Scardapane Arnaldo, Villani Laura, Bavaro Davide Fiore, Passerini Francesca, Ianora Amato Antonio Stabile, Lucarelli Nicola Maria, Angarano Gioacchino, Portincasa Piero, Palmieri Vincenzo Ostilio, Saracino Annalisa
Interdisciplinary Department of Medicine-Section of Diagnostic Imaging, University Hospital "Policlinico" of Bari Medical School, Italy.
Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University Hospital "Policlinico" of Bari Medical School, Italy.
Biomed Res Int. 2021 Mar 10;2021:8851736. doi: 10.1155/2021/8851736. eCollection 2021.
This study is aimed at assessing the prevalence of pulmonary artery filling defects (PAFDs) consistent with pulmonary artery embolism (PAE) in patients with SARS-CoV-2 infection and at investigating possible radiological or clinical predictors.
Computed Tomography Pulmonary Angiographies (CTPAs) from 43 consecutive patients with a confirmed COVID-19 infection were retrospectively reviewed, taking into consideration the revised Geneva score and the D-dimer value for each patient. Filling defects within the pulmonary arteries were recorded along with pleural and parenchymal findings such as ground glass opacities, consolidation, crazy paving, linear consolidation, and pleural effusion. All these variables were compared between patients with and without PAFD. The predictive performance of statistically different parameters was investigated using the receiver operating characteristics (ROC).
Pulmonary embolism was diagnosed in 15/43 patients (35%), whereas CTPA and parenchymal changes related to pulmonary COVID-19 disease were evident in 39/43 patients (91%). The revised Geneva score and the mean D-dimer value obtained using two consecutive measurements were significantly higher in patients with PAFD. The ROC analysis demonstrated that a mean D-dimer value is the parameter with the higher predictivity (AUC 0.831) that is a cut-off value > 1800 g/l which predicts the probability of PAFD with a sensitivity and specificity of 70% and 78%, respectively.
This single centre retrospective report shows a high prevalence of pulmonary artery filling defects revealed using CTPA in COVID-19 patients and demonstrates that the mean value of multiple D-dimer measurements may represent a predicting factor of this complication.
本研究旨在评估新型冠状病毒肺炎（SARS-CoV-2）感染患者中与肺动脉栓塞（PAE）相符的肺动脉充盈缺损（PAFD）的患病率，并调查可能的放射学或临床预测因素。
回顾性分析43例确诊新型冠状病毒病（COVID-19）感染患者的计算机断层扫描肺动脉造影（CTPA），同时考虑每位患者的修订版日内瓦评分和D-二聚体值。记录肺动脉内的充盈缺损以及胸膜和实质病变，如磨玻璃影、实变、铺路石征、线状实变和胸腔积液。比较有和没有PAFD的患者之间的所有这些变量。使用受试者工作特征（ROC）曲线研究具有统计学差异的参数的预测性能。
15/43例患者（35%）被诊断为肺栓塞，而39/43例患者（91%）出现与COVID-19肺部疾病相关的CTPA和实质改变。PAFD患者的修订版日内瓦评分和连续两次测量获得的平均D-二聚体值显著更高。ROC分析表明，平均D-二聚体值是预测性较高的参数（AUC 0.831），其临界值>1800μg/L，预测PAFD的概率时敏感性和特异性分别为70%和78%。
这份单中心回顾性报告显示，COVID-19患者中使用CTPA显示的肺动脉充盈缺损患病率很高，并表明多次D-二聚体测量的平均值可能是这种并发症的一个预测因素。
