From the Service de Médecine Nucléaire, CHU de Saint-Étienne, Saint-Étienne.
Service de Médecine Nucléaire, CHRU Nancy, Nancy.
Clin Nucl Med. 2022 Aug 1;47(8):e540-e547. doi: 10.1097/RLU.0000000000004261. Epub 2022 May 19.
In coronavirus disease 2019 (COVID-19) patients, clinical manifestations as well as chest CT lesions are variable. Lung scintigraphy allows to assess and compare the regional distribution of ventilation and perfusion throughout the lungs. Our main objective was to describe ventilation and perfusion injury by type of chest CT lesions of COVID-19 infection using V/Q SPECT/CT imaging.
We explored a national registry including V/Q SPECT/CT performed during a proven acute SARS-CoV-2 infection. Chest CT findings of COVID-19 disease were classified in 3 elementary lesions: ground-glass opacities, crazy-paving (CP), and consolidation. For each type of chest CT lesions, a semiquantitative evaluation of ventilation and perfusion was visually performed using a 5-point scale score (0 = normal to 4 = absent function).
V/Q SPECT/CT was performed in 145 patients recruited in 9 nuclear medicine departments. Parenchymal lesions were visible in 126 patients (86.9%). Ground-glass opacities were visible in 33 patients (22.8%) and were responsible for minimal perfusion impairment (perfusion score [mean ± SD], 0.9 ± 0.6) and moderate ventilation impairment (ventilation score, 1.7 ± 1); CP was visible in 43 patients (29.7%) and caused moderate perfusion impairment (2.1 ± 1.1) and moderate-to-severe ventilation impairment (2.5 ± 1.1); consolidation was visible in 89 patients (61.4%) and was associated with moderate perfusion impairment (2.1 ± 1) and severe ventilation impairment (3.0 ± 0.9).
In COVID-19 patients assessed with V/Q SPECT/CT, a large proportion demonstrated parenchymal lung lesions on CT, responsible for ventilation and perfusion injury. COVID-19-related pulmonary lesions were, in order of frequency and functional impairment, consolidations, CP, and ground-glass opacity, with typically a reverse mismatched or matched pattern.
在 2019 年冠状病毒病（COVID-19）患者中，临床表现和胸部 CT 病变多种多样。肺部闪烁显像可用于评估和比较整个肺部的通气和灌注的区域分布。我们的主要目的是使用 V/Q SPECT/CT 成像描述 COVID-19 感染的胸部 CT 病变类型的通气和灌注损伤。
我们探索了一个包括在已确诊的急性 SARS-CoV-2 感染期间进行的 V/Q SPECT/CT 的全国性登记。COVID-19 疾病的胸部 CT 发现分为 3 种基本病变：磨玻璃影、铺路石征（CP）和实变。对于每种类型的胸部 CT 病变，使用 5 分制评分（0=正常至 4=无功能）进行通气和灌注的半定量评估。
145 例患者在 9 个核医学部门进行了 V/Q SPECT/CT。126 例患者（86.9%）可见实质病变。33 例患者（22.8%）可见磨玻璃影，仅导致轻微的灌注损伤（灌注评分[均值±标准差]，0.9±0.6）和中度通气损伤（通气评分，1.7±1）；43 例患者（29.7%）可见 CP，导致中度灌注损伤（2.1±1.1）和中重度通气损伤（2.5±1.1）；89 例患者（61.4%）可见实变，与中度灌注损伤（2.1±1）和严重通气损伤（3.0±0.9）相关。
在接受 V/Q SPECT/CT 评估的 COVID-19 患者中，很大一部分患者在 CT 上显示肺部实质病变，导致通气和灌注损伤。COVID-19 相关的肺部病变按频率和功能损伤的顺序为实变、CP 和磨玻璃影，典型的表现为反向不匹配或匹配模式。
