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Dual-Energy CT Pulmonary Angiography (DECTPA) Quantifies Vasculopathy in Severe COVID-19 Pneumonia.
Ridge, Carole A; Desai, Sujal R; Jeyin, Nidhish; Mahon, Ciara; Lother, Dione L; Mirsadraee, Saeed; Semple, Tom; Price, Susanna; Bleakley, Caroline; Arachchillage, Deepa J; Shaw, Elizabeth; Patel, Brijesh V; Padley, Simon Pg; Devaraj, Anand.
  • Ridge CA; Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College L
  • Desai SR; Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College L
  • Jeyin N; Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College L
  • Mahon C; Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College L
  • Lother DL; Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College L
  • Mirsadraee S; Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College L
  • Semple T; Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College L
  • Price S; Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College L
  • Bleakley C; Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College L
  • Arachchillage DJ; Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College L
  • Shaw E; Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College L
  • Patel BV; Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College L
  • Padley SP; Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College L
  • Devaraj A; Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College L
Radiol Cardiothorac Imaging ; 2(5): e200428, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: covidwho-1356976
ABSTRACT

BACKGROUND:

The role of dual energy computed tomographic pulmonary angiography (DECTPA) in revealing vasculopathy in coronavirus disease 2019 (COVID-19) has not been fully explored.

PURPOSE:

To evaluate the relationship between DECTPA and disease duration, right ventricular dysfunction (RVD), lung compliance, D-dimer and obstruction index in COVID-19 pneumonia. MATERIALS AND

METHODS:

This institutional review board approved this retrospective study, and waived the informed consent requirement. Between March-May 2020, 27 consecutive ventilated patients with severe COVID-19 pneumonia underwent DECTPA to diagnose pulmonary thrombus (PT); 11 underwent surveillance DECTPA 14 ±11.6 days later. Qualitative and quantitative analysis of perfused blood volume (PBV) maps recorded i) perfusion defect 'pattern' (wedge-shaped, mottled or amorphous), ii) presence of PT and CT obstruction index (CTOI) and iii) PBV relative to pulmonary artery enhancement (PBV/PAenh); PBV/PAenh was also compared with seven healthy volunteers and correlated with D-Dimer and CTOI.

RESULTS:

Amorphous (n=21), mottled (n=4), and wedge-shaped (n=2) perfusion defects were observed (M=20; mean age=56 ±8.7 years). Mean extent of perfusion defects=36.1%±17.2. Acute PT was present in 11/27(40.7%) patients. Only wedge-shaped defects corresponded with PT (2/27, 7.4%). Mean CTOI was 2.6±5.4 out of 40. PBV/PAenh (18.2 ±4.2%) was lower than in healthy volunteers (27 ±13.9%, p = 0.002). PBV/PAenh correlated with disease duration (ß = 0.13, p = 0.04), and inversely correlated with RVD (ß = -7.2, p = 0.001), persisting after controlling for confounders. There were no linkages between PBV/PAenh and D-dimer or CTOI.

CONCLUSION:

Perfusion defects and decreased PBV/PAenh are prevalent in severe COVID-19 pneumonia. PBV/PAenh correlates with disease duration and inversely correlates with RVD. PBV/PAenh may be an important marker of vasculopathy in severe COVID-19 pneumonia even in the absence of arterial thrombus.
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Texto completo: Disponible Colección: Bases de datos internacionales Base de datos: MEDLINE Tipo de estudio: Estudio experimental / Estudio observacional / Investigación cualitativa Idioma: Inglés Revista: Radiol Cardiothorac Imaging Año: 2020 Tipo del documento: Artículo

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Texto completo
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Texto completo: Disponible Colección: Bases de datos internacionales Base de datos: MEDLINE Tipo de estudio: Estudio experimental / Estudio observacional / Investigación cualitativa Idioma: Inglés Revista: Radiol Cardiothorac Imaging Año: 2020 Tipo del documento: Artículo