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. 2022 Dec 1;133(6):1295-1299.
doi: 10.1152/japplphysiol.00458.2022. Epub 2022 Oct 21.

CT-derived measurements of pulmonary blood volume in small vessels and the need for supplemental oxygen in COVID-19 patients

Wendel Dierckx  1   2   3 , Wilfried De Backer  1   3 , Muriel Lins  4 , Yinka De Meyer  2   3 , Kris Ides  1   5   3 , Jan Vandevenne  6   7 , Jan De Backer  2 , Erik Franck  8 , Ben R Lavon  2 , Maarten Lanclus  2 , Muhunthan Thillai  9   10
Affiliations

CT-derived measurements of pulmonary blood volume in small vessels and the need for supplemental oxygen in COVID-19 patients

Wendel Dierckx et al. J Appl Physiol (1985). .

Abstract

Throughout the COVID-19 pandemic, a portion of those affected have evolved toward acute hypoxic respiratory failure. Initially, this was hypothesized to result from acute lung injury leading to acute respiratory distress syndrome (ARDS). In previous research, a novel quantitative CT post-processing technique was described to quantify the volume of blood contained within pulmonary blood vessels of a given size. We hypothesized that patients with lower BV5 blood flow would have higher supplemental oxygen needs and less favorable arterial blood gas profiles. From the initial data analysis, 111 hospitalized COVID-19 patients were retrospectively selected based on the availability of CT scans of the lungs with a slice thickness of 1.5 mm or less, as well as PCR-confirmed SARS-CoV2 infection. Three-dimensional (3-D) reconstructions of the lungs and pulmonary vasculature were created. Further analysis was performed on 50 patients. Patients were divided into groups based on their need for oxygen at the time of CT scan acquisition. Eighteen out of 50 patients needed >2 L/min supplemental oxygen and this group demonstrated a significantly lower median percentage of total blood flow in the BV5 vessels compared with the 32 patients who needed <2 L/min supplemental oxygen (41.61% vs. 46.89%, P = 0.023). Both groups had significantly less blood as a proportion in BV5 vessels compared with healthy volunteers. These data are consistent with the hypothesis that reduced blood volume within small (BV5) pulmonary vessels is associated with higher needs for supplemental oxygen and more severe gas exchange anomalies in COVID-19 infections.NEW & NOTEWORTHY This research provides, by using new imaging analysis on CT imaging, an insight into the pathophysiology of patients with COVID-19 infection. By visualizing and quantifying the blood in small vessels in the lung, we can link these results to the clinical need for oxygen in patients with COVID-19 infection.

Keywords: BV5; COVID-19; functional imaging; pulmonary blood vessels.

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Conflict of interest statement

W.D., Y.D.M., J.D.B., B.L., and M.Lanclus are employees of FLUIDDA, a company that develops and markets part of the technology described in this article. The other authors have no financial relationships with any organization or company that might have an interest in the submitted work and received no direct funding from FLUIDDA. None of the other authors has any conflicts of interest, financial or otherwise, to disclose.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
A: proportion of pulmonary blood within different caliber levels in COVID-19 vs. healthy volunteers. B: proportion of blood within BV5 (blood vessels of <5 mm2 cross-sectional area) in patients with COVID-19 with different levels of inspired oxygen. C: proportion of blood through BV5 levels and correlation with alveolar-arterial oxygen gradient (AaDO2). D: proportion of blood through BV5 levels and correlation with PaO2.
Figure 2.
Figure 2.
Example of blood vessel segmentation in healthy volunteers (A) and patients with COVID-19 (B).
See this image and copyright information in PMC

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