ABSTRACT
Background: Several clinical studies tested the efficacy of the different COVID-19 vaccinations while very few radiological researches targeted this issue before. Aim of the work: To verify the additive role of lung CT-Volumetry in testing the efficacy of three widely distributed COVID-19 vaccinations;namely the "Sinopharm", "Oxford-AstraZeneca", and "Pfizer-BioNTech" vaccinations, with comparative analysis of variance (ANOVA). Results: This study was retrospectively conducted on 341 COVID-19 patients during the period between June/2021 and March/2022. Based on the immunization status, they were divided into four groups;group (A) included 156/341 (46%) patients who did not receive any vaccination (control group), group (B) included 92/341 (27%) patients who received "Sinopharm" vaccine, group (C) included 55/341 (16%) patients who received "Oxford-AstraZeneca" vaccine, group (D) included 38/341 (11%) patients who received "Pfizer-BioNTech" vaccine. Every group was subdivided based on the medical history into three groups;group (1) patients without comorbidities, group (2) patients with comorbidities, and group (3) immunocompromised patients. Automated CT volumetry was calculated for the pathological lung parenchyma. Five CT-severity scores were provided (score 0 = 0%, score 1 = 1–25%, score 2 = 25–50%, score 3 = 51–75%, and score 4 = 76–100%). Analysis of variance (ANOVA) including Tukey HSD testing was utilized in comparison to the non-immunized patients. The "Phizer-Biontech" vaccine succeeded to eliminate severity in patients without and with comorbidity, and also decreased severity in immunocompromised patients (from 79 to 17%). The "Oxford-AstraZeneca" vaccine and to a lesser extent "Sinopharm" vaccine also decreased the clinical severity in patients with comorbidities and immunocompromised patients (from 15 to 9% & 10% as well as from 79 to 20% & 50% respectively). Significant variance was proved regarding the use of "Sinopharm", "Oxford-AstraZeneca", and "Phizer-Biontech" vaccines in patients without comorbidities (f-ratio averaged 4.0282, 10.8049, and 8.4404 respectively, also p-value averaged 0.04632, 0.001268, and 0.004294). Significant variance was proved regarding the use of "Oxford-AstraZeneca", and "Phizer-Biontech" vaccines in patients with comorbidities and immunocompromised patients (f-ratio averaged 4.7521, and 4.1682 as well as 11.7811, and 15.6 respectively, also p-value averaged 0.03492, and 0.04857, as well as both 0.003177, and 0.0009394 respectively, all < 0.05). No significant variance was proved regarding the use of the "Sinopharm" vaccine. Conclusions: In addition to the decline of clinical severity rates & CT severity scores, a significant variance was proved regarding the use of the "Sinopharm", "Oxford-AstraZeneca", and "Phizer-Biontech" vaccines in patients without comorbidities. Significant variance was also proved regarding the use of the "Oxford-AstraZeneca" and "Phizer-Biontech" vaccines in patients with comorbidities and immunocompromised patients. Despite that, no significant variance could be proved regarding the use of the "Sinopharm" vaccine in these patients, it decreases the percentage of clinical severity and CT severity scores. © 2023, The Author(s).
ABSTRACT
Background: Due to the paucity of scientific evidence, it is unclear among pulmonologists and physicians in critical care units if and when splenomegaly in novel coronavirus disease (2019) (COVID-19) patients is worrisome. This study aims to evaluate the significance of splenic volume during COVID-19 infection with or without cytokine storm and correlates splenic volume to the volume of pathological lung changes through linear regression analysis. Result(s): A retrospective study collected 509 polymerase chain reaction proved COVID-19 patients (399 males, 110 females;mean age 48 years, age range 24-78 years) between June and November 2021, without a history of splenic pathology. A control group of age and sex-matched 509 healthy subjects was used and analyzed according to the splenic volume. Five consulting radiologists evaluated initial and follow-up computed tomography (CT) examinations using lung CT volumetry and splenic volume calculation in consensus. Three consulting pulmonologists correlated the severity of clinical and laboratory findings, including oxygen requirements and interleukin-6 (IL-6) levels. The T test results for comparison between the COVID-19 patients and the healthy subjects control group regarding the splenic volume were significant (T value was - 4.731452 and p value was 0.00002). There was no significant correlation between the severity of the disease and normal-sized spleen (26% of patients, p = 0.916) or splenomegaly (24% of patients, p = 0.579). On the other hand, all patients with a small spleen or progressive splenomegaly during serial follow-up imaging had clinically severe disease with a statistically significant correlation (p = 0.017 and 0.003, respectively). Ninety-seven percent of patients with clinically mild disease and splenomegaly had 0-20% lung involvement (CT-severity score 1) while all patients with clinically severe disease and splenomegaly had 27-73% lung involvement (CT-severity score 2 and 3) (r = 0.305, p = 0.030). Conclusion(s): Splenomegaly is a non-specific sign that may be found during mild and severe COVID-19 infection, it was not statistically correlated with the clinical severity and a weak positive relationship was found between the splenic size and the CT-severity score of the pathological lung volume. On the other hand, the presence of splenic atrophy or progressive splenomegaly was correlated with severe COVID-19 presentation and "cytokine storm". Therefore, the splenic volume changes should not be overlooked in COVID-19 serial CT examinations, particularly in severe or critically ill patients with cytokine storms. Copyright © 2022, The Author(s).
ABSTRACT
Background: The importance of thymic CT-grading and presence of thymic rebound hyperplasia during COVID-19 infection were only investigated in a few studies. This multivariate study aims to evaluate the relation between thymus CT-grading and rebound during COVID-19 infection and the following: (1) the patients' age, (2) the patients' blood lymphocytic count, (3) the CT-volumetry of the diseased lung parenchyma, (4) the patient's clinical course and prognosis, and finally (5) the final radiological diagnosis. Results: Multicenter retrospective analyses were conducted between March and June 2021 on 325 adult COVID-19 patients with positive PCR results and negative history of malignant or autoimmune diseases. They included 186 males and 139 females (57.2%:42.8%). Their mean age was 40.42 years ± 14.531 SD. Three consulting radiologists performed CT-grading of the thymus gland (grade 0–3) and CT-severity scoring (CT-SS) of the pathological lung changes in consensus. Two consulting pulmonologists correlated the clinical severity and blood lymphocytic count. Pearson correlation coefficient (r) and linear regression analyses were statistically utilized. Sub-involuted thymus (with CT-grade 0:2) was detected in 42/325 patients (12.9%);all of them had a mild clinical course and low CT-SS (0–1). Thymic rebound hyperplasia was the only positive CT-finding in 15/325 patients (4.6%) without pathological lung changes. A weak positive significant correlation was proved between thymic grade and patient's age, clinical course, and CT-SS (r = 0.217, 0.163, and 0.352 with p ≤ 0.0001, < 0.0001, and 0.002, respectively). A weak negative significant correlation was found between thymic grade and lymphocytic count (r = − 0.343 and p ≤ 0.0001). A strong positive significant correlation was encountered between clinical severity against patients' age and CT-SS (r = 0.616 and 0.803 with p ≤ 0.0001). Conclusions: The presence of sub-involuted thymus or thymic rebound should not be radiologically overlooked in COVID-19 patients. During COVID-19 infection, the presence of sub-involuted thymus with low CT-grading (0–2) was correlated with young age groups, low CT-severity scoring, mild clinical course, and better prognosis (good prognostic factor). It was seldom seen in old hospitalized patients. Atypically, it was also correlated with normal lymphocytic count or even lymphocytosis. The thymic rebound could be the only positive CT-finding even during the absence of lung involvement. © 2022, The Author(s).
ABSTRACT
Background: One year has passed since the announcement of COVID-19 as a pandemic and two waves had already stricken Egypt. The authors witnessed several atypical radiological features through the second pandemic wave, either early at the active infective stage or delayed at the post-infectious convalescent period. They believed every radiologist should be familiar with these features. Therefore, they performed this comparative study on 2000 Egyptian patients using multi-slice computed tomography (MSCT) to highlight the radiological differences between the first and second pandemic waves and correlate them to the clinical status. Results: This random multi-center comparative study was retrospectively conducted on 2000 COVID-19 Egyptian patients;1000 patients were registered at the first pandemic wave from April 2020 till September 2020, while the other 1000 patients were registered at the second pandemic wave from October 2020 till March 2020. Follow up CT examinations were performed for 49 and 122 patients through the first and second pandemic waves respectively. MSCT examinations were carefully evaluated by four expert consulting radiologists who came to a consensus. Meanwhile, the correlation with the clinical outcome was performed by two consulting pulmonologists. During the second pandemic wave, the prevalence rate of the “crazy-paving” pattern had significantly increased by 1.3 times (P value = 0.002). Additionally, the prevalence rate of the “air-bubble” sign had significantly increased by 1.9 times (P value = 0.02). Similarly, the presence of enlarged mediastinal lymph nodes (> 1 cm in short-axis diameter) had significantly increased by 1.7 times (P value = 0.036). Furthermore, the prevalence rate of pericardial effusion had significantly increased by 2.5 times (P value = 0.003). The above-mentioned signs were correlated to increased clinical severity and higher rates of hospitalization. Unexpectedly, other atypical radiological signs were only encountered through the second pandemic wave, including bronchiectatic changes (2.5%), “head-cheese” pattern (0.8%), cavitation (0.5%), and “bulls-eye” sign (0.2%). The prevalence rate of post-COVID fibrosis had doubled through the second wave but not in a significant way (P value = 0.234). Secondary fungal infection was only encountered throughout the second pandemic wave in four patients. COVID-19 reinfection was encountered in a single patient only during the second pandemic wave. Conclusion: After 1 year from the announcement of COVID-19 as a pandemic, the radiological presentation of COVID-19 patients showed some significant differences between its first and second waves.