Assessment of pulmonary arterial circulation 3 months after hospitalization for SARS-CoV-2 pneumonia: Dual-energy CT (DECT) angiographic study in 55 patients

Abstract

Background During COVID-19, the main manifestations of the disease are not only pneumonia but also coagulation disorders. The purpose of this study was to evaluate pulmonary vascular abnormalities 3 months after hospitalization for SARS-CoV-2 pneumonia in patients with persistent respiratory symptoms. Methods Among the 320 patients who participated in a systematic follow-up 3 months after hospitalization, 76 patients had residual symptoms justifying a specialized follow-up in the department of pulmonology. Among them, dual-energy CT angiography (DECTA) was obtained in 55 patients. Findings The 55 patients had partial ( n = 40; 72.7%) or complete ( n = 15; 27.3%) resolution of COVID-19 lung infiltration. DECTA was normal in 52 patients (52/55; 94.6%) and showed endoluminal filling defects in 3 patients (3/55; 5.4%) at the level of one ( n = 1) and two ( n = 1) segmental arteries of a single lobe and within central and peripheral arteries ( n = 1). DECT lung perfusion was rated as non-interpretable ( n = 2;3.6%), normal ( n = 17; 30.9%) and abnormal ( n = 36; 65.5%), the latter group comprising 32 patients with residual COVID-19 opacities (32/36; 89%) and 4 patients with normal lung parenchyma (4/36; 11%). Perfusion abnormalities consisted of (a) patchy defects (30/36; 83%), (b) PE-type defects (6/36; 16.6%) with ( n = 1) or without proximal thrombosis ( n = 5); and (c) focal areas of hypoperfusion (2/36; 5.5%). Increased perfusion was seen in 15 patients, always matching GGOs, bands and/or vascular tree-in- bud patterns. Interpretation DECT depicted proximal arterial thrombosis in 5.4% of patients and perfusion abnormalities suggestive of widespread microangiopathy in 65.5% of patients. Lung microcirculation was abnormal in 4 patients with normal lung parenchyma.

The Usefulness of Chest CT Imaging in Patients With Suspected or Diagnosed COVID-19

“…30 This entity is best detected by dualenergy CT imaging (Fig 11A , 11B). 31 In a study by Remy-Jardin et al, 32 55 dual-energy CT scans obtained from patients with COVID-19 3 months after hospital discharge showed three interesting findings: (1) unexpected proximal arterial thrombosis in 5.4% of patients, (2) disseminated lung perfusion abnormalities indicating microangiopathy in 65.5% of patients, and (3) areas of increased perfusion corresponding to GGOs resulting from SARS-CoV-2 pneumonia.…”

S1-Leitlinie Post-COVID/Long-COVID

“…Algorithmen empfehlen, dass sich Patienten mit pulmonalen Beschwerden und funktionellen Einschränkungen zunächst einer konventionellen Röntgenuntersuchung des Thorax unterziehen [141]. Werden dort bzw.…”

CT of Post-Acute Lung Complications of COVID-19

“…Dual energy CT may have an important role in evaluating post-COVID patients with persistent symptoms. In a study of 55 patients who underwent dual-energy CT angiography for persistent symptoms at three months after COVID-19, three had filling defects compatible with thromboembolism, but 32 (58%) had perfusion defects, (including four patients who had normal-appearing lung parenchyma) suggesting persistent microvascular abnormalities in these patients ( 92 ). Interestingly 15 patients had areas of increased perfusion, which corresponded to areas of GGO, parenchymal bands or tree-in-bud pattern.…”