COVID-19 肺炎和肺栓塞的定性和定量 DECT 肺动脉造影。
Qualitative and quantitative DECT pulmonary angiography in COVID-19 pneumonia and pulmonary embolism.
机构信息
Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA; Azienda Ospedaliera Universitaria, SS 554 km 4,500, Monserrato, 09042, Cagliari, Italy.
Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA.
出版信息
Clin Radiol. 2021 May;76(5):392.e1-392.e9. doi: 10.1016/j.crad.2021.02.009. Epub 2021 Feb 25.
AIM
To assess differences in qualitative and quantitative parameters of pulmonary perfusion from dual-energy computed tomography (CT) pulmonary angiography (DECT-PA) in patients with COVID-19 pneumonia with and without pulmonary embolism (PE).
MATERIALS AND METHODS
This retrospective institutional review board-approved study included 74 patients (mean age 61±18 years, male:female 34:40) with COVID-19 pneumonia in two countries (one with 68 patients, and the other with six patients) who underwent DECT-PA on either dual-source (DS) or single-source (SS) multidetector CT machines. Images from DS-DECT-PA were processed to obtain virtual mono-energetic 40 keV (Mono40), material decomposition iodine (MDI) images and quantitative perfusion statistics (QPS). Two thoracic radiologists determined CT severity scores based on type and extent of pulmonary opacities, assessed presence of PE, and pulmonary parenchymal perfusion on MDI images. The QPS were calculated from the CT Lung Isolation prototype (Siemens). The correlated clinical outcomes included duration of hospital stay, intubation, SpO and death. The significance of association was determined by receiver operating characteristics and analysis of variance.
RESULTS
One-fifth (20.2%, 15/74 patients) had pulmonary arterial filling defects; most filling defects were occlusive (28/44) located in the segmental and sub-segmental arteries. The parenchymal opacities were more extensive and denser (CT severity score 24±4) in patients with arterial filling defects than without filling defects (20±8; p=0.028). Ground-glass opacities demonstrated increased iodine distribution; mixed and consolidative opacities had reduced iodine on DS-DECT-PA but increased or heterogeneous iodine content on SS-DECT-PA. QPS were significantly lower in patients with low SpO (p=0.003), intubation (p=0.006), and pulmonary arterial filling defects (p=0.007).
CONCLUSION
DECT-PA QPS correlated with clinical outcomes in COVID-19 patients.
目的
评估 COVID-19 肺炎伴与不伴肺栓塞（PE）患者双能 CT 肺动脉造影（DECT-PA）的肺灌注定性和定量参数的差异。
材料与方法
本回顾性机构审查委员会批准的研究纳入了两国（一个国家 68 例，另一个国家 6 例）的 74 例 COVID-19 肺炎患者，他们在双源（DS）或单源（SS）多探测器 CT 机上进行了 DECT-PA。从 DS-DECT-PA 图像中获取虚拟单能 40keV（Mono40）、物质分解碘（MDI）图像和定量灌注统计数据（QPS）。两名胸部放射科医生根据肺不张的类型和范围、评估 MD 的存在和 MDI 图像上的肺实质灌注，确定 CT 严重程度评分。QPS 是从 CT 肺隔离原型（西门子）计算得出的。相关临床结局包括住院时间、插管、SpO2 和死亡。通过受试者工作特征和方差分析确定关联的显著性。
结果
五分之一（20.2%，15/74 例）的患者存在肺动脉充盈缺损；大多数充盈缺损为闭塞性（28/44），位于段和亚段动脉。与无充盈缺损的患者相比，有动脉充盈缺损的患者的实质不张范围更广、密度更高（CT 严重程度评分 24±4 比 20±8；p=0.028）。磨玻璃密度不张显示碘分布增加；在 DS-DECT-PA 上，混合和实变密度不张的碘含量减少，但 SS-DECT-PA 上的碘含量增加或不均匀。低 SpO2（p=0.003）、插管（p=0.006）和肺动脉充盈缺损的患者 QPS 显著降低（p=0.007）。
结论
DECT-PA QPS 与 COVID-19 患者的临床结局相关。
Zotero 插件