Related Experiment Video
Updated: Nov 11, 2025
Lung CT Segmentation to Identify Consolidations and Ground Glass Areas for Quantitative Assesment of SARS-CoV Pneumonia
Published on: December 19, 2020
Pulmonary Embolism at CT Pulmonary Angiography in Patients with COVID-19
Mark Kaminetzky1, William Moore1, Kush Fansiwala1
1Department of Radiology (M.K., W.M., K.F., J.S.B., G.M., J.P.K.), Department of Medicine, Division of Hematology and Medical Oncology, Laura and Isaac Perlmutter Cancer Center (D.K.), and Center for Healthcare Innovation and Delivery Science (L.I.H.), NYU Langone Health, 550 First Ave, New York, NY 10016; Division of Healthcare Delivery Science, Department of Population Health and Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, New York, NY (L.I.H.); and Garden State Urology, Wayne, NJ (A.K.).
Insights
Pulmonary embolism (PE) was diagnosed in 37.1% of coronavirus disease 2019 (COVID-19) patients, a significantly higher rate than in pre-COVID-19 patients. D-dimer levels effectively stratify COVID-19 patients for PE risk and severity.
Area of Science:
- Radiology
- Cardiology
- Infectious Diseases
Background:
- Coronavirus disease 2019 (COVID-19) is associated with an increased risk of thrombotic events.
- Pulmonary embolism (PE) is a serious complication that can affect patients with COVID-19.
Purpose of the Study:
- To determine the prevalence of PE in COVID-19 patients undergoing CT pulmonary angiography (CTPA).
- To identify factors associated with PE severity in COVID-19 patients.
Main Methods:
- Retrospective study of 62 COVID-19 positive patients and 62 pre-COVID-19 controls who underwent CTPA.
- Radiologists assessed embolic severity using the Mastora system and evaluated right heart strain.
- Statistical analysis was used to identify factors associated with PE and arterial obstruction severity.
Main Results:
- PE was diagnosed in 37.1% of COVID-19 patients, significantly higher than 14.5% in the pre-COVID-19 cohort (P = .007).
- D-dimer levels correlated with PE severity (Mastora obstruction score) and can aid in diagnosis (optimal cutoff at 1394 ng/mL).
- 38.7% of COVID-19 patients had PE or deep venous thrombosis, despite prophylactic anticoagulation.
Conclusions:
- A significant proportion of COVID-19 patients have PE, identified via CTPA.
- PE can contribute to clinical decompensation in COVID-19 patients.
- D-dimer levels are valuable for stratifying PE risk and severity in COVID-19 patients.
Purpose:
To evaluate pulmonary embolism (PE) prevalence at CT pulmonary angiography in patients testing positive for coronavirus disease 2019 (COVID-19) and factors associated with PE severity.
Materials And Methods:
A retrospective, single-center study evaluated 62 patients who tested positive for COVID-19 who underwent CT pulmonary angiography between March 13 and April 5, 2020. Another 62-patient cohort who underwent CT pulmonary angiography before the first reported local COVID-19 case was retrospectively selected. The relative rate of CT pulmonary angiography positivity was recorded. For the COVID-19 positive cohort, comorbidities, laboratory values, clinical outcome, and venous thrombosis of the patients were recorded. Two thoracic radiologists assessed embolic severity using the Mastora system and evaluated right heart strain. Factors associated with PE and arterial obstruction severity were evaluated by using statistical analysis. A P value < .05 was considered significant.
Results:
Of the patients testing positive for COVID-19, 37.1% had PE, higher than 14.5% of pre-COVID-19 patients (P = .007). d-dimer levels closest to CT pulmonary angiography date correlated with the Mastora obstruction score. Receiver operating characteristic analysis identified optimal sensitivity (95%) and specificity (71%) for PE diagnosis at 1394 ng/mL d-dimer units. The mean d-dimer level was 1774 ng/mL and 6432 ng/mL d-dimer units in CT pulmonary angiography-negative and CT pulmonary angiography-positive subgroups, respectively (P < .001). One additional patient with negative results at CT pulmonary angiography had deep venous thrombosis, thus resulting in 38.7% with PE or deep venous thrombosis, despite 40% receiving prophylactic anticoagulation. Other factors did not demonstrate significant PE association.
Conclusion:
A total of 37.1% of COVID-19 patients underwent CT pulmonary angiographic examinations diagnosing PE. PE can be a cause of decompensation in patients testing positive for COVID-19, and d-dimer can be used to stratify patients in terms of PE risk and severity.Supplemental material is available for this article.© RSNA, 2020.
Related Concept Videos
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:29Pulmonary Embolism I: Introduction
01:27Pulmonary Embolism III: Nursing Management
01:13Radiological Investigation III: Pulmonary Angiogram and PET Scan
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...
01:28Imaging Studies for Cardiovascular System V: CT
01:27Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History