From the Department of Radiology, Addenbrooke's Hospital, Cambridge, UK (P.R., I.W.); Department of Radiology, University College London Hospital, 235 Euston Rd, UCH Podium 2, London NW1 2BU, UK (J.Y., B.C., M.S., T.B., M.H.C., C.v.S.); Department of Haematology, Queen Alexandra Hospital, Portsmouth, UK (A.K., A.G., B.M., R.A.); Department of Imaging, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK (A.S., J.H.); Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (A.M.); Department of Neurology, King's College Hospital, London, UK (M.B., S.A.M., P.R.M., L.S.); Department of Imaging, Queen Elizabeth University Hospital, Glasgow, UK (S.G.); Centre for Medical Imaging, University College London, UK (A.S., T.B., M.H.C.); Radiology Academic Network for Trainees (RADIANT), London, UK (P.R., J.Y., A.K., A.G., A.M., M.B., T.B., M.H.C.).
Radiology. 2022 Dec;305(3):590-596. doi: 10.1148/radiol.220365. Epub 2022 Jun 14.
Vaccination strategies have been at the forefront of controlling the COVID-19 pandemic. An association between vaccine-induced immune thrombotic thrombocytopenia (VITT) and one of these vaccines, the ChAdOx1 nCov-19 vaccine, is now recognized. The purpose of this study was to investigate the frequency and location of thrombosis in each vascular system using CT, MRI, and US to identify additional sites of thrombus in a United Kingdom-wide sample of patients with confirmed VITT. Thirty-two radiology centers identified through the national collaborative Radiology Academic Network for Trainees were invited from the United Kingdom; seven of these contributed to this study. All patients with confirmed VITT ¬between February 3 and May 12, 2021, who met the inclusion criteria were included. The location and extent of thrombi were evaluated using CT, MRI, and US. A total of 40 patients (median age, 41 years [IQR, 32-52]; 22 [55%] men) with confirmed vaccine-induced immune thrombotic thrombocytopenia after administration of their first ChAdOx1 nCov-19 vaccine were included. Thirty-two patients (80%) developed symptoms within the first 14 days, and eight (20%) developed symptoms within 14-28 days. Twenty-nine patients (72%) experienced neurologic symptoms and were confirmed to have cerebral venous sinus thrombosis, 12 (30%) had clinical deterioration and repeat imaging demonstrated extension of their primary thrombus, and eight (20%) died. Twenty-five of 30 patients (83%) who underwent additional imaging had occult thrombosis. In conclusion, patients with VITT are likely to have multiple sites of thrombosis, with the most frequent being cerebral venous sinus thrombosis in combination with pulmonary embolism and portomesenteric venous thrombosis. Whole-body imaging with contrast-enhanced CT can be used to identify occult thrombosis.
疫苗接种策略一直是控制 COVID-19 大流行的重点。现在已经认识到，疫苗引起的免疫性血栓性血小板减少症（VITT）与其中一种疫苗，即 ChAdOx1 nCov-19 疫苗之间存在关联。本研究的目的是使用 CT、MRI 和 US 来研究每个血管系统中血栓的频率和位置，以在英国范围内确诊的 VITT 患者样本中确定血栓的其他部位。通过全国合作的受训放射科医生学术网络，从英国邀请了 32 个放射学中心；其中 7 个参与了这项研究。所有在 2021 年 2 月 3 日至 5 月 12 日之间符合纳入标准的确诊 VITT 患者均被纳入本研究。使用 CT、MRI 和 US 评估血栓的位置和范围。共纳入 40 名（中位年龄，41 岁[IQR，32-52]；22 名[55%]男性）接受首剂 ChAdOx1 nCov-19 疫苗接种后确诊的疫苗诱导免疫性血栓性血小板减少症患者。32 名（80%）患者在第 14 天内出现症状，8 名（20%）患者在第 14-28 天内出现症状。29 名（72%）患者出现神经系统症状，并确诊为脑静脉窦血栓形成，12 名（30%）患者出现临床恶化，重复影像学检查显示其原发性血栓延伸，8 名（20%）患者死亡。25 名接受额外影像学检查的患者（83%）存在隐匿性血栓。总之，VITT 患者可能有多个部位的血栓形成，最常见的是脑静脉窦血栓形成，同时伴有肺栓塞和门腔静脉血栓形成。增强 CT 全身成像可用于发现隐匿性血栓。
