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参考文献
所見として報告している17).また Iwasaka らは
超高解像度 CT を用いて COVID-19 肺炎による
20)
局所の容積減少を明らかにした
1)
.線状影は,炎
症を伴う肺組織が虚脱したものと考えられ,場合
によっては肺炎の領域を過小評価させる可能性が
ある.線状影の存在は,疾患の重症度と直接相関
しなかったが,COVID-19 肺炎の診断と評価に寄
2)
与する可能性がある.
複数の肺葉に COVID-19 肺炎に典型的な GGO
を認めた場合の評価は容易であるが,単葉に限局
する病変の場合,しばしば評価が困難である.今
3)
回,胸部 CT で限局性病変を見た際の評価の一助
とするべく,限局性病変に対する検討を行った.
限局性病変の多くは末梢側に分布し,非区域性分
布を示す形態であり,比較的大型の陰影の場合,
4)
複数の肺葉で認める COVID-19 肺炎の陰影と類
似した形態を示した(図 1a).一方,いくつかの
症例で病変は円形・斑状の形態や,非特異的な不
整形陰影を示した.これらは,非特異的な炎症性
病変や陳旧性病変,肺癌との鑑別が困難な病変で
あり,実際にそれらの病変である可能性も考えら
れる.初診時の単回の胸部 CT では,肺野所見の
質的な評価には限界がある4).限局性病変を認め
5)
た場合,病変の局在と形態に着目して評価するこ
とが重要で,末梢側の分布や非区域性の形態は,
限局性病変であっても COVID-19 肺炎の可能性
がある所見であることを,本検討結果は示してい
6)
る.
本研究にはいくつかの限界がある.単一施設か
らの後ろ向き研究であり,限られた症例数のため
に信頼性のある多変量解析を実施することができ
7)
なかった.経過観察の胸部 CT は限られた症例で
のみ実行され,画像での肺炎の推移の観察は不十
分である.本研究の症例にはいくつかの家族内や
施設内でのクラスターが含まれており,症例の潜
在的なバイアスが結果に影響を及ぼした可能性が
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(Received for publication January 28, 2021)
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