COVID-19 progression in hospitalized patients using follow-up in vivo CT and ex vivo microCT

• Published in: Journal of thoracic disease 2023-07, Vol.15 (7), p.3646-3661
• Main Authors: Geudens, Vincent, Van Slambrouck, Jan, Aerts, Gitte, Willems, Lynn, Goos, Tinne, Kaes, Janne, Zajacova, Andrea, Gyselinck, Iwein, Aelbrecht, Celine, Vermaut, Astrid, Beeckmans, Hanne, Vermant, Marie, De Fays, Charlotte, Sacreas, Annelore, Aversa, Lucia, Orlitova, Michaela, Vanstapel, Arno, Josipovic, Ivan, Boone, Matthieu N, McDonough, John E, Weynand, Birgit, Pilette, Charles, Janssens, Wim, Dupont, Lieven, Wuyts, Wim A, Verleden, Geert M, Van Raemdonck, Dirk E, Vos, Robin, Gayan-Ramirez, Ghislaine, Ceulemans, Laurens J, Vanaudenaerde, Bart M
• Format: Article
• Language: English
• Subjects: Original
• ISSN: 2072-1439; 2077-6624
• DOI: 10.21037/jtd-22-1488

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease-19 (COVID-19) which can lead to acute respiratory distress syndrome (ARDS) and evolve to pulmonary fibrosis. Computed tomography (CT) is used to study disease progression and describe radiological patterns in COVID-19 patients. This study aimed to assess disease progression regarding lung volume and density over time on follow-up chest CT and give a unique look at parenchymal and morphological airway changes in "end-stage" COVID-19 lungs using microCT. Volumes and densities of the lung/lobes of three COVID-19 patients were assessed using follow-up CT and whole lung microCT scans. Airways were quantified by airway segmentations on whole lung microCT and small-partition microCT. As controls, three discarded healthy donor lungs were used. Histology was performed in differently affected regions in the COVID-19 lungs. , COVID-19 lung volumes decreased while density increased over time, mainly in lower lobes as previously shown. COVID-19 lung volumes decreased by 60% and all lobes were smaller compared to controls. Airways were more visible on microCT in COVID-19, probably due to fibrosis and increased airway diameter. In addition, small-partition microCT showed more deformation of (small) airway morphology and fibrotic organization in severely affected regions with heterogeneous distributions within the same lung which was confirmed by histology. COVID-19-ARDS and subsequent pulmonary fibrosis alters lung architecture and airway morphology which is described using CT, microCT, and histology.