Le Berre Alice, Boeken Tom, Caramella Caroline, Afonso Daniel, Nhy Caroline, Saccenti Laetitia, Tardivel Anne-Marie, Gerber Sophie, Frison Roche Adrien, Emmerich Joseph, Marini Valeria, Zins Marc, Toledano Sarah
Department of Radiology, Fondation Hôpital Saint Joseph, 185 rue Raymond Losserand, 75014, Paris, France.
Department of Radiology, Hôpital Marie Lannelongue, 133 Avenue de la Résistance, 92350, Le Plessis-Robinson, France.
Insights Imaging. 2021 Feb 17;12(1):24. doi: 10.1186/s13244-021-00972-0.
Lung perfusion defects (PDs) have been described in COVID-19 using dual-energy computed tomography pulmonary angiography (DE-CTPA). We assessed the prevalence and characteristics of PDs in COVID-19 patients with suspected pulmonary embolism (PE) and negative CTPA.
This retrospective study included COVID-19 and non-COVID-19 pneumonia groups of patients with DE-CTPA negative for PE. Two radiologists rated the presence of PD within the lung opacities and analyzed the type of lung opacities and PD pattern (i.e. homogeneous or heterogeneous). The clinical, biological, radiological characteristics including time from first symptoms and admission to DE-CTPA, oxygen requirements, CRP, D-dimer levels, duration of hospital admission and death were compared within the COVID-19 group between patients with (PD +) or without PD (PD-).
67 COVID-19 and 79 non-COVID-19 patients were included. PDs were more frequent in the COVID-19 than in the non-COVID-19 group (59.7% and 26.6% respectively, p < 0.001). Patterns of PDs were different, with COVID-19 patients exhibiting heterogenous PDs (38/40, 95%) whereas non-COVID-19 patients showed mostly homogeneous perfusion defects (7/21 heterogeneous PDs, 33%), p < 0.001. In COVID-19 patients, most consolidations (9/10, 90%) exhibited PDs while less than a third of consolidations (19/67, 28%) had PDs in non-COVID-19 patients. D-dimer, oxygen levels and outcome were similar between COVID-19 PD + and PD- patients; however, time between admission and DE-CTPA was longer in PD + patients (median [IQR], 1 [0-7] and 0 [0-2]; p = 0.045).
Unlike in bacterial pneumonia, heterogeneous PDs within lung opacities are a frequent feature of COVID-19 pneumonia in PE-suspected patients.
在新冠病毒疾病（COVID-19）中，利用双能计算机断层扫描肺血管造影（DE-CTPA）已观察到肺部灌注缺损（PDs）。我们评估了疑似肺栓塞（PE）且CTPA结果为阴性的COVID-19患者中PDs的患病率及特征。
这项回顾性研究纳入了PE的DE-CTPA结果为阴性的COVID-19组和非COVID-19肺炎组患者。两名放射科医生对肺实变区域内PDs的存在情况进行评分，并分析肺实变的类型及PD模式（即均匀或不均匀）。在COVID-19组中，对有（PD+）或无PD（PD-）的患者的临床、生物学、放射学特征进行比较，包括从首次症状出现到进行DE-CTPA的时间、氧需求、CRP、D-二聚体水平、住院时间及死亡情况。
纳入了67例COVID-19患者和79例非COVID-19患者。COVID-19组中PDs比非COVID-19组更常见（分别为59.7%和26.6%，p<0.001）。PDs的模式不同，COVID-19患者表现为不均匀的PDs（38/40，95%），而非COVID-19患者大多表现为均匀的灌注缺损（7/21例不均匀PDs，33%），p<0.001。在COVID-19患者中，大多数实变（9/10，90%）存在PDs，而非COVID-19患者中不到三分之一的实变（19/67，28%）有PDs。COVID-19的PD+患者和PD-患者之间D-二聚体、氧水平及预后相似；然而，PD+患者从入院到进行DE-CTPA的时间更长（中位数[四分位间距]，1[0-7]和0[0-2]；p=0.045）。
与细菌性肺炎不同，在疑似PE的患者中，肺实变区域内不均匀的PDs是COVID-19肺炎的常见特征。
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