The heterogeneity of lung perfusion patterns in SPECT/CT during COVID-19: not only embolism

Monaco, Lavinia; Crivellaro, Cinzia; Cressoni, Massimo; Landoni, Claudio; Messa, Cristina; Guerra, Luca

doi:10.1007/s00259-021-05377-1

Cited by 6 publications

(8 citation statements)

References 4 publications

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“…In six patients with a laboratory-confirmed diagnosis of COVID-19 and a moderate or high pre-test probability of pulmonary embolism (PE), perfusion (Q)-single-photon emission computed tomography (SPECT)/CT was found positive in 4/6 of patients with bilateral and segmental PE in 3/4 of patients.From these data, the authors concluded that Q-SPECT/ CT has clinical utility for diagnosing PE in such COVID-19 patients where there is a contraindication for iodinated contrast media [2]. Even if the incidence of PE is known to be increased in COVID-19 patients [3], we agree with Lavinia Monaco et al that all the heterogeneities of lung perfusion patterns found in SPECT/CT during COVID-19 must not be only attributed to PE [1]. As they pointed out in their letter (and illustrated in their Fig.…”

supporting

confidence: 81%

“…From these data, the authors concluded that Q-SPECT/ CT has clinical utility for diagnosing PE in such COVID-19 patients where there is a contraindication for iodinated contrast media [2]. Even if the incidence of PE is known to be increased in COVID-19 patients [3], we agree with Lavinia Monaco et al that all the heterogeneities of lung perfusion patterns found in SPECT/CT during COVID-19 must not be only attributed to PE [1]. As they pointed out in their letter (and illustrated in their Fig.…”

supporting

confidence: 81%

“…Such vascular abnormalities could be also found in SPECT/CT through an increased perfusion in normally aerated lung regions (or hyperventilated) [9], as shown, but not described, in Fig. 1a of their letter (areas of augmented perfusion in the right middle lobe despite any evident parenchyma lesions on CT at this level) [1]. We believe that such mismatches may reflect the specific intrapulmonary shunt that we suggest to be the cornerstone of the COVID-19 disease [10] and explain the so-called COVID-19 related "happy hypoxic state."…”

mentioning

confidence: 66%

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The importance of lung hyperperfusion patterns in COVID-19-related AVDS

Jounieaux

Mahjoub

El-Esper

et al. 2021

Eur J Nucl Med Mol Imaging

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et al. [1] about the article by Jeeban P. Das et al. [2] that were both published in your European Journal of Nuclear Medicine and Molecular Imaging. In six patients with a laboratory-confirmed diagnosis of COVID-19 and a moderate or high pre-test probability of pulmonary embolism (PE), perfusion (Q)-single-photon emission computed tomography (SPECT)/CT was found positive in 4/6 of patients with bilateral and segmental PE in 3/4 of patients.From these data, the authors concluded that Q-SPECT/ CT has clinical utility for diagnosing PE in such COVID-19 patients where there is a contraindication for iodinated contrast media [2]. Even if the incidence of PE is known to be increased in COVID-19 patients [3], we agree with Lavinia Monaco et al. that all the heterogeneities of lung perfusion patterns found in SPECT/CT during COVID-19 must not be only attributed to PE [1]. As they pointed out in their letter (and illustrated in their Fig. 1) [1], perfusion SPECT/TC is not only able to confirm PE (segmental perfusion defect of a normally aerated lung area at CT images) but can also reveal increased perfusion in consolidated or hypoventilated lung regions. Such mismatch abnormality This article is part of the Topical Collection on Letter to the Editor.

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supporting

confidence: 81%

supporting

confidence: 81%

mentioning

confidence: 66%

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The importance of lung hyperperfusion patterns in COVID-19-related AVDS

Jounieaux

Mahjoub

El-Esper

et al. 2021

Eur J Nucl Med Mol Imaging

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“…Thus, it is suggested to perform a Q-only SPECT combined with ldCT instead of the routine V/Q protocol in patients with suspicion of acute PE, if CTPA is contraindicated, as the ldCT component increases the diagnostic accuracy of the test as perfusion defects can be correlated with parenchymal abnormalities in the CT images [ 9 ]. To date, some articles have demonstrated that Tc-99m macroaggregated albumin (Tc-99m MAA) Q-SPECT/CT is a safe procedure without the increased risk of spreading contagious aerosols and enables to diagnose PE in patients with COVID-19, if contrast enhanced CT is contraindicated [ 11 , 12 ]. In addition to identifying PE, Q-SPECT/CT examinations could detect other functional and morphological alterations in COVID-19 patients (e.g., infiltrates with increased perfusion), which may contribute to the better understanding of the pathomechanism of the disease [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…To date, some articles have demonstrated that Tc-99m macroaggregated albumin (Tc-99m MAA) Q-SPECT/CT is a safe procedure without the increased risk of spreading contagious aerosols and enables to diagnose PE in patients with COVID-19, if contrast enhanced CT is contraindicated [ 11 , 12 ]. In addition to identifying PE, Q-SPECT/CT examinations could detect other functional and morphological alterations in COVID-19 patients (e.g., infiltrates with increased perfusion), which may contribute to the better understanding of the pathomechanism of the disease [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Unusual perfusion patterns on perfusion-only SPECT/CT scans in COVID-19 patients

Farkas

Képes

Barna³

et al. 2022

Ann Nucl Med

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Purpose We aimed at examining both the incidence and extent of different lung perfusion abnormalities as well as the relationship between them on Tc-99m macroaggregated albumin (MAA) perfusion-only SPECT/CT scans in COVID-19 patients. Methods Ninety-one patients (71.4 ± 13.9 years; range: 29–98 years, median age: 74 years; 45 female and 46 male) with confirmed SARS-CoV-2 virus infection were included in this retrospective study. After performing perfusion-only Tc-99m MAA SPECT/CT scans, visual, semi-quantitative assessment of the subsequent perfusion abnormalities was carried out: mismatch lesions (MM; activity defects on SPECT images identical to apparently healthy parenchyma on CT images), matched lesions (MA; activity defects with corresponding parenchymal lesions on CT scans), and reverse mismatch lesions (RM; parenchymal lesions with preserved or increased tracer uptake). Lesion-based and patient-based analysis were performed to evaluate the extent, severity, and incidence of each perfusion abnormality. Statistical tests were applied to investigate the association between the experienced perfusion impairments. Results Moderately severe parenchymal lesions were detected in 87 (95.6%) patients. Although, 50 (54.95%) patients were depicted to have MM lesions, the whole patient cohort was mildly affected by this abnormality. MA lesions of average moderate severity were seen in most of the patients (89.01%). In 65 (71.43%) patients RM lesions were found with mild severity on average. Positive association was detected between total CT score and total RM score and between total CT score and total MA score. Significantly higher total CT scores were experienced in the subgroup, where RM lesions were present. Conclusions Heterogeneous perfusion abnormalities were found in most of COVID-19 patients: parenchymal lesions with normal, decreased or increased perfusion and perfusion defects in healthy lung areas. These phenomena may be explained by the failure of the hypoxic pulmonary vasoconstriction mechanism and presence of pulmonary thrombosis and embolism.

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