Dual-energy CT angiography reveals high prevalence of perfusion defects unrelated to pulmonary embolism in COVID-19 lesions
Open Access
- 17 February 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Insights into Imaging
- Vol. 12 (1), 1-9
- https://doi.org/10.1186/s13244-021-00972-0
Abstract
Lung perfusion defects (PDs) have been described in COVID-19 using dual-energy computed tomography pulmonary angiography (DE-CTPA). We assessed the prevalence and characteristics of PDs in COVID-19 patients with suspected pulmonary embolism (PE) and negative CTPA. This retrospective study included COVID-19 and non-COVID-19 pneumonia groups of patients with DE-CTPA negative for PE. Two radiologists rated the presence of PD within the lung opacities and analyzed the type of lung opacities and PD pattern (i.e. homogeneous or heterogeneous). The clinical, biological, radiological characteristics including time from first symptoms and admission to DE-CTPA, oxygen requirements, CRP, D-dimer levels, duration of hospital admission and death were compared within the COVID-19 group between patients with (PD +) or without PD (PD-). 67 COVID-19 and 79 non-COVID-19 patients were included. PDs were more frequent in the COVID-19 than in the non-COVID-19 group (59.7% and 26.6% respectively, p < 0.001). Patterns of PDs were different, with COVID-19 patients exhibiting heterogenous PDs (38/40, 95%) whereas non-COVID-19 patients showed mostly homogeneous perfusion defects (7/21 heterogeneous PDs, 33%), p < 0.001. In COVID-19 patients, most consolidations (9/10, 90%) exhibited PDs while less than a third of consolidations (19/67, 28%) had PDs in non-COVID-19 patients. D-dimer, oxygen levels and outcome were similar between COVID-19 PD + and PD- patients; however, time between admission and DE-CTPA was longer in PD + patients (median [IQR], 1 [0–7] and 0 [0–2]; p = 0.045). Unlike in bacterial pneumonia, heterogeneous PDs within lung opacities are a frequent feature of COVID-19 pneumonia in PE-suspected patients.Keywords
This publication has 28 references indexed in Scilit:
- Curative anticoagulation prevents endothelial lesion in COVID-19 patientsJournal of Thrombosis and Haemostasis, 2020
- Acute Pulmonary Embolism in Patients with COVID-19 at CT Angiography and Relationship to d-Dimer LevelsRadiology, 2020
- Acute Pulmonary Embolism Associated with COVID-19 Pneumonia Detected with Pulmonary CT AngiographyRadiology, 2020
- Image-proven thromboembolism in patients with severe COVID-19 in a tertiary critical care unit in the United KingdomThrombosis Research, 2020
- Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, ItalyThrombosis Research, 2020
- Incidence of thrombotic complications in critically ill ICU patients with COVID-19Thrombosis Research, 2020
- Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, ChinaJAMA, 2020
- Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort studyThe Lancet, 2020
- A Novel Coronavirus from Patients with Pneumonia in China, 2019The New England Journal of Medicine, 2020
- Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumoniaJournal of Thrombosis and Haemostasis, 2020