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. 2020 Oct;27(10):1449-1455.
doi: 10.1016/j.acra.2020.07.019. Epub 2020 Jul 25.

Assessment of Small Pulmonary Blood Vessels in COVID-19 Patients Using HRCT

Muriel Lins  1 , Jan Vandevenne  2 , Muhunthan Thillai  3 , Ben R Lavon  4 , Maarten Lanclus  4 , Stijn Bonte  4 , Rik Godon  4 , Irvin Kendall  4 , Jan De Backer  4 , Wilfried De Backer  5
Affiliations

Assessment of Small Pulmonary Blood Vessels in COVID-19 Patients Using HRCT

Muriel Lins et al. Acad Radiol. 2020 Oct.

Abstract

Rationale and objectives: Mounting evidence supports the role of pulmonary hemodynamic alternations in the pathogenesis of COVID-19. Previous studies have demonstrated that changes in pulmonary blood volumes measured on computed tomography (CT) are associated with histopathological markers of pulmonary vascular pruning, suggesting that quantitative CT analysis may eventually be useful in the assessment pulmonary vascular dysfunction more broadly.

Materials and methods: Building upon previous work, automated quantitative CT measures of small blood vessel volume and pulmonary vascular density were developed. Scans from 103 COVID-19 patients and 107 healthy volunteers were analyzed and their results compared, with comparisons made both on lobar and global levels.

Results: Compared to healthy volunteers, COVID-19 patients showed significant reduction in BV5 (pulmonary blood volume contained in blood vessels of <5 mm2) expressed as BV5/(total pulmonary blood volume; p < 0.0001), and significant increases in BV5-10 and BV 10 (pulmonary blood volumes contained in vessels between 5 and 10 mm2 and above 10 mm2, respectively, p < 0.0001). These changes were consistent across lobes.

Conclusion: COVID-19 patients display striking anomalies in the distribution of blood volume within the pulmonary vascular tree, consistent with increased pulmonary vasculature resistance in the pulmonary vessels below the resolution of CT.

Keywords: COVID-19; Pulmonary vascular disease; Quantitative CT metrics.

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Figures

Figure 1
Figure 1
Spectrum plot describing the blood volume as a function of the blood vessel cross-sectional area for the large spectrum (top) reflecting most blood vessels visible in the HRCT scans and the small spectrum (bottom) zooming in on the small blood vessels visible in the HRCT scans.
Figure 2
Figure 2
Comparison of BV5, BV5-10, and BV10 (expressed as % total pulmonary blood volume) between healthy volunteers and patients with COVID-19.
Figure 3
Figure 3
Comparison of total pulmonary blood volume between healthy volunteers and patients with COVID-19.
Figure 4
Figure 4
Visual representation of the blood vessels colored according to their size. Red denotes the small vessels, yellow the mid-size vessels, and blue the larger vessels. (Color version of figure is available online.)
Figure 5
Figure 5
Mixed effect model BV5 (top), BV5-10 (middle), and BV10 (bottom) as function of lobar opacity (ml), assessed by lobe.
See this image and copyright information in PMC

References

    1. Gattinoni L, Coppola S, Cressoni M. Covid-19 does not lead to a ‘typical’ acute respiratory distress syndrome. Am J Respirat Critic Care Med. 2020 doi: 10.1164/rccm.202003-0817LE. - DOI - PMC - PubMed
    1. Vaduganathan M, Vardeny O, Michel T. Renin–Angiotensin–Aldosterone system inhibitors in patients with Covid-19. New Engl J Med. 2020;382(17):1653–1659. doi: 10.1056/NEJMsr2005760. - DOI - PMC - PubMed
    1. Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020 doi: 10.1182/blood.2020006000. - DOI - PMC - PubMed
    1. Rahaghi FN., Argemí G, Nardelli P. Pulmonary vascular density: comparison of findings on computed tomography imaging with histology. Eur Respirat J. 2019;54(2) doi: 10.1183/13993003.00370-2019. - DOI - PMC - PubMed
    1. Yang J, Ma S, Sun Q. Improved Hessian multiscale enhancement filter. Bio-med Mater Eng. 2014;24:3267–3275. doi: 10.3233/BME-141149. - DOI - PubMed

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