ABSTRACT
BackgroundSome COVID-19 patients with similar quantitative CT measurements had variable clinical presentation and outcome. The absence of reasonable clinical explanations, such as pre-existing comorbidities or vascular complications, adds to the confusion. The authors believed that neglecting the impact of certain severe morphologic features could be an alternative radiological explanation. This study aims to optimize the initial CT staging of COVID-19 and propose a new combined morphologic/volumetric CT severity index (CTSI) to solve this clinico-radiological mismatch.ResultsThis multi-center study included two major steps. The first step of the study entailed a standardized combined morphologic/volumetric CT severity analyses to propose a new optimized CTSI. This was conducted retrospectively during the period from June till September 2020. It included 379 acutely symptomatic COVID-19 patients. They were clinically classified according to their oxygen saturation and respiratory therapeutic requirements into three groups: group A (mild 298/79%), group B (borderline severity 57/15%), and group C (severe/critical 24/6%). The morphologic and volumetric assessment of their HRCT was analyzed according to severity, by two consultant radiologists in consensus. A new 25 point-CTSI has been created, combining eight morphological CT patterns [M1:M8;8 points] and four grades of volumetric scores [S1:S4;17 points]. The addition of the M5 pattern (air bubble sign), M6 pattern (early fibrosis and architectural distortion), or M7 pattern (crazy-paving) proved to increase the clinical severity. The second step of the study entailed a standardized blinded/independent validation analysis for the proposed CTSI. This was prospectively conducted on other 132 patients during October 2020 and independently performed by other two consultant radiologists. Validation results reached 80.2% sensitivity, 91.8% specificity, AUROC-curve = 0.8356, and 90.9% accuracy.ConclusionA new optimized CTSI with accepted validation is proposed for initial staging of COVID-19 patients, using combined morphologic/volumetric assessment instead of the quantitative assessment alone. It could solve the clinico-radiological mismatch among patients with similar quantitative CT results and variable clinical presentation during the absence of pre-existing comorbidities or vascular complications.
ABSTRACT
Background COVID-19 vasculopathy is a critical condition that impacts the disease prognosis including vasculitis and thromboembolic complications. This study aimed to provide the Egyptian experience about the COVID-19 vasculopathy during the past two years of the pandemic and to collectively include the different modalities and imaging techniques for the diagnosis of cerebrovascular, pulmonary, gastrointestinal, and peripheral arterial vascular complications. Results This is a multi-center retrospective analysis of 3500 PCR-proved COVID-19 infection between March 2020 and December 2021. A cohort of 282 consecutive patients with COVID-19 vasculopathy was considered for inclusion. They included 204 males and 78 females (72:28%). The mean age was 68 years, and age ranged from 48 to 90 years. Five radiologists evaluated the different imaging examinations in consensus including computed tomography (CT), CT-angiography (CTA), CT-perfusion (CTP), magnetic resonance imaging (MRI), MR-arteriography (MRA), and MR-venography (MRV). 244/282 (86.5%) patients suffered from non-hemorrhagic cerebral ischemic infarctions. 13/282 (4.6%) patients suffered from hemorrhagic cerebral infarctions. 5/282 (1.8%) patients suffered from cerebral vasculitis. Pulmonary vascular angiopathy was detected in 10/282 (3.5%) patients, including pulmonary embolism in 10/10 patients, pulmonary infarctions in 8/10 patients, pulmonary vascular enlargement in 5/10 patients, and vascular "tree-in-bud" sign in 2/10 patients. Intestinal ischemia and small bowel obstruction were detected in 3/282 patients (1%) while GIT bleeding was encountered in 4/282 patients (1.4%). Lower limb arterial ischemia was found in 3/282 patients (1%). Additionally;39/282 (13.8%) patients developed peripheral deep venous thrombosis (DVT) due to prolonged ICU recumbence while 28/282 (10%) patients developed jugular vein thrombosis sequel to prolonged catheterization. A p value (0.002) and (r) = 0.8 statistically proved strong significant relation between COVID-19 vasculopathy and D-dimer levels. Conclusions Multi-system vasculopathy was a serious complication of COVID-19 which impacted the patients' morbidity and mortality. An Egyptian experience about the COVID-19 vasculopathy during the past two years of the pandemic was provided. It encountered the different modalities and imaging techniques for the diagnosis of cerebrovascular, pulmonary, gastrointestinal, and peripheral arterial COVID-19 vascular complications.