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1.
Radiology ; : 211670, 2022 Mar 29.
Article in English | MEDLINE | ID: covidwho-1765163

ABSTRACT

Background The long-term pulmonary sequelae of coronavirus disease 2019 (COVID-19) is not well known. Purpose To characterize patterns and rates of improvement of chest CT abnormalities one year after COVID-19 pneumonia. Materials and Methods This was a secondary analysis of a prospective, multicenter observational cohort study conducted from April 29 to August 12, 2020 to assess pulmonary abnormalities on chest CT at approximately 2, 3, 6 months, and 1 year after onset of COVID-19 symptoms. Pulmonary findings were graded for each lung lobe using a qualitative CT severity score (CTSS), range 0 (normal) to 25 (all lobes involved). The association of demographic and clinical factors with CT abnormalities after 1 year was assessed with logistic regression. The rate of change of the CTSS at follow-up CT was investigated by Friedmann test. Results Out of 142 enrolled participants, 91 participants had a 1-year follow-up CT and were included in the analysis [mean age, 59 years ± 13 [standard deviation]; 35 women (38%)]. In 49/91 (54%) participants, CT abnormalities were observed: 31/91 (34%) participants showed subtle subpleural reticulation, ground-glass opacities or both and 18/91 (20%) participants revealed extensive ground-glass opacities, reticulations, bronchial dilation and/or microcystic changes. In multivariable analysis, age > 60 years (OR 5.8 [95% CI: 1.7 - 24]; p = .009) critical COVID-19 severity (OR 29 [95% CI: 4.8 - 280]; p < .001) and male gender (OR 8.9 [95% CI: 2.6 - 36]; p < .001) were associated with persistent CT abnormalities at 1 year. Reduction of CTSS was observed in participants in subsequent follow-up CTs (p < .001) and during the study period 49% (69/142) of participants had complete resolution of CT abnormalities. 31/49 (63%) participants with CT abnormalities did not show further improvement after 6 months. Conclusion Long-term CT abnormalities were common 1 year after COVID-19 pneumonia. The study is registered at ClinicalTrials.gov number (registration number NCT04416100). See also the editorial by Leung.

2.
Wien Klin Wochenschr ; 133(23-24): 1298-1309, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1748480

ABSTRACT

Hundreds of millions got infected, and millions have died worldwide and still the number of cases is rising.Chest radiographs and computed tomography (CT) are useful for imaging the lung but their use in infectious diseases is limited due to hygiene and availability.Lung ultrasound has been shown to be useful in the context of the pandemic, providing clinicians with valuable insights and helping identify complications such as pleural effusion in heart failure or bacterial superinfections. Moreover, lung ultrasound is useful for identifying possible complications of procedures, in particular, pneumothorax.Associations between coronavirus disease 2019 (COVID-19) and cardiac complications, such as acute myocardial infarction and myocarditis, have been reported. As such, point of care echocardiography as well as a comprehensive approach in later stages of the disease provide important information for optimally diagnosing and treating complications of COVID-19.In our experience, lung ultrasound in combination with echocardiography, has a great impact on treatment decisions. In the acute state as well as in the follow-up setting after a severe or critical state of COVID-19, ultrasound can be of great impact to monitor the progression and regression of disease.


Subject(s)
COVID-19 , Critical Illness , Echocardiography , Humans , Lung/diagnostic imaging , Point-of-Care Systems , SARS-CoV-2 , Ultrasonography
3.
PLoS One ; 16(10): e0258351, 2021.
Article in English | MEDLINE | ID: covidwho-1496507

ABSTRACT

BACKGROUND: Elevated D-dimer is known as predictor for severity of SARS-CoV2-infection. Increased D-dimer is associated with thromboembolic complications, but it is also a direct consequence of the acute lung injury seen in COVID-19 pneumonia. OBJECTIVES: To evaluate the rate of persistent elevated D-dimer and its association with thromboembolic complications and persistent ground glass opacities (GGO) after recovery from COVID-19. METHODS: In this post hoc analysis of a prospective multicenter trial, patients underwent blood sampling, measurement of diffusion capacity, blood gas analysis, and multidetector computed tomography (MDCT) scan following COVID-19. In case of increased D-dimer (>0,5 µg/ml), an additional contrast medium-enhanced CT was performed in absence of contraindications. Results were compared between patients with persistent D-dimer elevation and patients with normal D-dimer level. RESULTS: 129 patients (median age 48.8 years; range 19-91 years) underwent D-Dimer assessment after a median (IQR) of 94 days (64-130) following COVID-19. D-dimer elevation was found in 15% (19/129) and was significantly more common in patients who had experienced a severe SARS-CoV2 infection that had required hospitalisation compared to patients with mild disease (p = 0.049). Contrast-medium CT (n = 15) revealed an acute pulmonary embolism in one patient and CTEPH in another patient. A significant lower mean pO2 (p = 0.015) and AaDO2 (p = 0.043) were observed in patients with persistent D-Dimer elevation, but the rate of GGO were similar in both patient groups (p = 0.33). CONCLUSION: In 15% of the patients recovered from COVID-19, persistent D-dimer elevation was observed after a median of 3 months following COVID-19. These patients had experienced a more severe COVID and still presented more frequently a lower mean pO2 and AaDO2.


Subject(s)
COVID-19/metabolism , Fibrin Fibrinogen Degradation Products/analysis , Adult , Aged , Aged, 80 and over , Biomarkers/blood , Female , Fibrin Fibrinogen Degradation Products/metabolism , Humans , Male , Middle Aged , Prospective Studies , Pulmonary Embolism/prevention & control , RNA, Viral , Retrospective Studies , SARS-CoV-2/pathogenicity , Severity of Illness Index , Tomography, X-Ray Computed/methods
4.
Wien Klin Wochenschr ; 133(23-24): 1298-1309, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1491144

ABSTRACT

Hundreds of millions got infected, and millions have died worldwide and still the number of cases is rising.Chest radiographs and computed tomography (CT) are useful for imaging the lung but their use in infectious diseases is limited due to hygiene and availability.Lung ultrasound has been shown to be useful in the context of the pandemic, providing clinicians with valuable insights and helping identify complications such as pleural effusion in heart failure or bacterial superinfections. Moreover, lung ultrasound is useful for identifying possible complications of procedures, in particular, pneumothorax.Associations between coronavirus disease 2019 (COVID-19) and cardiac complications, such as acute myocardial infarction and myocarditis, have been reported. As such, point of care echocardiography as well as a comprehensive approach in later stages of the disease provide important information for optimally diagnosing and treating complications of COVID-19.In our experience, lung ultrasound in combination with echocardiography, has a great impact on treatment decisions. In the acute state as well as in the follow-up setting after a severe or critical state of COVID-19, ultrasound can be of great impact to monitor the progression and regression of disease.


Subject(s)
COVID-19 , Critical Illness , Echocardiography , Humans , Lung/diagnostic imaging , Point-of-Care Systems , SARS-CoV-2 , Ultrasonography
5.
Radiologe ; 61(10): 888-895, 2021 Oct.
Article in German | MEDLINE | ID: covidwho-1413121

ABSTRACT

BACKGROUND: Following coronavirus disease 2019 (COVID-19), a proportion of patients report prolonged or worsening symptoms and impairments. These symptoms are increasingly referred to as "long COVID" syndrome. They may be associated with radiological changes on computed tomography (CT) and pulmonary function impairment. OBJECTIVES: To discuss the role of long-term assessment of COVID-19 patients to determine which patients may benefit from follow-up. MATERIALS AND METHODS: This article presents the current results of clinical, radiological, and pulmonary function follow-up tests after COVID-19 pneumonia. RESULTS: Chronic fatigue and dyspnea are the most common persistent symptoms after COVID-19. Patients also present impaired exercise capacity. On CT, ground-glass opacities and parenchymal bands are the most common residual changes after COVID-19 pneumonia, histologically corresponding to organizing pneumonia. A proportion of patients who had severe COVID-19 pneumonia may show fibrotic-like changes during follow-up. Patients with severe acute infection may present with a restrictive syndrome with lower diffusing capacity for carbon monoxide (DLCO) and total lung capacity (TLC) values. Overall, significant and continuous improvement in all symptoms as well as radiomorphological and functional changes were observed over time. CONCLUSIONS: Patients with persistent symptoms after COVID-19 should be evaluated and treated in specialized post-COVID-19 clinics in a multidisciplinary manner.


Subject(s)
COVID-19 , Pneumonia , Humans , Lung/diagnostic imaging , Respiratory Function Tests , SARS-CoV-2
6.
Eur J Nucl Med Mol Imaging ; 48(8): 2500-2524, 2021 07.
Article in English | MEDLINE | ID: covidwho-1208672

ABSTRACT

Medical imaging methods are assuming a greater role in the workup of patients with COVID-19, mainly in relation to the primary manifestation of pulmonary disease and the tissue distribution of the angiotensin-converting-enzyme 2 (ACE 2) receptor. However, the field is so new that no consensus view has emerged guiding clinical decisions to employ imaging procedures such as radiography, computer tomography (CT), positron emission tomography (PET), and magnetic resonance imaging, and in what measure the risk of exposure of staff to possible infection could be justified by the knowledge gained. The insensitivity of current RT-PCR methods for positive diagnosis is part of the rationale for resorting to imaging procedures. While CT is more sensitive than genetic testing in hospitalized patients, positive findings of ground glass opacities depend on the disease stage. There is sparse reporting on PET/CT with [18F]-FDG in COVID-19, but available results are congruent with the earlier literature on viral pneumonias. There is a high incidence of cerebral findings in COVID-19, and likewise evidence of gastrointestinal involvement. Artificial intelligence, notably machine learning is emerging as an effective method for diagnostic image analysis, with performance in the discriminative diagnosis of diagnosis of COVID-19 pneumonia comparable to that of human practitioners.


Subject(s)
COVID-19 , Pneumonia, Viral , Artificial Intelligence , Humans , Positron Emission Tomography Computed Tomography , SARS-CoV-2
7.
Radiologe ; 60(10): 908-915, 2020 Oct.
Article in German | MEDLINE | ID: covidwho-856132

ABSTRACT

CLINICAL ISSUE: Since its emergence in late 2019, the disease caused by the novel coronavirus, termed COVID-19, has been declared a pandemic by the World Health Organization. Reference standard for the diagnosis of COVID-19 is a positive reverse transcription polymerase chain reaction (RT-PCR) test. While the RT-PCR shows a high specificity, its sensitivity depends on the duration of symptoms, viral load, quality of the sample, and the assay used. STANDARD RADIOLOGICAL METHODS: Chest radiography and computed tomography (CT) of the chest are the imaging modalities primarily used for assessment of the lung manifestations, extent, and complications of COVID-19 pneumonia. PERFORMANCE: Sensitivity and specificity of chest radiography is low. While sensitivity of CT for detecting COVID-19 pneumonia is high-averaging around 90%-its specificity is low-between 25 and 33%. PRACTICAL RECOMMENDATIONS: Indications for imaging in patients with suspected or diagnosed COVID-19 infection should be carefully considered to minimize the risk of infection for medical personnel and other patients. Imaging, particularly CT, can assess disease extent, complications, and differential diagnoses. COVID-19 pneumonia typically presents with bilateral, subpleural areas of ground glass opacifications with or without consolidations. During the course of the disease features resembling organizing pneumonia can occur. Follow-up examinations after recovery from COVID-19 pneumonia should focus on fibrotic changes of the lung parenchyma.


Subject(s)
Betacoronavirus , Coronavirus Infections , Pandemics , Pneumonia, Viral , COVID-19 , Humans , Lung , SARS-CoV-2
9.
Res Pract Thromb Haemost ; 4(5): 835-841, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-324313

ABSTRACT

BACKGROUND: The COVID-19 pandemic has focused medical attention on treating affected patients and protecting others from infection. However, concerns have been raised regarding the pandemic´s impact and associated containment measures (eg curfew, lockdown) on non-coronavirus disease 2019 (COVID-19)-related acute medical diseases. OBJECTIVES: To investigate changes in the incidence of pulmonary embolism (PE) during the COVID-19 pandemic compared to the period before the pandemic and reference periods in previous years. METHODS: In this single-center study, we explored all diagnostic imaging tests performed for suspected PE between weeks 1 and 17 of the years 2018, 2019, and 2020. Incidence of PE (ie, primary outcome) was analyzed. Secondary outcomes included number of imaging tests for suspected PE. RESULTS: Compared to weeks 1 to 11, 2020, an abrupt decline in PE diagnosis (mean weekly rate, 5.2; 95% confidence interval [CI], 3.8-6.6 vs 1.8; 95% CI, 0.0-3.6) and imaging tests (mean weekly rate, 32.5; 95% CI, 27.5-37.6 vs. 17.3; 95% CI, 11.6-23.1) was observed from week 12, with beginning of the containment measures and public lockdown in Austria. Compared to weeks 12 to 17 of 2018 and 2019, PE incidence and imaging tests were similarly decreased from 5.3 (95% CI, 3.6-7.1) to 1.8 (95% CI, 0.0-3.6) and 31.5 (95% CI, 27.1-35.9) to 17.3 (95% CI, 11.6-23.1), respectively. The median simplified pulmonary embolism severity index (sPESI) score of PE patients during the pandemic was higher than in all other PE patients (3; interquartile range, 1-3 vs 1; interquartile range, 0-2; P = .002). CONCLUSION: Our study demonstrates that the COVID-19 pandemic has an impact on non-COVID-19-related acute diseases as shown by the decline in incidence of PE and imaging procedures for diagnostic workup. Further studies from other hospitals are needed to confirm our findings.

10.
Eur J Radiol Open ; 7: 100237, 2020.
Article in English | MEDLINE | ID: covidwho-232617

ABSTRACT

Coronavirus Disease-2019 (COVID-19) originated in the Wuhan, Hubei Province, China in November 2019 and has since been declared a pandemic by the WHO. COVID-19 is an acute infectious disease, primarily affecting the respiratory system. Currently, real-time reverse transcription polymerase chain reaction (RT-PCR) performed on respiratory specimens is considered the reference by which to diagnose COVID-19. However, the limitations of RT-PCR, specifically, the fact that it is time-consuming and inadequate for the assessment of disease severity, have affected the process of epidemiological disease containment and has taken a toll on the healthcare management chain. As the risk of infection for other patients and personnel must be kept to a minimum, the indications for imaging have to be carefully considered. Imaging is primarily performed in patients with a negative RT-PCR, but a high clinical suspicion of COVID-19, or, in patients with diagnosed COVID-19 who are suffering from moderate to severe symptoms. In this article, we review the typical imaging findings in COVID-19, the differential diagnoses, and common complications.

11.
Eur Radiol ; 30(9): 4903-4909, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-88511

ABSTRACT

This document from the European Society of Radiology (ESR) and the European Society of Thoracic Imaging (ESTI) aims to present the main imaging features, and the role of CT scan in the early diagnosis of COVID-19, describing, in particular, the typical findings which make it possible to identify the disease and distinguish it from bacterial causes of infection, and to define which category of patients may benefit from CT imaging. The precautions that must be taken when performing scans to protect radiologists and technologists from infection will be described. The organisational measures that can be taken within radiology departments in order to cope with the influx of patients, while continuing to manage other emergency and time-sensitive activity (e.g. oncology, other infectious diseases etc.), will be discussed. KEY POINTS: • Bilateral ground glass opacities are typical CT manifestations of COVID-19. • Crazy paving and organising pneumonia pattern are seen at a later stage. • Extensive consolidation is associated with a poor prognosis.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , COVID-19 , Emergency Service, Hospital , Europe , Humans , Pandemics , Radiography, Thoracic , Radiology Department, Hospital , SARS-CoV-2 , Societies, Medical , Tomography, X-Ray Computed
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