Kaminetzky Mark, Moore William, Fansiwala Kush, Babb James S, Kaminetzky David, Horwitz Leora I, McGuinness Georgeann, Knoll Abraham, Ko Jane P
Department of Radiology (M.K., W.M., K.F., J.S.B., G.M., J.P.K.), Department of Medicine, Division of Hematology and Medical Oncology, Laura and Isaac Perlmutter Cancer Center (D.K.), and Center for Healthcare Innovation and Delivery Science (L.I.H.), NYU Langone Health, 550 First Ave, New York, NY 10016; Division of Healthcare Delivery Science, Department of Population Health and Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, New York, NY (L.I.H.); and Garden State Urology, Wayne, NJ (A.K.).
Radiol Cardiothorac Imaging. 2020 Jul 2;2(4):e200308. doi: 10.1148/ryct.2020200308. eCollection 2020 Aug.
To evaluate pulmonary embolism (PE) prevalence at CT pulmonary angiography in patients testing positive for coronavirus disease 2019 (COVID-19) and factors associated with PE severity.
A retrospective, single-center study evaluated 62 patients who tested positive for COVID-19 who underwent CT pulmonary angiography between March 13 and April 5, 2020. Another 62-patient cohort who underwent CT pulmonary angiography before the first reported local COVID-19 case was retrospectively selected. The relative rate of CT pulmonary angiography positivity was recorded. For the COVID-19 positive cohort, comorbidities, laboratory values, clinical outcome, and venous thrombosis of the patients were recorded. Two thoracic radiologists assessed embolic severity using the Mastora system and evaluated right heart strain. Factors associated with PE and arterial obstruction severity were evaluated by using statistical analysis. A value < .05 was considered significant.
Of the patients testing positive for COVID-19, 37.1% had PE, higher than 14.5% of pre-COVID-19 patients ( = .007). d-dimer levels closest to CT pulmonary angiography date correlated with the Mastora obstruction score. Receiver operating characteristic analysis identified optimal sensitivity (95%) and specificity (71%) for PE diagnosis at 1394 ng/mL d-dimer units. The mean d-dimer level was 1774 ng/mL and 6432 ng/mL d-dimer units in CT pulmonary angiography-negative and CT pulmonary angiography-positive subgroups, respectively ( < .001). One additional patient with negative results at CT pulmonary angiography had deep venous thrombosis, thus resulting in 38.7% with PE or deep venous thrombosis, despite 40% receiving prophylactic anticoagulation. Other factors did not demonstrate significant PE association.
A total of 37.1% of COVID-19 patients underwent CT pulmonary angiographic examinations diagnosing PE. PE can be a cause of decompensation in patients testing positive for COVID-19, and d-dimer can be used to stratify patients in terms of PE risk and severity.© RSNA, 2020.
评估2019冠状病毒病（COVID-19）检测呈阳性的患者在CT肺动脉造影时肺栓塞（PE）的患病率以及与PE严重程度相关的因素。
一项回顾性单中心研究评估了2020年3月13日至4月5日期间接受CT肺动脉造影且COVID-19检测呈阳性的62例患者。另回顾性选取了62例在当地首次报告COVID-19病例之前接受CT肺动脉造影的患者作为对照队列。记录CT肺动脉造影阳性率。对于COVID-19阳性队列，记录患者的合并症、实验室检查值、临床结局和静脉血栓形成情况。两名胸部放射科医生使用马托拉系统评估栓塞严重程度并评估右心应变。采用统计分析评估与PE和动脉阻塞严重程度相关的因素。P值<0.05被认为具有统计学意义。
COVID-19检测呈阳性的患者中，37.1%患有PE，高于COVID-19前患者的14.5%（P = 0.007）。最接近CT肺动脉造影日期的D-二聚体水平与马托拉阻塞评分相关。受试者操作特征分析确定D-二聚体单位为1394 ng/mL时，PE诊断的最佳敏感性为95%，特异性为71%。CT肺动脉造影阴性和阳性亚组的平均D-二聚体水平分别为1774 ng/mL和6432 ng/mL D-二聚体单位（P<0.001）。另外1例CT肺动脉造影结果为阴性的患者患有深静脉血栓形成，因此尽管40%的患者接受了预防性抗凝治疗，但仍有38.7%的患者患有PE或深静脉血栓形成。其他因素未显示与PE有显著关联。
共有37.1%的COVID-19患者接受了CT肺动脉造影检查并诊断为PE。PE可能是COVID-19检测呈阳性患者失代偿的原因之一，D-二聚体可用于对患者的PE风险和严重程度进行分层。©RSNA，2020年。
