Wu Gang, Wu Yin, Gharaibeh Nadeer M, Li Ting, Cao Xueqin, Li Xiaoming
Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
Quant Imaging Med Surg. 2024 Sep 1;14(9):6413-6424. doi: 10.21037/qims-23-1607. Epub 2024 Aug 28.
Viral pneumonia (VP) often leads to the development of deep vein thrombosis (DVT) in hospitalized patients. The aim of the study was to investigate the incidence of DVT in discharged patients with VP, and whether new and old DVT differ in transverse relaxation time.
In this prospective cohort study in Wuhan, China, 338 consecutive discharged VP patients from February 2021 to March 2023 who underwent T2 weighted Sampling Perfection with Application Optimized Contrast Evolution (SPACE) were recruited to detect DVT. T2 mapping and T2* mapping were performed for the patients with DVT detected by magnetic resonance imaging (MRI). The minimum, maximum, mean of T2 time and T2* time of DVT were recorded as T2min, T2max, T2mean, T2min, T2max, and T2*mean, respectively. Clinical data and laboratory findings were compared between new and old DVT cases, which were defined based on the examination results before and after discharge. A Mann-Whitney test was used to compare transverse relaxation time parameters between new and old DVT.
Twelve percent of VP patients (40/338) developed new DVT after discharge. Thirty-three out of 104 DVTs did not resolve after discharge. Compared with patients with new DVT, patients with old DVT were older (67 59 years, P=0.003); and had a higher proportion of bedridden time >72 hours (72.7% 37.0%, P<0.001). Patients with old DVT had a lower lymphocyte count (0.67×10/L 0.97×10/L, P=0.01), higher C-reactive protein (59 35 mg/L, P=0.019), and higher levels of D-dimer (6.7 0.9 µg/mL, P<0.001) than patients with new DVT. Patients with old DVT received more invasive mechanical ventilation (30.3% 7.4%, P<0.001) and had a higher proportion of acute respiratory distress syndrome (75.8% 51.9%, P<0.001), and a higher proportion of cardiac injury (39.4% 14.8%, P=0.033) than patients with new DVT. T2min, T2max, T2mean, and T2*max of new DVT were significantly greater than old DVT (17.6±10.4 13.2±5.9 ms, 94.9±44.9 42.3±23.6 ms, 46.8±24.0 25.0±12.6 ms, 22.5±12.4 10.7±3.5 ms, P<0.05 for all). There was no significant difference in T2*min or T2*mean between new and old DVT (3.2±0.4 3.1±0.4 ms, 8.2±4.9 5.5±1.5 ms, P>0.05 for both).
T2 weighted SPACE magnetic resonance (MR) is valuable in the follow-up of thrombosis of discharged VP patients. T2 mapping distinguishes between new and old DVT.
病毒性肺炎（VP）常导致住院患者发生深静脉血栓形成（DVT）。本研究旨在调查出院的VP患者中DVT的发生率，以及新发和陈旧性DVT在横向弛豫时间上是否存在差异。
在这项于中国武汉开展的前瞻性队列研究中，招募了2021年2月至2023年3月期间连续出院的338例VP患者，这些患者均接受了应用优化对比增强的T2加权采样完美采集（SPACE）序列检查以检测DVT。对通过磁共振成像（MRI）检测出DVT的患者进行T2映射和T2映射。将DVT的T2时间和T2时间的最小值、最大值、平均值分别记录为T2min、T2max、T2mean、T2min、T2max和T2*mean。根据出院前后的检查结果对新发和陈旧性DVT病例进行定义，并比较两者的临床资料和实验室检查结果。采用Mann-Whitney检验比较新发和陈旧性DVT的横向弛豫时间参数。
12%的VP患者（40/338）出院后发生新发DVT。104例DVT中有33例出院后未缓解。与新发DVT患者相比，陈旧性DVT患者年龄更大（67±59岁，P = 0.003）；卧床时间>72小时的比例更高（72.7%±37.0%，P<0.001）。陈旧性DVT患者的淋巴细胞计数更低（0.67×10⁹/L±0.97×10⁹/L，P = 0.01），C反应蛋白更高（59±35mg/L，P = 0.019），D-二聚体水平更高（6.7±0.9μg/mL，P<0.001）。与新发DVT患者相比，陈旧性DVT患者接受有创机械通气的比例更高（30.3%±7.4%，P<0.001），急性呼吸窘迫综合征的比例更高（75.8%±51.9%，P<0.001），心脏损伤的比例更高（39.4%±14.8%，P = 0.033）。新发DVT的T2min、T2max、T2mean和T2*max均显著大于陈旧性DVT（17.6±10.4ms±13.2±5.9ms，94.9±44.9ms±42.3±23.6ms，46.8±24.0ms±25.0±12.6ms，22.5±12.4ms±10.7±3.5ms，P均<0.05）。新发和陈旧性DVT的T2*min或T2*mean无显著差异（3.2±0.4ms±3.1±0.4ms，8.2±4.9ms±5.5±1.5ms，P均>0.05）。
T2加权SPACE磁共振（MR）在出院VP患者血栓形成的随访中具有重要价值。T2映射可区分新发和陈旧性DVT。
