Role of CT angiography in detecting acute pulmonary embolism associated with COVID-19 pneumonia

• Published in: Radiologia medica 2021-12, Vol.126 (12), p.1553-1560
• Main Authors: Masselli, Gabriele, Almberger, Maria, Tortora, Alessandra, Capoccia, Lucia, Dolciami, Miriam, D’Aprile, Maria Rosaria, Valentini, Cristina, Avventurieri, Giacinta, Bracci, Stefano, Ricci, Paolo
• Format: Article
• Language: English
• Subjects: Acute Disease; Aged; Angiography; Chest Radiology; Computed tomography; Computed Tomography Angiography - methods; Contrast agents; Coronaviruses; COVID-19; COVID-19 - complications; Criteria; Diagnostic Radiology; Dimers; Dyspnea; Embolisms; Female; Humans; Imaging; Interventional Radiology; Lung - diagnostic imaging; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Oxygen content; Polymerase chain reaction; Prospective Studies; Pulmonary Embolism - diagnostic imaging; Pulmonary Embolism - etiology; Pulmonary embolisms; Radiology; Reproducibility of Results; Severe acute respiratory syndrome coronavirus 2; Signs and symptoms; Statistical analysis; Ultrasound; Viral diseases
• ISSN: 0033-8362; 1826-6983
• DOI: 10.1007/s11547-021-01415-y

Purpose Recently coronavirus disease (COVID-19) caused a global pandemic, characterized by acute respiratory distress syndrome (ARDS). The aim of our study was to detect pulmonary embolism (PE) in patients with severe form of COVID-19 infection using pulmonary CT angiography, and its associations with clinical and laboratory parameters. Methods From March to December 2020, we performed a prospective monocentric study collecting data from 374 consecutive patients with confirmed SARS-CoV-2 infection, using real-time reverse-transcriptase polymerase-chain-reaction (rRT-PCR) assay of nasopharyngeal swab specimens. We subsequently selected patients with at least two of the following inclusion criteria: (1) severe acute respiratory symptoms (such as dyspnea, persistent cough, fever > 37.5 °C, fatigue, etc.); (2) arterial oxygen saturation ≤ 93% at rest; (3) elevated D-dimer (≥ 500 ng/mL) and C-reactive protein levels (≥ 0.50 mg/dL); and (4) presence of comorbidities. A total of 63/374 (17%) patients met the inclusion criteria and underwent CT angiography during intravenous injection of iodinated contrast agent (Iomeprol 400 mgI/mL). Statistical analysis was performed using Wilcoxon rank-sum and Chi-square tests. Results About, 26/60 patients (40%) were found positive for PE at chest CT angiography. In these patients, D-dimer and CRP values were significantly higher, while a reduction in SaO2