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Clin Nucl Med ; 47(8): e540-e547, 2022 Aug 01.
Article in English | MEDLINE | ID: covidwho-1861003


PURPOSE: In coronavirus disease 2019 (COVID-19) patients, clinical manifestations as well as chest CT lesions are variable. Lung scintigraphy allows to assess and compare the regional distribution of ventilation and perfusion throughout the lungs. Our main objective was to describe ventilation and perfusion injury by type of chest CT lesions of COVID-19 infection using V/Q SPECT/CT imaging. PATIENTS AND METHODS: We explored a national registry including V/Q SPECT/CT performed during a proven acute SARS-CoV-2 infection. Chest CT findings of COVID-19 disease were classified in 3 elementary lesions: ground-glass opacities, crazy-paving (CP), and consolidation. For each type of chest CT lesions, a semiquantitative evaluation of ventilation and perfusion was visually performed using a 5-point scale score (0 = normal to 4 = absent function). RESULTS: V/Q SPECT/CT was performed in 145 patients recruited in 9 nuclear medicine departments. Parenchymal lesions were visible in 126 patients (86.9%). Ground-glass opacities were visible in 33 patients (22.8%) and were responsible for minimal perfusion impairment (perfusion score [mean ± SD], 0.9 ± 0.6) and moderate ventilation impairment (ventilation score, 1.7 ± 1); CP was visible in 43 patients (29.7%) and caused moderate perfusion impairment (2.1 ± 1.1) and moderate-to-severe ventilation impairment (2.5 ± 1.1); consolidation was visible in 89 patients (61.4%) and was associated with moderate perfusion impairment (2.1 ± 1) and severe ventilation impairment (3.0 ± 0.9). CONCLUSIONS: In COVID-19 patients assessed with V/Q SPECT/CT, a large proportion demonstrated parenchymal lung lesions on CT, responsible for ventilation and perfusion injury. COVID-19-related pulmonary lesions were, in order of frequency and functional impairment, consolidations, CP, and ground-glass opacity, with typically a reverse mismatched or matched pattern.

COVID-19 , COVID-19/diagnostic imaging , Humans , Lung/diagnostic imaging , Registries , SARS-CoV-2 , Ventilation-Perfusion Scan
Medicina (Kaunas) ; 56(12)2020 Dec 03.
Article in English | MEDLINE | ID: covidwho-963621


Pulmonary embolism (PE) is a commonly encountered clinical entity in patients with coronavirus disease 2019 (COVID-19). Up to 1/3 of patients have been found to have PE in the setting of COVID-19. Given the novelty of the virus causing this pandemic, it has not been easy to address diagnostic and management issues in PE. Ongoing research and publications of the scientific literature have helped in dealing with COVID-19 lately and this applies to PE as well. In this article, we attempt to succinctly yet comprehensively discuss PE in patients with COVID-19 with a review of the prevailing literature.

COVID-19/blood , Pulmonary Embolism/diagnosis , Pulmonary Embolism/therapy , Thrombophilia/blood , Anticoagulants/therapeutic use , COVID-19/complications , Computed Tomography Angiography , Disease Management , Disseminated Intravascular Coagulation/blood , Echocardiography , Extracorporeal Membrane Oxygenation , Fibrin Fibrinogen Degradation Products/metabolism , Fibrinogen/metabolism , Humans , Lower Extremity/diagnostic imaging , Partial Thromboplastin Time , Platelet Count , Point-of-Care Systems , Prothrombin Time , Pulmonary Embolism/blood , Pulmonary Embolism/etiology , Thrombolytic Therapy , Thrombophilia/complications , Ultrasonography, Doppler, Duplex , Venous Thrombosis/diagnostic imaging , Ventilation-Perfusion Scan
Lancet Respir Med ; 9(1): 107-116, 2021 01.
Article in English | MEDLINE | ID: covidwho-939393


A compelling body of evidence points to pulmonary thrombosis and thromboembolism as a key feature of COVID-19. As the pandemic spread across the globe over the past few months, a timely call to arms was issued by a team of clinicians to consider the prospect of long-lasting pulmonary fibrotic damage and plan for structured follow-up. However, the component of post-thrombotic sequelae has been less widely considered. Although the long-term outcomes of COVID-19 are not known, should pulmonary vascular sequelae prove to be clinically significant, these have the potential to become a public health problem. In this Personal View, we propose a proactive follow-up strategy to evaluate residual clot burden, small vessel injury, and potential haemodynamic sequelae. A nuanced and physiological approach to follow-up imaging that looks beyond the clot, at the state of perfusion of lung tissue, is proposed as a key triage tool, with the potential to inform therapeutic strategies.

COVID-19/complications , COVID-19/diagnostic imaging , Computed Tomography Angiography/methods , Pulmonary Artery/diagnostic imaging , Pulmonary Embolism/diagnostic imaging , Pulmonary Fibrosis/diagnostic imaging , Thrombosis/diagnostic imaging , Ventilation-Perfusion Scan/methods , Aftercare , COVID-19/physiopathology , Chronic Disease , Contrast Media , Humans , Hypertension, Pulmonary/diagnostic imaging , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/physiopathology , Lung/blood supply , Lung/diagnostic imaging , Lung/physiopathology , Perfusion Imaging , Pulmonary Embolism/etiology , Pulmonary Embolism/physiopathology , Pulmonary Fibrosis/etiology , Pulmonary Fibrosis/physiopathology , Respiratory Function Tests , SARS-CoV-2 , Thrombosis/etiology , Thrombosis/physiopathology , Tomography, Emission-Computed, Single-Photon/methods , Tomography, X-Ray Computed/methods , Post-Acute COVID-19 Syndrome