Nevesny Franck, Rotzinger David C, Sauter Alexander W, Loebelenz Laura I, Schmuelling Lena, Alkadhi Hatem, Ebner Lukas, Christe Andreas, Platon Alexandra, Poletti Pierre-Alexandre, Qanadli Salah D
Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 21079 Dijon, France.
Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), 1011 Lausanne, Switzerland.
Biomedicines. 2022 Jun 2;10(6):1300. doi: 10.3390/biomedicines10061300.
Background: Vascular abnormalities, including venous congestion (VC) and pulmonary embolism (PE), have been recognized as frequent COVID-19 imaging patterns and proposed as severity markers. However, the underlying pathophysiological mechanisms remain unclear. In this study, we aimed to characterize the relationship between VC, PE distribution, and alveolar opacities (AO). Methods: This multicenter observational registry (clinicaltrials.gov identifier NCT04824313) included 268 patients diagnosed with SARS-CoV-2 infection and subjected to contrast-enhanced CT between March and June 2020. Acute PE was diagnosed in 61 (22.8%) patients, including 17 females (27.9%), at a mean age of 61.7 ± 14.2 years. Demographic, laboratory, and outcome data were retrieved. We analyzed CT images at the segmental level regarding VC (qualitatively and quantitatively [diameter]), AO (semi-quantitatively as absent, <50%, or >50% involvement), clot location, and distribution related to VC and AO. Segments with vs. without PE were compared. Results: Out of 411 emboli, 82 (20%) were lobar or more proximal and 329 (80%) were segmental or subsegmental. Venous diameters were significantly higher in segments with AO (p = 0.031), unlike arteries (p = 0.138). At the segmental level, 77% of emboli were associated with VC. Overall, PE occurred in 28.2% of segments with AO vs. 21.8% without (p = 0.047). In the absence of VC, however, AO did not affect PE rates (p = 0.94). Conclusions: Vascular changes predominantly affected veins, and most PEs were located in segments with VC. In the absence of VC, AOs were not associated with the PE rate. VC might result from increased flow supported by the hypothesis of pulmonary arteriovenous anastomosis dysregulation as a relevant contributing factor.
血管异常，包括静脉充血（VC）和肺栓塞（PE），已被认为是常见的新冠肺炎影像学表现，并被提议作为疾病严重程度的标志物。然而，其潜在的病理生理机制仍不清楚。在本研究中，我们旨在描述VC、PE分布与肺泡实变（AO）之间的关系。方法：这项多中心观察性注册研究（clinicaltrials.gov标识符NCT04824313）纳入了2020年3月至6月期间268例确诊感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）并接受增强CT检查的患者。61例（22.8%）患者诊断为急性PE，其中女性17例（27.9%），平均年龄61.7±14.2岁。收集人口统计学、实验室检查和结局数据。我们在节段水平分析CT图像，观察VC（定性和定量[直径]）、AO（半定量为无、<50%或>50%累及）、血栓位置以及与VC和AO相关的分布情况。比较有PE和无PE的节段。结果：在411个栓子中，82个（20%）位于叶或更靠近近端，329个（80%）位于节段或亚节段。与动脉不同（p = 0.138），AO节段的静脉直径显著更高（p = 0.031）。在节段水平，77%的栓子与VC相关。总体而言，AO节段中28.2%发生PE，无AO节段中为21.8%（p = 0.047）。然而，在无VC的情况下，AO不影响PE发生率（p = 0.94）。结论：血管变化主要影响静脉，大多数PE位于有VC的节段。在无VC的情况下，AO与PE发生率无关。VC可能是由于肺动静脉吻合失调假说所支持的血流增加导致的，这是一个相关的促成因素。
