15

Zhang Xiaochun, Central South Hospital: is CT feasible as the basis of diagnosis of new crown pneumonia?

category:Internet
 Zhang Xiaochun, Central South Hospital: is CT feasible as the basis of diagnosis of new crown pneumonia?


As of 24:00 on February 7, more than 34000 people had been diagnosed with new crown pneumonia, and more than 27000 were suspected of infection. Is it necessary to use CT image as an important basis for screening, clinical diagnosis and efficacy monitoring of suspected nucleic acid negative patients in the current situation? Compared with nucleic acid detection, what are the advantages and challenges of CT image?

On February 6, with these questions, the reporter of surging news (www.thepaper. CN) interviewed Dr. Zhang Xiaochun.

Previously, Zhang Xiaochun wrote through wechat circle of friends that: in Hubei province or Wuhan, a key epidemic area, it is necessary to exclude suspected patients or patients with a history of close contact with confirmed patients with lung CT images, as the main basis for the current screening of ncov pneumonia in 2019; at the same time, he called for the isolation treatment of asymptomatic or nucleic acid negative but CT image positive people to prevent family clustering infection, Let the epidemic spread further.

In the interview, she told surging journalists that since the release of the circle of friends, she has encountered many misunderstandings. I mean dont wait for the result of nucleic acid test. At the same time of nucleic acid test, carry out CT image examination of lung, and treat the patients with acute inflammatory signs of lung CT as early as possible in accordance with the principle of from the presence of suspicious diseases . However, nucleic acid detection is still the gold standard for final etiological diagnosis, and its etiological evidence is irreplaceable and beyond doubt.

At present, nucleic acid detection has some limitations, such as the problem of false negative. Zhang Xiaochun pointed out that this is mainly caused by several reasons: first, the current development time of nucleic acid kit is particularly short, and the product stability is not high; second, different manufacturers, the quality level of nucleic acid testing kit is not uniform, which will also affect the test results; third, the accuracy of sampling depends on the individual operator, and many sampling personnel are recruited from each In medical posts, not everyone is professional, and the operation of sampling is different for each person, which will also lead to sampling error.

Zhang Xiaochuns suggestion was supported by many medical colleagues. Zhang Yujiao, director of clinical radiotherapy for chest tumor at MD Anderson Cancer Center in the United States, also wrote, it is urgent to use CT as the diagnostic standard for new pneumonia.

According to the above article, nucleic acid detection has the following limitations: when the viral load is not high, its detection rate is relatively low, so it appears false negative; it can only be used for etiological diagnosis, but can not judge the severity of pneumonia and its development process (CT image is OK); the number of kits is insufficient, and the quality of new products of major companies needs to be studied and improved; after sampling, it needs 1 Days or more to get results.

Zhang Xiaochun told the surging news reporter that the reason why she made such an appeal was based on the actual needs of the clinical front line in the key epidemic areas, the key epidemic areas should take extraordinary measures in the extraordinary period, and have to do it. In this case, if we dont concentrate our efforts to tighten our fists and fight hard, the epidemic will be difficult to contain.

On February 5, Wang Chen, an expert in respiratory and critical care medicine, vice president of the Chinese Academy of engineering and President of the Chinese Academy of Medical Sciences, visited the news 1 + 1 column and said, not all people who are ill can detect nucleic acids, and the detection rate of nucleic acids for real cases is less than 30% to 50%.

Where are the remaining 50%? If it is missed, he will return to his family and community, and be outside the society will cause potential infection. Zhang Xiaochun said.

Zhang Xiaochun pointed out that the results of CT examination are intuitive, fast and highly available to the public. So I proposed not to wait for the results of nucleic acid examination, and at the same time carry out CT image examination of lung, a two legged walking method. But not waiting is not equal to not doing, this is that CT can not replace the etiology of nucleic acid detection, only as an objective means of response to lung inflammation

Since CT cant tell whether its other pneumonia or new crown pneumonia, will it lead to wrong treatment if patients who dont get the test result of the kit are admitted together?

However, Zhang also stressed that after the treatment of such patients, they should be treated in isolation to reduce the probability of cross infection, if there is no condition, it is necessary to create conditions.

For regions outside Hubei Province, Zhang said the move was not suitable for provinces with only sporadic cases.

To Zhang Xiaochuns satisfaction, the value of image diagnosis has been reflected in the fifth edition of the newly updated diagnosis and treatment plan for pneumonia caused by new coronavirus infection. It is mentioned in the plan that the suspected cases with pneumonia imaging characteristics is the clinical diagnosis case standard of Hubei Province, which suggests that the clinical diagnosis of new coronavirus in Hubei Province will not wait for the results of nucleic acid detection, which is conducive to the early and timely treatment of pneumonia patients in Hubei Province.

At the same time, Wuhan built three shelter hospitals overnight, which will provide 3400 beds for the treatment of mild pneumonia patients infected with new coronavirus. In addition to Hubei, prevention and control measures are also upgrading, with unprecedented severity.

Zhang Xiaochun pointed out that at present, the epidemic prevention pressure in Wuhan and Hubei is still huge. Taking CT image as the basis of clinical diagnosis will also face great challenges, not only testing the resource reserve in Hubei Province, but also putting forward higher requirements for the professional of medical staff, as well as new requirements for cross infection control.

There are two challenges to put CT into practice as one of the screening standards for new pneumonia. The first is to introduce a large number of suspected patients into the hospital. In many places, the number of CT machines and technical personnel are insufficient, and the carrying capacity is still greatly challenged. This requires the unified deployment and support of the state. Zhang Xiaochun said. The second challenge is the prevention and control of cross infection in hospital. Its not only the cross infection between patients, but also the occupational exposure risk of doctors. We need to do a good job of one person, one machine and one disinfection. Patients and doctors need to disinfect at the same time, and the protective materials are insufficient. In this case, its difficult to implement. Wuhan, Hubei Province, is the focus of the epidemic area, and more efforts should be concentrated to solve it. Recently, Zhang Xiaochun put forward the suggestion of mobile CT or shelter CT entering Wuhan to meet the needs of lung CT examination in shelter hospital and isolation point. Source: Qiao JunJing, editor in charge of surging news

There are two challenges to put CT into practice as one of the screening standards for new pneumonia. The first is to introduce a large number of suspected patients into the hospital. In many places, the number of CT machines and technical personnel are insufficient, and the carrying capacity is still greatly challenged. This requires the unified deployment and support of the state. Zhang Xiaochun said. The second challenge is the prevention and control of cross infection in hospital. Its not only the cross infection between patients, but also the occupational exposure risk of doctors. We need to do a good job of one person, one machine and one disinfection. Patients and doctors need to disinfect at the same time, and the protective materials are insufficient. In this case, its difficult to implement. Wuhan, Hubei Province, is the focus of the epidemic area, and more efforts should be concentrated to solve it. Recently, Zhang Xiaochun put forward the suggestion of mobile CT or shelter CT entering Wuhan to meet the needs of lung CT examination in shelter hospital and isolation point.