Imaging in the aftermath of COVID-19: what to expect

Ebner, Lukas; Funke-Chambour, Manuela; Garnier, Christophe von; Ferretti, Gilbert; Ghaye, Benoît

doi:10.1007/s00330-020-07465-6

Cited by 19 publications

(22 citation statements)

References 10 publications

(9 reference statements)

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“…Bronchiolitis leads to discrepancies between lung opacities and poor oxygenation while compliance is preserved [56]. On chest CT, small airways disease manifests by opacities with mosaic patterns [20, 45]. The long-term outcome of these changes and the usefulness of corticosteroids remain unclear.…”

Section: Results Of the Swiss National Survey Among Pulmonologistsmentioning

confidence: 99%

Swiss Recommendations for the Follow-Up and Treatment of Pulmonary Long COVID

et al. 2021

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Introduction: Emerging evidence suggests that long-term pulmonary symptoms and functional impairment occurs in a proportion of individuals following SARS-CoV-2 infection. Although the proportion of affected patients remains to be determined, physicians are increasingly being confronted with patients reporting respiratory symptoms and impairment beyond the acute phase of COVID-19. In face of limited evidence, the Swiss Society for Pulmonology established a working group to address this area of unmet need and formulated diagnostic and treatment recommendations for the care of patients with pulmonary long COVID (LC). Method: The Swiss COVID Lung Study group and Swiss Society for Pulmonology (SSP) formulated 13 questions addressing the diagnosis and treatment of pulmonary LC. A survey within the SSP special interest groups involved in care of LC patients was conducted in Switzerland. A CORE process/Delphi-like process was used to formulate recommendations. Forty experienced pulmonologists replied to the first survey and 22 completed the second follow-up survey. Agreement of ≥70% consensus led to formulation of a recommendation. Results: The participants in the survey reached consensus and formulated a strong recommendation for regarding the following points. Patients hospitalized for COVID-19 should have a pulmonary assessment including pulmonary function tests. Symptomatic subjects affected by COVID-19, including those with mild disease, should benefit from a pulmonary follow-up. Persistent respiratory symptoms after COVID-19 should be investigated by a pulmonary follow-up including plethysmography, diffusion capacity measurement, and blood gases analysis. Individuals having suffered from COVID-19 and who present with persistent respiratory symptoms should be offered a rehabilitation. Additional questions were given moderateor weak recommendations for. The panel did not reach sufficient consensus for pharmacological therapy (e.g., therapy specifically targeting lung fibrosis) to formulate recommendations for LC drug treatment. Conclusion: The formulated recommendations should serve as an interim guidance to facilitate diagnosis and treatment of patients with pulmonary LC. As new evidence emerges, these recommendations may need to be adapted.

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Section: Results Of the Swiss National Survey Among Pulmonologistsmentioning

confidence: 99%

Swiss Recommendations for the Follow-Up and Treatment of Pulmonary Long COVID

et al. 2021

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“…An alarmingly large number of COVID-19 patients reported persistent symptoms, mainly fatigue and dyspnea, even months after first diagnosis in multiple independent surveys (166)(167)(168). In line, radiological signs of fibrosis become apparent as early as 3 weeks after diagnosis (169) and persist over months (170,171). After 3 months, impaired diffusion capacity and persisting radiological abnormalities are observed in many survivors, while others recover completely (172)(173)(174)(175)(176).…”

Section: Emerging Evidence Of Covid-19-associated Lung Fibrosismentioning

confidence: 92%

“…However, uncontrolled inflammatory and early fibrotic signatures are typically found in post-mortem lung autopsies of COVID-19 patients after a long disease course (132,258). Radiologic abnormalities, including small airway abnormalities, are also found in the lungs of recovering COVID-19 patients but their consequences on the patient's quality of life are of yet unknown (170). Therefore, it will be important to dissect the sequela of virus clearance, resolution of the immune response and tissue regeneration in more detail.…”

Section: Modeling Alveolar Epithelium Regeneration and Covid-19-associated Fibrotic Tissue Remodelingmentioning

confidence: 99%

Human-Based Advanced in vitro Approaches to Investigate Lung Fibrosis and Pulmonary Effects of COVID-19

et al. 2021

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The coronavirus disease 2019 (COVID-19) pandemic has caused considerable socio-economic burden, which fueled the development of treatment strategies and vaccines at an unprecedented speed. However, our knowledge on disease recovery is sparse and concerns about long-term pulmonary impairments are increasing. Causing a broad spectrum of symptoms, COVID-19 can manifest as acute respiratory distress syndrome (ARDS) in the most severely affected patients. Notably, pulmonary infection with Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), the causing agent of COVID-19, induces diffuse alveolar damage (DAD) followed by fibrotic remodeling and persistent reduced oxygenation in some patients. It is currently not known whether tissue scaring fully resolves or progresses to interstitial pulmonary fibrosis. The most aggressive form of pulmonary fibrosis is idiopathic pulmonary fibrosis (IPF). IPF is a fatal disease that progressively destroys alveolar architecture by uncontrolled fibroblast proliferation and the deposition of collagen and extracellular matrix (ECM) proteins. It is assumed that micro-injuries to the alveolar epithelium may be induced by inhalation of micro-particles, pathophysiological mechanical stress or viral infections, which can result in abnormal wound healing response. However, the exact underlying causes and molecular mechanisms of lung fibrosis are poorly understood due to the limited availability of clinically relevant models. Recently, the emergence of SARS-CoV-2 with the urgent need to investigate its pathogenesis and address drug options, has led to the broad application of in vivo and in vitro models to study lung diseases. In particular, advanced in vitro models including precision-cut lung slices (PCLS), lung organoids, 3D in vitro tissues and lung-on-chip (LOC) models have been successfully employed for drug screens. In order to gain a deeper understanding of SARS-CoV-2 infection and ultimately alveolar tissue regeneration, it will be crucial to optimize the available models for SARS-CoV-2 infection in multicellular systems that recapitulate tissue regeneration and fibrotic remodeling. Current evidence for SARS-CoV-2 mediated pulmonary fibrosis and a selection of classical and novel lung models will be discussed in this review.

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“…Importantly, pleural effusion, cavities, lymphadenopathy, mucous plugging, and tree-in-bud are uncommon findings in COVID-19, and their presence should thus raise the suspicion of a bacterial superinfection or other complications [53,54]. Initial reports also address the issue of late effects in recovered patients following COVID-19 [55,56]. Figure 4 shows lungimaging sequelae of severe COVID-19.…”

Section: Imaging Findings On Chest Ctmentioning

confidence: 99%

A comprehensive review of imaging findings in COVID-19 - status in early 2021

Afshar‐Oromieh

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Schaefer-Prokop

et al. 2021

Eur J Nucl Med Mol Imaging

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Medical imaging methods are assuming a greater role in the workup of patients with COVID-19, mainly in relation to the primary manifestation of pulmonary disease and the tissue distribution of the angiotensin-converting-enzyme 2 (ACE 2) receptor. However, the field is so new that no consensus view has emerged guiding clinical decisions to employ imaging procedures such as radiography, computer tomography (CT), positron emission tomography (PET), and magnetic resonance imaging, and in what measure the risk of exposure of staff to possible infection could be justified by the knowledge gained. The insensitivity of current RT-PCR methods for positive diagnosis is part of the rationale for resorting to imaging procedures. While CT is more sensitive than genetic testing in hospitalized patients, positive findings of ground glass opacities depend on the disease stage. There is sparse reporting on PET/CT with [18F]-FDG in COVID-19, but available results are congruent with the earlier literature on viral pneumonias. There is a high incidence of cerebral findings in COVID-19, and likewise evidence of gastrointestinal involvement. Artificial intelligence, notably machine learning is emerging as an effective method for diagnostic image analysis, with performance in the discriminative diagnosis of diagnosis of COVID-19 pneumonia comparable to that of human practitioners.

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Imaging in the aftermath of COVID-19: what to expect

Cited by 19 publications

References 10 publications

Swiss Recommendations for the Follow-Up and Treatment of Pulmonary Long COVID

Swiss Recommendations for the Follow-Up and Treatment of Pulmonary Long COVID

Human-Based Advanced in vitro Approaches to Investigate Lung Fibrosis and Pulmonary Effects of COVID-19

A comprehensive review of imaging findings in COVID-19 - status in early 2021

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