双能量CT肺血管造影（DECTPA）对重症新型冠状病毒肺炎血管病变进行定量分析。
Dual-Energy CT Pulmonary Angiography (DECTPA) Quantifies Vasculopathy in Severe COVID-19 Pneumonia.
作者信息
Ridge Carole A, Desai Sujal R, Jeyin Nidhish, Mahon Ciara, Lother Dione L, Mirsadraee Saeed, Semple Tom, Price Susanna, Bleakley Caroline, Arachchillage Deepa J, Shaw Elizabeth, Patel Brijesh V, Padley Simon Pg, Devaraj Anand
机构信息
Department of Imaging, Royal Brompton Hospital, London, UK (C.A.R., S.R.D., C.M., D.L.L., S.M., T.S., E.S., S.P.P, A.D.); Imperial College London, London, UK (N.J.); Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK (S.P., C.B., B.V.P.); Department of Haematology, Imperial College London, London, UK and Department of Haematology, Royal Brompton Hospital, London, UK (D.J.A).
出版信息
Radiol Cardiothorac Imaging. 2020 Oct 29;2(5):e200428. doi: 10.1148/ryct.2020200428. eCollection 2020 Oct.
BACKGROUND
The role of dual energy computed tomographic pulmonary angiography (DECTPA) in revealing vasculopathy in coronavirus disease 2019 (COVID-19) has not been fully explored.
PURPOSE
To evaluate the relationship between DECTPA and disease duration, right ventricular dysfunction (RVD), lung compliance, D-dimer and obstruction index in COVID-19 pneumonia.
MATERIALS AND METHODS
This institutional review board approved this retrospective study, and waived the informed consent requirement. Between March-May 2020, 27 consecutive ventilated patients with severe COVID-19 pneumonia underwent DECTPA to diagnose pulmonary thrombus (PT); 11 underwent surveillance DECTPA 14 ±11.6 days later. Qualitative and quantitative analysis of perfused blood volume (PBV) maps recorded: i) perfusion defect 'pattern' (wedge-shaped, mottled or amorphous), ii) presence of PT and CT obstruction index (CTOI) and iii) PBV relative to pulmonary artery enhancement (PBV/PAenh); PBV/PAenh was also compared with seven healthy volunteers and correlated with D-Dimer and CTOI.
RESULTS
Amorphous (n=21), mottled (n=4), and wedge-shaped (n=2) perfusion defects were observed (M=20; mean age=56 ±8.7 years). Mean extent of perfusion defects=36.1%±17.2. Acute PT was present in 11/27(40.7%) patients. Only wedge-shaped defects corresponded with PT (2/27, 7.4%). Mean CTOI was 2.6±5.4 out of 40. PBV/PAenh (18.2 ±4.2%) was lower than in healthy volunteers (27 ±13.9%, p = 0.002). PBV/PAenh correlated with disease duration (β = 0.13, p = 0.04), and inversely correlated with RVD (β = -7.2, p = 0.001), persisting after controlling for confounders. There were no linkages between PBV/PAenh and D-dimer or CTOI.
CONCLUSION
Perfusion defects and decreased PBV/PAenh are prevalent in severe COVID-19 pneumonia. PBV/PAenh correlates with disease duration and inversely correlates with RVD. PBV/PAenh may be an important marker of vasculopathy in severe COVID-19 pneumonia even in the absence of arterial thrombus.
背景
双能计算机断层扫描肺血管造影（DECTPA）在揭示2019冠状病毒病（COVID-19）血管病变中的作用尚未得到充分探索。
目的
评估DECTPA与COVID-19肺炎患者的病程、右心室功能障碍（RVD）、肺顺应性、D-二聚体及阻塞指数之间的关系。
材料与方法
本回顾性研究经机构审查委员会批准，并免除了知情同意要求。2020年3月至5月期间，连续27例接受机械通气的重症COVID-19肺炎患者接受DECTPA以诊断肺血栓（PT）；其中11例在14±11.6天后接受了监测DECTPA。对灌注血容量（PBV）图进行定性和定量分析，记录：i）灌注缺损“模式”（楔形、斑片状或无定形），ii）PT的存在及CT阻塞指数（CTOI），以及iii）PBV相对于肺动脉强化的比值（PBV/PAenh）；还将PBV/PAenh与7名健康志愿者进行比较，并与D-二聚体和CTOI进行相关性分析。
结果
观察到无定形灌注缺损21例、斑片状4例、楔形2例（中位数=20；平均年龄=56±8.7岁）。灌注缺损的平均范围为36.1%±17.2。11/27（40.7%）例患者存在急性PT。仅楔形缺损与PT相关（2/27，7.4%）。平均CTOI为40分中的2.6±5.4分。PBV/PAenh（18.2±4.2%）低于健康志愿者（27±13.9%，p=0.002）。PBV/PAenh与病程相关（β=0.13，p=0.04），与RVD呈负相关（β=-7.2，p=0.001），在控制混杂因素后依然如此。PBV/PAenh与D-二聚体或CTOI之间无关联。
结论
灌注缺损和PBV/PAenh降低在重症COVID-19肺炎中普遍存在。PBV/PAenh与病程相关，与RVD呈负相关。即使在无动脉血栓的情况下，PBV/PAenh也可能是重症COVID-19肺炎血管病变的重要标志物。
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