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Published on: July 16, 2018
Lung and kidney perfusion deficits diagnosed by dual-energy computed tomography in patients with COVID-19-related
Ilkay S Idilman1, Gulcin Telli Dizman2, Selin Ardali Duzgun1
1Faculty of Medicine, Department of Radiology, Hacettepe University, Sihhiye, Ankara, Turkey.
Insights
Dual-energy computed tomography (DECT) revealed lung and kidney perfusion deficits in COVID-19 patients, indicating microvascular obstruction and disease severity. D-dimer levels effectively predicted these thrombotic events.
Area of Science:
- Radiology
- Cardiovascular Medicine
- Pulmonology
Background:
- Increasing evidence suggests thrombotic events in COVID-19 patients.
- Microvascular obstruction is a suspected complication of COVID-19.
Purpose of the Study:
- To evaluate lung and kidney perfusion abnormalities in COVID-19 patients using dual-energy computed tomography (DECT).
- To investigate the association between perfusion abnormalities and disease severity as indicators of microvascular obstruction.
Main Methods:
- Thirty-one COVID-19 patients suspected of pulmonary thromboembolism underwent pulmonary DECT angiography.
- Pulmonary and kidney images were reviewed, and patient characteristics and laboratory findings were compared between groups with and without lung perfusion deficits (PDs).
Main Results:
- DECT identified lung PDs in 25.8% of patients, unrelated to ground-glass opacity or consolidation.
- Patients with PDs exhibited longer hospital stays, higher ICU admission rates, and more severe disease.
- Significantly elevated ferritin, AST, fibrinogen, D-dimer, CRP, and troponin levels, along with lower albumin, were observed in the PD group.
- D-dimer levels ≥0.485 μg/L predicted PD with 100% specificity and 87% sensitivity.
- Renal perfusion abnormalities were detected in 50% of patients, correlating with lower sodium levels.
Conclusions:
- A significant proportion of COVID-19 patients present with lung and kidney perfusion abnormalities, suggesting systemic microangiopathy and micro-thrombosis.
- These findings aid in understanding hypoxemia physiology and may guide management strategies, including thromboprophylaxis and oxygenation optimization.
- Pulmonary DECT can detect perfusion abnormalities indicative of disease severity, and D-dimer levels serve as a strong predictor of lung PDs.
Objectives:
There 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.
Methods:
Thirty-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).
Results:
DECT 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).
Conclusions:
We 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.
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