Dual-energy CT angiography reveals high prevalence of perfusion defects unrelated to pulmonary embolism in COVID-19 lesions

Berre, Alice Le; Boeken, Tom; Caramella, Caroline; Afonso, Daniel; Nhy, Caroline; Saccenti, Laetitia; Tardivel, Anne-Marie; Gerber, Sophie; Roche, Adrien Frison; Emmerich, Joseph; Marini, Valéria; Zins, Marc; Toledano, Sarah

doi:10.1186/s13244-021-00972-0

Cited by 15 publications

(14 citation statements)

References 29 publications

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“…One hypothesis could be that greater attention was paid to the risk of PE, which might have resulted in a more inclusive indication for CTPA, as already reported [ 22 ]. An overdiagnosis of PE when there were perfusion defects unrelated to PE in dual energy CT angiography is also a possible explanation [ 23 ]. The potential overdiagnosis bias should be considered alongside a potential underdiagnosis bias, which may have occurred both in non-COVID-19 patients and in less severe non-ICU COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 and lockdowns on pulmonary embolism in hospitalized patients in France: a nationwide study

et al. 2021

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Background This study assessed the impact of the COVID-19 epidemic on overall hospitalizations for pulmonary embolism (PE) in France in comparison with previous years, and by COVID-19 and non-COVID-19 status. Methods Hospitalization data (2017–2020) were extracted from the French National Discharge database (all public and private hospitals). We included all patients older than 18 years hospitalized during the 3 years and extracted PE status and COVID-19 status (from March 2020). Age, sex and risk factors for PE (such as obesity, cancer) were identified. We also extracted transfer to an intensive care unit (ICU) and hospital death. The number of PE and the frequency of death in patients in 2019 and 2020 were described by month and by COVID-19 status. Logistic regressions were performed to identify the role of COVID-19 among other risk factors for PE in hospitalized patients. Results The overall number of patients hospitalized with PE increased by about 16% in 2020 compared with 2019, and mortality also increased to 10.3% (+ 1.2%). These increases were mostly linked to COVID-19 waves, which were associated with PE hospitalization in COVID-19 patients (PE frequency was 3.7%; 2.8% in non-ICU and 8.8% in ICU). The final PE odds ratio for COVID-19 hospitalized patients was 4 compared with other hospitalized patients in 2020. The analyses of PE in non-COVID-19 patients showed a 2.7% increase in 2020 compared with the previous three years. Conclusion In 2020, the overall number of patients hospitalized with PE in France increased compared to the previous three years despite a considerable decrease in scheduled hospitalizations. Nevertheless, proactive public policy focused on the prevention of PE in all patients should be encouraged.

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Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 and lockdowns on pulmonary embolism in hospitalized patients in France: a nationwide study

et al. 2021

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“…However, no PE or pulmonary hypertension was found in this patient. The PBV Z eff maps show normal perfusion with an average PBV value of 33 [27,37] ml/100 g in the left lung and 32 [19,46] ml/100 g in the right lung. In comparison, the iodine material images of this subject show a much higher signal in the left lung (6.7 [5.8, 7.6] mg/ml) than the right lung (3.0 [1.8, 4.2] mg/ml, p < 0.001).…”

Section: Resultsmentioning

confidence: 94%

“…In addition, as shown by the human subject results in this work, lung regions with consolidations and GGOs can generate a higher PBV iodine signal relative to the normally aerated lung regions.In fact,data published in multiple prior studies support the existence of this effect. [37][38][39] For example, in a fast kV switching DECT study of patients with COVID-19 pneumonia and suspected PE, two of the three showcases demonstrated higher iodine material image signal in the consolidation regions than the normally aerated parenchyma regions: one case shows a I value of 6.053 mg/ml in the consolidation, compared to 0.723 mg/ml in the normally aerated region. 37 In another dual-source DECT-based study of patients with GGOs, two of the three showcases demonstrated higher a I signals in the GGO regions than normally aerated regions.…”

Section: Discussionmentioning

confidence: 99%

“…[37][38][39] For example, in a fast kV switching DECT study of patients with COVID-19 pneumonia and suspected PE, two of the three showcases demonstrated higher iodine material image signal in the consolidation regions than the normally aerated parenchyma regions: one case shows a I value of 6.053 mg/ml in the consolidation, compared to 0.723 mg/ml in the normally aerated region. 37 In another dual-source DECT-based study of patients with GGOs, two of the three showcases demonstrated higher a I signals in the GGO regions than normally aerated regions. 38 The increased signal of consolidations and GGOs in PBV iodine maps can be misleading, as both the reflex pulmonary artery vasoconstriction theory and nuclear medicine perfusion imaging can indicate a decreased (instead of increased) perfusion for consolidations and GGOs.…”

Section: Discussionmentioning

confidence: 99%

“…7,[30][31][32][33][34][35] However, as shown by a recent survey conducted by the Society of Thoracic Radiology, 36 iodine material image-based pulmonary perfusion imaging remains underutilized in clinical practice due to several important limitations.The first important limitation of the iodine material image is that its signal does not necessarily reflect the magnitude of the pulmonary blood pool, as noniodine materials with Z eff different from that of the counterpart basis material (e.g., water) can also contribute to the iodine image signal. This is particularly a problem for pulmonary consolidation and ground-glass opacity (GGO) that may not only have different Z eff (relative to water), but also much higher densities than the normal lung tissue: as shown by the analysis in Section 2.2 and published literature, [37][38][39] those tissues can generate a relatively high signal in PBV iodine images which can mislead the evaluation of regional perfusion conditions. The second limitation lies in the fact that DECT-based iodine material images can only provide a relative measurement of PBV.…”

Section: Introductionmentioning

confidence: 99%

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Quantitative lung perfusion blood volume using dual energy CT–based effective atomic number (Z_eff) imaging

et al. 2021

Medical Physics

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Background: Iodine material images (aka iodine basis images) generated from dual energy computed tomography (DECT) have been used to assess potential perfusion defects in the pulmonary parenchyma. However, iodine material images do not provide the needed absolute quantification of the pulmonary blood pool, as materials with effective atomic numbers (Z eff ) different from those of basis materials may also contribute to iodine material images, thus confounding the quantification of perfusion defects. Purpose: (i) To demonstrate the limitations of iodine material images in pulmonary perfusion defect quantification and (ii) to develop and validate a new quantitative biomarker using effective atomic numbers derived from DECT images. Methods: The quantitative relationship between the perfusion blood volume (PBV) in pulmonary parenchyma and the effective atomic number (Z eff ) spatial distribution was studied to show that the desired quantitative PBV maps are determined by the spatial maps of Z eff as PBV Z eff (x) = a Z 𝛽 eff (x) + b, where a, b, and β are three constants. Namely, quantitative PBV Z eff is determined by Z eff images instead of the iodine basis images. Perfusion maps were generated for four human subjects to demonstrate the differences between conventional iodine material image-based PBV (PBV iodine ) derived from two-material decompositions and the proposed PBV Z eff method. Results: Among patients with pulmonary emboli, the proposed PBV Z eff maps clearly show the perfusion defects while the PBV iodine maps do not. Additionally, when there are no perfusion defects present in the derived PBV maps, no pulmonary emboli were diagnosed by an experienced thoracic radiologist. Conclusion: Effective atomic number-based quantitative PBV maps provide the needed sensitive and specific biomarker to quantify pulmonary perfusion defects.

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Repurposing Inhaled Ibuprofenate, a Non Steroidal Anti‐Inflammatory Drug, as a Potential Adjuvant Treatment for Pneumonia, CARDS and its Aetiological Agent SARS‐CoV‐2

Zurita‐Lizza

Rodriguez-Sanchez

Doreski³

2023

Clinical and Translational Dis

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In this manuscript, we will describe and highlight the most important potential underlying mechanisms of action of the inhaled sodium ibuprofenate in hypertonic saline formulation-NaIHS aerosolisable, as a probable adjuvant treatment for moderate and severe pneumonia and coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome in COVID-19. In both pathological entities, we will refer exclusively to the pulmonary vasoplegic type and we will describe the following therapeutic effects of NaIHS: antiinflammatory, immunomodulatory and antiangiogenic. The synergistic action of these therapeutic effects anti-inflammatory and immunomodulatory together may exert their action at the pulmonary level through the possible reversal of pulmonary vasoplegia and may thereby restore hypoxic pulmonary vasoconstriction, correcting the uncoupling of the ventilation/ perfusion ratio and vasoplegic intrapulmonary shunting and, above all, it may reverse severe hypoxaemia and acute respiratory failure. We will also mention the potential virucidal effects of NaIHS on severe acute respiratory syndrome-coronavirus 2.

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Dual-energy CT angiography reveals high prevalence of perfusion defects unrelated to pulmonary embolism in COVID-19 lesions

Cited by 15 publications

References 29 publications

Impact of COVID-19 and lockdowns on pulmonary embolism in hospitalized patients in France: a nationwide study

Impact of COVID-19 and lockdowns on pulmonary embolism in hospitalized patients in France: a nationwide study

Quantitative lung perfusion blood volume using dual energy CT–based effective atomic number (Z_eff) imaging

Repurposing Inhaled Ibuprofenate, a Non Steroidal Anti‐Inflammatory Drug, as a Potential Adjuvant Treatment for Pneumonia, CARDS and its Aetiological Agent SARS‐CoV‐2

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Dual-energy CT angiography reveals high prevalence of perfusion defects unrelated to pulmonary embolism in COVID-19 lesions

Cited by 15 publications

References 29 publications

Impact of COVID-19 and lockdowns on pulmonary embolism in hospitalized patients in France: a nationwide study

Impact of COVID-19 and lockdowns on pulmonary embolism in hospitalized patients in France: a nationwide study

Quantitative lung perfusion blood volume using dual energy CT–based effective atomic number (Zeff) imaging

Repurposing Inhaled Ibuprofenate, a Non Steroidal Anti‐Inflammatory Drug, as a Potential Adjuvant Treatment for Pneumonia, CARDS and its Aetiological Agent SARS‐CoV‐2

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Quantitative lung perfusion blood volume using dual energy CT–based effective atomic number (Z_eff) imaging