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BACKGROUND AND AIMS: To analyze the diagnostic performance of pulmonary CT angiography and to compare different D-dimer cutoffs for the diagnosis of acute pulmonary embolism in patients with and without SARS-CoV-2 infections. MATERIALS AND METHODS: We retrospectively analyzed all consecutive pulmonary CT angiography studies done for suspected pulmonary embolism in a tertiary hospital during two time periods: the first December 2020 through February 2021 and the second December 2017 through February 2018.D-dimer levels were obtained less than 24 hours before the pulmonary CT angiography studies. We analyzed the sensitivity, specificity, positive and negative predictive values, area under the receiver operating curve (AUC), and pattern of pulmonary embolism for six different values of D-dimer and the extent of the embolism. During the pandemic period, we also analyzed whether the patients had COVID-19. RESULTS: After excluding 29 poor-quality studies, 492 studies were analyzed; 352 of these were done during the pandemic, 180 in patients with COVID-19 and 172 in patients without COVID-19.The absolute frequency of pulmonary embolism diagnosed was higher during the pandemic period (34 cases during the prior period and 85 during the pandemic; 47 of these patients had COVID-19). No significant differences were found in comparing the AUCs for the D-dimer values. The optimum values calculated for the receiver operating characteristic curves differed between patients with COVID-19 (2200 mcg/L), without COVID-19 (4800 mcg/L), and diagnosed in the prepandemic period (3200 mcg/L).Peripheral distribution of the emboli was more common in patients with COVID-19 (72%) than in those without COVID-19 and than in those diagnosed before the pandemic [OR 6.6, 95% CI:1.5â24.6, p<0.05 when compared to central distribution]. CONCLUSIONS: The number of CT angiography studies and the number of pulmonary embolisms diagnosed during the pandemic increased due to SARS-CoV-2 infection. The optimal D-dimer cutoffs and the distribution of the pulmonary embolisms differed between the groups of patients with and without COVID-19.
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Background and aims To analyze the diagnostic performance of pulmonary CT angiography and to compare different D-dimer cutoffs for the diagnosis of acute pulmonary embolism in patients with and without SARS-CoV-2 infections. Materials and methods We retrospectively analyzed all consecutive pulmonary CT angiography studies done for suspected pulmonary embolism in a tertiary hospital during two time periods: the first December 2020 through February 2021 and the second December 2017 through February 2018. D-dimer levels were obtained less than 24 hours before the pulmonary CT angiography studies. We analyzed the sensitivity, specificity, positive and negative predictive values, area under the receiver operating curve (AUC), and pattern of pulmonary embolism for six different values of D-dimer and the extent of the embolism. During the pandemic period, we also analyzed whether the patients had COVID-19. Results After excluding 29 poor-quality studies, 492 studies were analyzed;352 of these were done during the pandemic, 180 in patients with COVID-19 and 172 in patients without COVID-19. The absolute frequency of pulmonary embolism diagnosed was higher during the pandemic period (34 cases during the prior period and 85 during the pandemic;47 of these patients had COVID-19). No significant differences were found in comparing the AUCs for the D-dimer values. The optimum values calculated for the receiver operating characteristic curves differed between patients with COVID-19 (2200 mcg/L), without COVID-19 (4800 mcg/L), and diagnosed in the prepandemic period (3200 mcg/L). Peripheral distribution of the emboli was more common in patients with COVID-19 (72%) than in those without COVID-19 and than in those diagnosed before the pandemic [OR 6.6, 95% CI:1.5‒24.6, p < 0.05 when compared to central distribution]. Conclusions The number of CT angiography studies and the number of pulmonary embolisms diagnosed during the pandemic increased due to SARS-CoV-2 infection. The optimal D-dimer cutoffs and the distribution of the pulmonary embolisms differed between the groups of patients with and without COVID-19.
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Antecedentes y objetivo: Analizar el rendimiento diagnóstico de la angio-TC pulmonar y comparar distintos valores de corte del dímero-D para el diagnóstico de tromboembolia pulmonar (TEP) aguda en pacientes con y sin infección por SARS-CoV-2. Materiales y métodos: Análisis retrospectivo de todas las angio-TC pulmonares realizadas consecutivamente por sospecha de TEP en un hospital de tercer nivel durante 2 periodos distintos. El primero de diciembre del 2020 a febrero del 2021 y el segundo de diciembre del 2017 a febrero del 2018. Se recogieron los resultados del dímero-D durante las 24 h previas a la realización de las angio-TC pulmonares, así como el resultado de estas últimas para todos los pacientes incluidos. Se analizaron la sensibilidad, especificidad, valores predictivos, área bajo la curva (AUC) y patrón de tromboembolia para 6 valores distintos del dímero-D y la extensión del tromboembolia. Durante el periodo de la pandemia se registró si los pacientes tenían enfermedad por SARS-CoV-2. Resultados Tras desestimar 29 estudios de baja calidad, se incluyeron 492 para el análisis. De ellos, 352 fueron realizados durante la pandemia;180 en enfermos con COVID-19 y 172 sin la enfermedad. La frecuencia absoluta de TEP diagnosticados durante la pandemia fue mayor (34 durante el periodo previo a la pandemia y 85 durante la pandemia, correspondiendo 47 de este último grupo a pacientes con COVID-19). No se encontraron diferencias significativas al comparar el AUC para los valores del dímero-D. Los valores óptimos calculados a partir de las curvas ROC fueron distintos (2.200, 4.800 y 3.200 µg/l en pacientes con COVID-19, sin COVID-19 y en diagnosticados durante el periodo prepandemia, respectivamente). La distribución periférica de los trombos fue más frecuente en pacientes con COVID-19 (72%), respecto a los pacientes sin COVID-19 y los diagnosticados antes de la pandemia, con un OR de 6,6, IC del 95%: 1,5-24,6 (p < 0,05) al compararla con la distribución central. Conclusiones El número de angio-TC realizadas y TEP diagnosticados durante la pandemia aumentó debido a la infección por SARS-CoV-2. Los valores de corte del dímero-D óptimos y la distribución del TEP fueron distintos en los grupos con y sin COVID-19.
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In March 2020, the World Health Organization declared a global pandemic of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); epidemic conditions continue in nearly all countries today. Although the symptoms and imaging manifestations of COVID-19 predominantly involve the respiratory system, it is fundamental to know the manifestations of the disease and its possible complications in other organs to help in diagnosis and orient the prognosis. To improve the diagnostic process without increasing the risk of contagion unnecessarily, it is crucial to know when extrathoracic imaging tests are indicated and which tests are best in each situation. This paper aims to provide answers to these questions. To this end, we describe and illustrate the extrathoracic imaging manifestations of COVID-19 in adults as well as the entire spectrum of imaging findings in children.
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During the COVID-19 epidemic, the prevalence of the disease means that practically any lung opacity on an X-ray could represent pneumonia due to infection with SARS-CoV-2. Nevertheless, atypical radiologic findings add weight to negative microbiological or serological tests. Likewise, outside the epidemic wave and with the return of other respiratory diseases, radiologists can play an important role in decision making about diagnoses, treatment, or preventive measures (isolation), provided they know the key findings for entities that can simulate COVID-19 pneumonia. Unifocal opacities or opacities located in upper lung fields and predominant airway involvement, in addition to other key radiologic and clinical findings detailed in this paper, make it necessary to widen the spectrum of possible diagnoses. Resumen La prevalencia en fase epidémica de la COVID-19 hace que prácticamente cualquier opacidad pulmonar en la radiografía de tórax pueda ser una neumonía por SARS-CoV-2. Sin embargo, hallazgos radiológicos atípicos aumentarán la credibilidad de un resultado microbiológico o serológico negativo. Asimismo, fuera de la ola epidémica y con el retorno de otras entidades respiratorias, el radiólogo puede tener gran relevancia en la toma de decisiones diagnósticas, terapéuticas o preventivas (aislamiento) si conoce las claves diagnósticas de las entidades simuladoras de neumonía COVID-19. La distribución unifocal o en campos pulmonares superiores de las opacidades y la afectación predominante de vía aérea, entre otras claves radiológicas y clínicas detalladas en este capítulo, implican necesariamente ampliar el abanico de posibilidades diagnósticas.
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During the COVID-19 epidemic, the prevalence of the disease means that practically any lung opacity on an X-ray could represent pneumonia due to infection with SARS-CoV-2. Nevertheless, atypical radiologic findings add weight to negative microbiological or serological tests. Likewise, outside the epidemic wave and with the return of other respiratory diseases, radiologists can play an important role in decision making about diagnoses, treatment, or preventive measures (isolation), provided they know the key findings for entities that can simulate COVID-19 pneumonia. Unifocal opacities or opacities located in upper lung fields and predominant airway involvement, in addition to other key radiologic and clinical findings detailed in this paper, make it necessary to widen the spectrum of possible diagnoses.