Severe COVID-19 pneumonia: Perfusion analysis in correlation with pulmonary embolism and vessel enlargement using dual-energy CT data

• Published in: PloS one 2021-06, Vol.16 (6), p.e0252478-e0252478
• Main Authors: Poschenrieder, Florian, Meiler, Stefanie, Lubnow, Matthias, Zeman, Florian, Rennert, Janine, Scharf, Gregor, Schaible, Jan, Stroszczynski, Christian, Pfeifer, Michael, Hamer, Okka W
• Format: Article
• Language: English
• Subjects: Analysis; Anticoagulants; Autopsies; Autopsy; Biology and Life Sciences; Blood; Care and treatment; Coronaviruses; COVID-19; Embolism; Energy; Enlargement; Ethics; Internal medicine; Medicine and Health Sciences; Patients; Perfusion; Perfusion (Physiology); Physical Sciences; Pneumonia; Pulmonary arteries; Pulmonary embolism; Pulmonary embolisms; Radiology; Research and Analysis Methods; Severe acute respiratory syndrome coronavirus 2; Software; Thromboembolism; Thrombosis; Veins & arteries; Ventilation
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0252478

Gas exchange in COVID-19 pneumonia is impaired and vessel obstruction has been suspected to cause ventilation-perfusion mismatch. Dual-energy CT (DECT) can depict pulmonary perfusion by regional assessment of iodine uptake. The purpose of this study was the analysis of pulmonary perfusion using dual-energy CT in a cohort of 27 consecutive patients with severe COVID-19 pneumonia. We retrospectively analyzed pulmonary perfusion with DECT in 27 consecutive patients (mean age 57 years, range 21-73; 19 men and 8 women) with severe COVID-19 pneumonia. Iodine uptake (IU) in regions-of-interest placed into normally aerated lung, ground-glass opacifications (GGO) and consolidations was measured using a dedicated postprocessing software. Vessel enlargement (VE) within opacifications and presence of pulmonary embolism (PE) was assessed by subjective analysis. Linear mixed models were used for statistical analyses. Compared to normally aerated lung 106/151 (70.2%) opacifications without upstream PE demonstrated an increased IU, 9/151 (6.0%) an equal IU and 36/151 (23.8%) a decreased IU. The estimated mean iodine uptake (EMIU) in opacifications without upstream PE (GGO 1.77 mg/mL; 95%-CI: 1.52-2.02; p = 0.011, consolidations 1.82 mg/mL; 95%-CI: 1.56-2.08, p = 0.006) was significantly higher compared to normal lung (1.22 mg/mL; 95%-CI: 0.95-1.49). In case of upstream PE, EMIU of opacifications (combined GGO and consolidations) was significantly decreased compared to normal lung (0.52 mg/mL; 95%-CI: -0.07-1.12; p = 0.043). The presence of VE in opacifications correlated significantly with iodine uptake (p