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Approximation of EVLWI in severe COVID-19 pneumonia using quantitative imaging techniques: an observational study
Jonas Biehler1,2, Marie Brei3,4, Nina Pischke3,4
1Institute for Computational Mechanics, Technical University Munich, Boltzmannstr. 15, 85748, Munich, Germany. jonas.biehler@tum.de.
Intensive Care Medicine Experimental
|May 19, 2025
Summary
Quantitative imaging using chest CT scans can estimate extravascular lung water (EVLW) in severe COVID-19 pneumonia. This offers a practical, cost-effective alternative to transpulmonary thermodilution (TPTD) for ICUs.
Area of Science:
- Critical Care Medicine
- Pulmonary Medicine
- Radiology
Background:
- Elevated extravascular lung water (EVLW) correlates with diffuse alveolar damage and mortality in severe COVID-19 pneumonia.
- Transpulmonary thermodilution (TPTD) is the gold standard for EVLW measurement but is invasive and resource-intensive.
Purpose of the Study:
- To approximate EVLW levels in severe COVID-19 pneumonia patients using quantitative imaging.
- To evaluate the feasibility of using chest CT scans as an alternative to TPTD for EVLW assessment.
Main Methods:
- Included severe COVID-19 patients with chest CT scans and TPTD monitoring within 48 hours of ICU admission.
- Utilized in-house software for automatic semantic segmentation to obtain lung masks for EVLW estimation.
- Compared CT-derived EVLW estimations with TPTD measurements.
Main Results:
- A significant correlation was found between EVLW measured by TPTD and EVLW estimated from CT images (r=0.629, p=0.0014).
Conclusions:
- Quantitative imaging techniques with chest CT scans provide a viable method for EVLW assessment in severe COVID-19 pneumonia.
- CT-based EVLW estimation is a convenient and low-cost option for ICUs lacking TPTD equipment.
