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[新冠病毒肺炎患者的蓝色肺：超越使用碘映射的MDCT诊断肺血栓栓塞的一步]

[Blue Lungs in Covid-19 Patients: A Step beyond the Diagnosis of Pulmonary Thromboembolism using MDCT with Iodine Mapping].

作者信息

Pérez Dueñas Virginia, Allona Krauel María, Agrela Rojas Emilio, Ramírez Prieto Maria Teresa, Díez Izquierdo Laura, López de la Guardia Ulpiano, Torres Sánchez Isabel

机构信息

Servicio de Radiología, HM Hospitales, Hospital Universitario HM Sanchinarro, Madrid, España.

Servicio de Neumología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España.

出版信息

Arch Bronconeumol. 2021 Jan;57:35-46. doi: 10.1016/j.arbres.2020.07.031. Epub 2020 Aug 28.

DOI:10.1016/j.arbres.2020.07.031
PMID:34629642
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7455161/
Abstract

OBJECTIVE

To evaluate the diagnostic capacity of pulmonary angiography with multidetector computed tomography (MDCT) and iodine mapping in the diagnosis of pulmonary thromboembolism (PTE) in patients with Covid-19 disease.

METHODS

Retrospective observational study of 81 consecutive patients admitted with Covid-19 respiratory infection who underwent MDCT for clinical suspicion of PTE (sudden dyspnea, chest pain, hemoptysis, severe respiratory failure (SRF) not corrected with high O flow) and/or raised D-dimer.

RESULTS

Of the 81 patients studied [64 (79.01%) men], acute PTE was identified in 22 (27.16%), bilaterally in 13 (59.09%), and 13 (59,09%) showed areas of hypoperfusion. Of the 59 (72.83%) patients without PTE, hypoperfusion was observed in 41 (69.49%) (attributable in one case to pulmonary emphysema). In 18 (22.2%) of the total number of patients, neither PTE nor hypoperfusion were seen. A crazy paving pattern is a risk factor for developing PTE (OR 1.94; 95% CI 0.28-13.57), as are consolidations (OR 1.44; 95% CI 0.24-8.48) and septal thickening/bronchiectasis (OR 1.47; 95% CI 0.12-17.81).Patients with O-refractory SRF showed a 6.36-fold higher risk for hypoperfusion on the iodine map.

CONCLUSION

By adding the functional image to the anatomical image, pulmonary angiography with MDCT and iodine mapping can demonstrate not only PTE in main, lobar and segmental arteries, but also the presence of hypoperfusion in distal vessels. This makes it a highly useful tool for the accurate diagnosis and therapeutic orientation of patients with Covid-19 lung involvement.

摘要

目的

评估多排螺旋计算机断层扫描（MDCT）肺血管造影和碘图对新型冠状病毒肺炎（Covid-19）患者肺血栓栓塞症（PTE）的诊断能力。

方法

对81例因临床怀疑PTE（突发呼吸困难、胸痛、咯血、高流量吸氧不能纠正的严重呼吸衰竭（SRF））和/或D-二聚体升高而接受MDCT检查的Covid-19呼吸道感染连续入院患者进行回顾性观察研究。

结果

在研究的81例患者中[64例（79.01%）为男性]，22例（27.16%）确诊为急性PTE，其中双侧发病13例（59.09%），13例（59.09%）显示灌注减低区域。在59例（72.83%）无PTE的患者中，41例（69.49%）观察到灌注减低（1例归因于肺气肿）。在总数18例（22.2%）患者中，未发现PTE和灌注减低。铺路石样表现是发生PTE的危险因素（比值比1.94；95%可信区间0.28-13.57），实变（比值比1.44；95%可信区间0.24-8.

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a415/7455161/af94824508df/mmc1_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a415/7455161/f921346efbcf/fx1_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a415/7455161/13ad3cc3bd23/gr1_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a415/7455161/a149816e2834/gr2_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a415/7455161/3cf05df56478/gr3_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a415/7455161/35df573bb698/gr4_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a415/7455161/c58453fcb4be/gr5_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a415/7455161/0487e32c57d9/gr6_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a415/7455161/acc4ef910f88/gr7_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a415/7455161/af94824508df/mmc1_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a415/7455161/f921346efbcf/fx1_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a415/7455161/13ad3cc3bd23/gr1_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a415/7455161/a149816e2834/gr2_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a415/7455161/3cf05df56478/gr3_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a415/7455161/35df573bb698/gr4_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a415/7455161/c58453fcb4be/gr5_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a415/7455161/0487e32c57d9/gr6_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a415/7455161/acc4ef910f88/gr7_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a415/7455161/af94824508df/mmc1_lrg.jpg

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