Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
Department of Vascular Surgery, Beth Israel Deaconess Medical Center, Boston, USA.
Abdom Radiol (NY). 2021 Mar;46(3):1263-1271. doi: 10.1007/s00261-020-02753-7. Epub 2020 Sep 17.
To determine the feasibility and safety of ultrasound-guided minimally invasive autopsy in COVID-19 patients.
60 patients who expired between 04/22/2020-05/06/2020 due to COVID-19 were considered for inclusion in the study, based on availability of study staff. Minimally invasive ultrasound-guided autopsy was performed with 14G core biopsies through a 13G coaxial needle. The protocol required 20 cores of the liver, 30 of lung, 12 of spleen, 20 of heart, 20 of kidney, 4 of breast, 4 of testis, 2 of skeletal muscle, and 4 of fat with total of 112 cores per patient. Quality of the samples was evaluated by number, size, histology, immunohistochemistry, and in situ hybridization for COVID-19 and PCR-measured viral loads for SARS-CoV-2.
Five (5/60, 8%) patients were included. All approached families gave their consent for the minimally invasive autopsy. All organs for biopsy were successfully targeted with ultrasound guidance obtaining all required samples, apart from 2 patients where renal samples were not obtained due to atrophic kidneys. The number, size, and weight of the tissue cores met expectation of the research group and tissue histology quality was excellent. Pathology findings were concordant with previously reported autopsy findings for COVID-19. Highest SARS-CoV-2 viral load was detected in the lung, liver, and spleen that had small to moderate amount, and low viral load in was detected in the heart in 2/5 (40%). No virus was detected in the kidney (0/3, 0%).
Ultrasound-guided percutaneous post-mortem core biopsies can safely provide adequate tissue. Highest SARS-CoV-2 viral load was seen in the lung, followed by liver and spleen with small amount in the myocardium.
确定 COVID-19 患者超声引导微创尸检的可行性和安全性。
根据研究人员的可用性，考虑纳入 60 名于 2020 年 4 月 22 日至 5 月 6 日期间因 COVID-19 死亡的患者进行研究。采用 13G 同轴针进行 14G 核心活检的微创超声引导尸检。该方案要求对肝脏进行 20 次活检、肺 30 次、脾 12 次、心 20 次、肾 20 次、乳腺 4 次、睾丸 4 次、骨骼肌 2 次和脂肪 4 次，每位患者总共 112 个样本。通过数量、大小、组织学、免疫组织化学和 COVID-19 的原位杂交以及 SARS-CoV-2 的 PCR 测量病毒载量来评估样本的质量。
共纳入 5 例（5/60，8%）患者。所有接受调查的家庭都同意进行微创尸检。所有用于活检的器官均通过超声引导成功定位，获得了所有所需的样本，但有 2 例患者由于肾脏萎缩而未能获得肾样本。组织芯的数量、大小和重量符合研究小组的预期，组织学质量非常好。病理学发现与之前报道的 COVID-19 尸检结果一致。在肺、肝和脾中检测到的 SARS-CoV-2 病毒载量最高，量小到中等，在 2/5（40%）的心脏中检测到低病毒载量。在肾脏（0/3，0%）中未检测到病毒。
超声引导经皮死后核心活检可以安全地提供足够的组织。SARS-CoV-2 病毒载量最高的是肺，其次是肝和脾，心肌中的含量较少。
