Dual-Energy CT Pulmonary Angiography (DECTPA) Quantifies Vasculopathy in Severe COVID-19 Pneumonia.

Journal

Radiology. Cardiothoracic imaging
ISSN: 2638-6135
Titre abrégé: Radiol Cardiothorac Imaging
Pays: United States
ID NLM: 101748663

Informations de publication

Date de publication:
Oct 2020
Historique:
entrez: 29 3 2021
pubmed: 30 3 2021
medline: 30 3 2021
Statut: epublish

Résumé

The role of dual energy computed tomographic pulmonary angiography (DECTPA) in revealing vasculopathy in coronavirus disease 2019 (COVID-19) has not been fully explored. To evaluate the relationship between DECTPA and disease duration, right ventricular dysfunction (RVD), lung compliance, D-dimer and obstruction index in COVID-19 pneumonia. This institutional review board approved this retrospective study, and waived the informed consent requirement. Between March-May 2020, 27 consecutive ventilated patients with severe COVID-19 pneumonia underwent DECTPA to diagnose pulmonary thrombus (PT); 11 underwent surveillance DECTPA 14 ±11.6 days later. Qualitative and quantitative analysis of perfused blood volume (PBV) maps recorded: i) perfusion defect 'pattern' (wedge-shaped, mottled or amorphous), ii) presence of PT and CT obstruction index (CTOI) and iii) PBV relative to pulmonary artery enhancement (PBV/PAenh); PBV/PAenh was also compared with seven healthy volunteers and correlated with D-Dimer and CTOI. Amorphous (n=21), mottled (n=4), and wedge-shaped (n=2) perfusion defects were observed (M=20; mean age=56 ±8.7 years). Mean extent of perfusion defects=36.1%±17.2. Acute PT was present in 11/27(40.7%) patients. Only wedge-shaped defects corresponded with PT (2/27, 7.4%). Mean CTOI was 2.6±5.4 out of 40. PBV/PAenh (18.2 ±4.2%) was lower than in healthy volunteers (27 ±13.9%, p = 0.002). PBV/PAenh correlated with disease duration (β = 0.13, p = 0.04), and inversely correlated with RVD (β = -7.2, p = 0.001), persisting after controlling for confounders. There were no linkages between PBV/PAenh and D-dimer or CTOI. Perfusion defects and decreased PBV/PAenh are prevalent in severe COVID-19 pneumonia. PBV/PAenh correlates with disease duration and inversely correlates with RVD. PBV/PAenh may be an important marker of vasculopathy in severe COVID-19 pneumonia even in the absence of arterial thrombus.

Sections du résumé

BACKGROUND BACKGROUND
The role of dual energy computed tomographic pulmonary angiography (DECTPA) in revealing vasculopathy in coronavirus disease 2019 (COVID-19) has not been fully explored.
PURPOSE OBJECTIVE
To evaluate the relationship between DECTPA and disease duration, right ventricular dysfunction (RVD), lung compliance, D-dimer and obstruction index in COVID-19 pneumonia.
MATERIALS AND METHODS METHODS
This institutional review board approved this retrospective study, and waived the informed consent requirement. Between March-May 2020, 27 consecutive ventilated patients with severe COVID-19 pneumonia underwent DECTPA to diagnose pulmonary thrombus (PT); 11 underwent surveillance DECTPA 14 ±11.6 days later. Qualitative and quantitative analysis of perfused blood volume (PBV) maps recorded: i) perfusion defect 'pattern' (wedge-shaped, mottled or amorphous), ii) presence of PT and CT obstruction index (CTOI) and iii) PBV relative to pulmonary artery enhancement (PBV/PAenh); PBV/PAenh was also compared with seven healthy volunteers and correlated with D-Dimer and CTOI.
RESULTS RESULTS
Amorphous (n=21), mottled (n=4), and wedge-shaped (n=2) perfusion defects were observed (M=20; mean age=56 ±8.7 years). Mean extent of perfusion defects=36.1%±17.2. Acute PT was present in 11/27(40.7%) patients. Only wedge-shaped defects corresponded with PT (2/27, 7.4%). Mean CTOI was 2.6±5.4 out of 40. PBV/PAenh (18.2 ±4.2%) was lower than in healthy volunteers (27 ±13.9%, p = 0.002). PBV/PAenh correlated with disease duration (β = 0.13, p = 0.04), and inversely correlated with RVD (β = -7.2, p = 0.001), persisting after controlling for confounders. There were no linkages between PBV/PAenh and D-dimer or CTOI.
CONCLUSION CONCLUSIONS
Perfusion defects and decreased PBV/PAenh are prevalent in severe COVID-19 pneumonia. PBV/PAenh correlates with disease duration and inversely correlates with RVD. PBV/PAenh may be an important marker of vasculopathy in severe COVID-19 pneumonia even in the absence of arterial thrombus.

Identifiants

DOI: 10.1148/ryct.2020200428 PMID: 33778632 PMC: PMC7605077
pubmed: 33778632
doi: 10.1148/ryct.2020200428
pmc: PMC7605077
doi:

Types de publication

Journal Article

Langues

eng

Pagination

e200428

Informations de copyright

2020 by the Radiological Society of North America, Inc.

Références

J Clin Invest. 2020 May 1;130(5):2620-2629
pubmed: 32217835
Med Sci Monit. 2020 Apr 04;26:e923885
pubmed: 32246819
N Engl J Med. 2020 Jul 9;383(2):120-128
pubmed: 32437596
J Thromb Haemost. 2020 Apr;18(4):844-847
pubmed: 32073213
AJR Am J Roentgenol. 2020 Jun;214(6):1280-1286
pubmed: 32130038
Radiol Cardiothorac Imaging. 2020 Jun 18;2(3):e200277
pubmed: 34036264
AJR Am J Roentgenol. 2009 Jul;193(1):144-9
pubmed: 19542406
Lancet Infect Dis. 2020 Dec;20(12):1365-1366
pubmed: 32359410
Lancet. 2020 Feb 15;395(10223):497-506
pubmed: 31986264
Arch Pathol Lab Med. 2004 Feb;128(2):195-204
pubmed: 14736283
Eur Radiol. 2020 Jun;30(6):3306-3309
pubmed: 32055945
Chest. 2015 Jan;147(1):259-265
pubmed: 25560864
J Thorac Imaging. 2017 Jan;32(1):43-49
pubmed: 27846051
J Comput Assist Tomogr. 2018 Nov/Dec;42(6):866-872
pubmed: 30371620
Radiographics. 2014 Nov-Dec;34(7):1769-90
pubmed: 25384277
Eur Heart J. 2020 May 14;41(19):1858
pubmed: 32227120
AJR Am J Roentgenol. 2001 Jun;176(6):1415-20
pubmed: 11373204
Pulm Circ. 2015 Sep;5(3):498-505
pubmed: 26401250
Am J Respir Crit Care Med. 2010 Aug 1;182(3):436-7
pubmed: 20675682
Am J Respir Crit Care Med. 2020 May 15;201(10):1297-1299
pubmed: 32203672
Intensive Care Med. 2020 Jun;46(6):1099-1102
pubmed: 32291463
Radiol Cardiothorac Imaging. 2020 Jul 02;2(4):e200308
pubmed: 33778610
Radiology. 2020 Jun;295(3):200463
pubmed: 32077789
Intensive Care Med. 2020 May;46(5):846-848
pubmed: 32125452
World J Radiol. 2013 May 28;5(5):202-7
pubmed: 23805370
Radiol Cardiothorac Imaging. 2020 Mar 16;2(2):e200067
pubmed: 33778561
Circulation. 2020 Jul 28;142(4):342-353
pubmed: 32469253
Am J Respir Crit Care Med. 2020 Sep 1;202(5):690-699
pubmed: 32667207
AJR Am J Roentgenol. 2011 Mar;196(3):524-32
pubmed: 21343493
Lancet Respir Med. 2020 Jul;8(7):681-686
pubmed: 32473124
Radiology. 2013 Jun;267(3):747-56
pubmed: 23192773
Rev Esp Cardiol (Engl Ed). 2020 Aug;73(8):672-674
pubmed: 32402687
Radiology. 2020 Oct;297(1):E216-E222
pubmed: 32324101
Thromb Res. 2020 Jul;191:145-147
pubmed: 32291094

Auteurs

Carole A Ridge (CA)

Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A).
ORCID: 0000-0003-2510-5856

Sujal R Desai (SR)

Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A).
ORCID: 0000-0002-5237-3613

Nidhish Jeyin (N)

Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A).

Ciara Mahon (C)

Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A).
ORCID: 0000-0002-0467-1122

Dione L Lother (DL)

Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A).
ORCID: 0000-0002-1759-1463

Saeed Mirsadraee (S)

Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A).
ORCID: 0000-0003-3051-4355

Tom Semple (T)

Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A).
ORCID: 0000-0003-3740-6429

Susanna Price (S)

Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A).

Caroline Bleakley (C)

Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A).

Deepa J Arachchillage (DJ)

Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A).
ORCID: 0000-0001-5993-4850

Elizabeth Shaw (E)

Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A).

Brijesh V Patel (BV)

Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A).
ORCID: 0000-0002-5573-2503

Simon Pg Padley (SP)

Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A).

Anand Devaraj (A)

Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A).

Classifications MeSH