографит илрэх шинжүүд:
Эрт үед:
Сүүн шилний шинж /GGO/ ба нэвдэст өөрчлөлтүүд
/Condolidation/ (ихэвчилэн 2 уушгийг зэрэг хамарсан,
захын байрлалтай, уушигны арын хэсгүүдийг
хамарсан, дугуй эсвэл зууван хэлбэртэй)
Хожуу үед:
Уушигны дэлбэн хоорондын таславчууд зузаарах
(interlobular septal thickening)
Чулуун шигтгээний шинж (Crazy paving pattern)
Гуурсан хоолойн өргөсөл (Traction bronchiectasis)
Торлог сүүдэр харагдана (reticular opacity)
ТҮГЭЭМЭЛ ИЛРЭХ
Зонхилон: Вирусын гаралтай уушгины
хатгалгаа (SARS, MERS, H1N1, COVID19)
ихэвчлэн илэрнэ.
ХОВОР ИЛРЭХ
Уушгины жижиг зангилаанууд
Тунгалгийн булчирхайн томрол
Эмфизема
Гялтангийн хөндийд шингэн хурах
Хөндийт өөрчлөлтүүд
Зонхилон: Үжлийн хатгалгаа болон
нянгийн хатгалгааны үед ихэвчлэн
илэрнэ.

27. ШИНЖ ТЭМДЭГ SARS MERS H3N2 COVID 19
1. ХУРЦ ҮЕ (0-4 хоног)
Хэвийн дүрслэл 10-20% 17% 0% 15-20%
Нийтлэг шинж
Захын байрлалтай
олон тооны GGO,
consolidation
Захын байрлалтай
олон тооны GGO,
consolidation
Тархмал байрлалтай
GGO, олон голомтот
consolidation
Захын байрлалтай
олон тооны GGO,
consolidation
Ховор илрэх Пневмоторакс Пневмоторакс Пневмоторакс Пневмоторакс
Илрэхгүй шинж
тэмдэг
Хөндий үүсэх,
тунгалгийн
булчирхайн томрол
Хөндий үүсэх,
тунгалгийн
булчирхайн томрол
Хөндий үүсэх,
тунгалгийн
булчирхайн томрол
Хөндий үүсэх,
тунгалгийн
булчирхайн томрол
Байрлал
Нэг уушги-хэсэг
газар (50%)
олон хэсэг (40%)
тархмал (10)
2 уушги уушгины
суурь, олон хэсэг
(80%), нэг талын
уушги (20%)
Бүх дэлбэнг (57%)
доод дэлбэнг (29%)
Дээд болон дунд
дэлбэн (10%)
2 уушги, уушгины
суурь, олон хэсэг
15% Рентген зурагт
хэвийн.
Компьютер томографит илрэх шинжүүд:

28. ШИНЖ ТЭМДЭГ SARS MERS H3N2 COVID 19
2. ХОЖУУ ҮЕ (7-14 хоног)
Торлог сүүдэржилт
шилжих + + + Цөөн
Фиброз Ховор 1/3 тутамд Ховор
Одоогоор
бүртгэгдээгүй
Air trapping Түгээмэл Бараг илрэхгүй
https://www.ajronline.org/doi/full/10.2214/AJR.20.22969

29. Thank you for your attention