Abstract
ObjectivesThere is increasing evidence that thrombotic events occur in patients with coronavirus disease (COVID-19). We evaluated lung and kidney perfusion abnormalities in patients with COVID-19 by dual-energy computed tomography (DECT) and investigated the role of perfusion abnormalities on disease severity as a sign of microvascular obstruction.MethodsThirty-one patients with COVID-19 who underwent pulmonary DECT angiography and were suspected of having pulmonary thromboembolism were included. Pulmonary and kidney images were reviewed. Patient characteristics and laboratory findings were compared between those with and without lung perfusion deficits (PDs).ResultsDECT images showed PDs in eight patients (25.8%), which were not overlapping with areas of ground-glass opacity or consolidation. Among these patients, two had pulmonary thromboembolism confirmed by CT angiography. Patients with PDs had a longer hospital stay (p = 0.14), higher intensive care unit admission rates (p = 0.02), and more severe disease (p = 0.01). In the PD group, serum ferritin, aspartate aminotransferase, fibrinogen, D-dimer, C-reactive protein, and troponin levels were significantly higher, whereas albumin level was lower (p < 0.05). D-dimer levels ≥ 0.485 μg/L predicted PD with 100% specificity and 87% sensitivity. Renal iodine maps showed heterogeneous enhancement consistent with perfusion abnormalities in 13 patients (50%) with lower sodium levels (p = 0.03).ConclusionsWe found that a large proportion of patients with mild-to-moderate COVID-19 had PDs in their lungs and kidneys, which may be suggestive of the presence of systemic microangiopathy with micro-thrombosis. These findings help in understanding the physiology of hypoxemia and may have implications in the management of patients with COVID-19, such as early indications of thromboprophylaxis or anticoagulants and optimizing oxygenation strategies.Key Points • Pulmonary perfusion abnormalities in COVID-19 patients, associated with disease severity, can be detected by pulmonary DECT. • A cutoff value of 0.485 μg/L for D-dimer plasma levels predicted lung perfusion deficits with 100% specificity and 87% sensitivity (AUROC, 0.957). • Perfusion abnormalities in the kidney are suggestive of a subclinical systemic microvascular obstruction in these patients. Electronic supplementary materialThe online version of this article (10.1007/s00330-020-07155-3) contains supplementary material, which is available to authorized users.
Highlights
Radiological imaging of the lungs has become a diagnostic tool for the coronavirus disease (COVID-19) due to the low sensitivity of real-time reverse-transcription polymerase chain reaction (RT-PCR) tests from swab samples [1,2,3]
Multiorgan endotheliitis was identified in patients with COVID-19, which may be due to the widespread distribution and co-expression of ACE-2 and S-protein-specific proteases [6,7,8]
Iodine maps obtained with this method can be used to evaluate kidney perfusion, which are included at the caudal aspect of the dual-energy computed tomography (DECT) angiography
Summary
Radiological imaging of the lungs has become a diagnostic tool for the coronavirus disease (COVID-19) due to the low sensitivity of real-time reverse-transcription polymerase chain reaction (RT-PCR) tests from swab samples [1,2,3]. Microangiopathic lesions with thrombosis have been shown in pathological specimens from the lungs of critically ill patients with COVID-19 [9], and anticoagulant therapy has been shown to improve their prognosis [10]. These findings are based on recent pathological studies and it is evident that noninvasive diagnosis of the microvascular obstruction would be beneficial in the management of COVID-19 patients using early thromboprophylaxis. We aimed to evaluate lung and kidney perfusion abnormalities in COVID-19 patients by dual-energy computed tomography (DECT) and to investigate the role of perfusion abnormalities on disease severity as a sign of microvascular obstruction
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