Response

Abstract

We thank Rotzinger and Qanadli for the interest in our article on the chest CT imaging signature of coronavirus disease 2019 (COVID-19) infection.1Adams H.J.A. Kwee T.C. Yakar D. Hope M.D. Kwee R.M. Chest CT imaging signature of coronavirus disease 2019 infection: in pursuit of the scientific evidence.Chest. 2020; 158: 1885-1895Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar In our article, we reported a pooled prevalence of vascular thickening of 72.9% (95% CI, 64.4% to 81.4%) in patients with COVID-19.1Adams H.J.A. Kwee T.C. Yakar D. Hope M.D. Kwee R.M. Chest CT imaging signature of coronavirus disease 2019 infection: in pursuit of the scientific evidence.Chest. 2020; 158: 1885-1895Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar At the time our article was published, there was a lack of scientific data that correlated chest CT imaging to postmortem pathologic findings in this disease. Recently, Henkel et al2Henkel M. Weikert T. Marston K. et al.Lethal COVID-19: radiological-pathological correlation of the lungs.Radiol Cardiothorac Imaging. 2020; 2: e200406Crossref PubMed Scopus (15) Google Scholar published a series of 14 patients who died of COVID-19, in whom a morphologic comparison of antemortem chest CT scans with postmortem gross findings and histopathologic findings was performed. Five of 14 patients in their study also underwent contrast-enhanced CT imaging.2Henkel M. Weikert T. Marston K. et al.Lethal COVID-19: radiological-pathological correlation of the lungs.Radiol Cardiothorac Imaging. 2020; 2: e200406Crossref PubMed Scopus (15) Google Scholar Both vascular thickening (vascular enlargement/vascular congestion) and pulmonary arterial enlargement (related to the corresponding bronchus) were present in 12 of 14 patients (86%) on chest CT imaging.2Henkel M. Weikert T. Marston K. et al.Lethal COVID-19: radiological-pathological correlation of the lungs.Radiol Cardiothorac Imaging. 2020; 2: e200406Crossref PubMed Scopus (15) Google Scholar Based on their histopathologic correlation and previous autopsy studies,3Wichmann D. Sperhake J.P. Lütgehetmann M. et al.Autopsy findings and venous thromboembolism in patients with COVID-19: a prospective cohort study.Ann Intern Med. 2020; 173: 268-277Crossref PubMed Scopus (1437) Google Scholar,4Ackermann M. Verleden S.E. Kuehnel M. et al.Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19.N Engl J Med. 2020; 383: 120-128Crossref PubMed Scopus (3079) Google Scholar Henkel et al2Henkel M. Weikert T. Marston K. et al.Lethal COVID-19: radiological-pathological correlation of the lungs.Radiol Cardiothorac Imaging. 2020; 2: e200406Crossref PubMed Scopus (15) Google Scholar speculated that the observation of enlarged pulmonary arteries might be related to an increase of parenchymal and predominantly intravascular pressure, due to severe COVID-19 pulmonary microangiopathy that affected the alveolar capillary network. The high incidence of microthrombosis was also thought to be suggestive of a possible underestimation of the vascular alterations associated with COVID-19 with the use of imaging, especially on unenhanced scans.2Henkel M. Weikert T. Marston K. et al.Lethal COVID-19: radiological-pathological correlation of the lungs.Radiol Cardiothorac Imaging. 2020; 2: e200406Crossref PubMed Scopus (15) Google Scholar Henkel et al2Henkel M. Weikert T. Marston K. et al.Lethal COVID-19: radiological-pathological correlation of the lungs.Radiol Cardiothorac Imaging. 2020; 2: e200406Crossref PubMed Scopus (15) Google Scholar concluded that both severe acute lung injury and vascular complications contribute to fatal outcomes. These considerations largely resonate with the excellent remarks by Rotzinger and Qanadli.1Adams H.J.A. Kwee T.C. Yakar D. Hope M.D. Kwee R.M. Chest CT imaging signature of coronavirus disease 2019 infection: in pursuit of the scientific evidence.Chest. 2020; 158: 1885-1895Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar Nevertheless, the scientific evidence on the pathophysiologic condition and clinical relevance of vascular changes on chest CT imaging in COVID-19, besides frank pulmonary embolism, is still limited, and the interpretation of this limited evidence remains somewhat speculative. Further studies are warranted to understand the nature of vascular abnormalities seen on chest CT scans and how this can help to improve patient management and outcome. Chest CT Imaging Signature of Coronavirus Disease 2019 Infection: In Pursuit of the Scientific EvidenceCHESTVol. 158Issue 5PreviewStudies on chest CT imaging findings in COVID-19 suffer from methodologic quality concerns. More high-quality research is necessary to establish diagnostic CT criteria for COVID-19. Based on the available evidence that requires cautious interpretation, several chest CT imaging findings appear to be suggestive of COVID-19, but normal chest CT imaging findings do not exclude COVID-19, not even in symptomatic patients. Full-Text PDF Open AccessShould Vascular Abnormalities Be Integrated Into the Chest CT Imaging Signature of Coronavirus Disease 2019?CHESTVol. 159Issue 5PreviewWe enjoyed reading the systematic review recently published in CHEST (November 2020) by Adams et al.1 Based on 28 studies that included 3,466 patients, the authors analyzed known CT findings and structured the disease’s imaging signature. Expectedly, the most frequent pattern was ground glass opacity (81.0%), but more interesting was the high prevalence of “vascular thickening” (72.9%). Although vascular abnormalities have escaped the attention of early reports, they are described increasingly and recently gained interest regarding both pathophysiologic condition and prognosis. Full-Text PDF