Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 19;13(1):52.
doi: 10.1186/s40635-025-00752-w.

Approximation of EVLWI in severe COVID-19 pneumonia using quantitative imaging techniques: an observational study

Jonas Biehler  1   2 , Marie Brei  3   4 , Nina Pischke  3   4 , Sebastian Rasch  5 , Miriam Dibos  5 , Johanna Erber  5 , Roland M Schmid  5 , Rickmer F Braren  6 , Markus R Makowski  6 , Karl-Robert Wichmann  3   4 , Kei Wieland Mueller  3   4 , Wolfgang A Wall  3   4 , Tobias Lahmer  5
Affiliations

Approximation of EVLWI in severe COVID-19 pneumonia using quantitative imaging techniques: an observational study

Jonas Biehler et al. Intensive Care Med Exp. .

Abstract

Background: This study aimed to approximate the level of extravascular lung water (EVLW) in patients with severe COVID-19 pneumonia using quantitative imaging techniques. The elevation of EVLW is known to correlate with the degree of diffuse alveolar damage and linked with the mortality of critically ill patients. Transpulmonary thermodilution (TPTD) is the gold standard technique to estimate the total amount of EVLW, but it is invasive and requires specialized equipment and trained personnel.

Methods: The study included patients with severe COVID-19 who required chest CT scanning within the first 48 h of Intensive Care Unit (ICU) admission and had TPTD monitoring. Using in-house software tools for automatic semantic segmentation, lung masks were obtained for estimating the EVLW content. The results were compared with the TPTD measurements.

Results: The results demonstrate a significant correlation between EVLW-TPTP measured by thermodilution and EVLW-CT estimated from the patient's CT-image (r = 0.629, p = 0.0014).

Conclusion: The study showed that quantitative imaging techniques using chest CT-scans could be used as a convenient and low-cost option for ICUs without TPTD equipment for the assessment of EVLW in severe COVID-19 pneumonia.

Keywords: ARDS; Extravascular lung water; Pulmonary edema; Quantitative image analysis.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: This observational study was approved (Approval No. 178/20S) by the Ethics Committee of University hospital Klinikum rechts der Isar and written informed consent was obtained from all patients or their legal representatives. Consent for publication: Not applicable. Competing interests: JB, KRW, KWM, and W.W. hold shares of Ebenbuild. All other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Illustration of overall image segmentation process using deep learning techniques
Fig. 2
Fig. 2
Relationship and agreement between extra-vascular lung water measured by thermodilution (EVLW-TPTD) and extra-vascular lung water (EVLW-CT, EVLW-CT-Corr) and tissue volume (TV) estimated from CT-images. The left panel presents scatterplots illustrating the relationship between a EVLW-TPTD and EVLW-CT, b EVLW-TPTD and EVLW-CT-Corr, and c EVLW-TPTD and TV with a regression line, Spearman correlation (r) and p-value. The right panel displays Bland–Altman plots assessing the agreement between d EVLW-TPTD and EVLW-CT, e EVLW-TPTD and EVLW-CT-Corr, and f EVLW-TPTD and TV, including the mean bias and 95% limits of agreement (LoA)
Fig. 3
Fig. 3
Relationship and agreement between extra-vascular lung water index measured by thermodilution (EVLWI-TPTD) and extra-vascular lung water index (EVLWI-CT, EVLWI-CT-Corr) and tissue volume index (TVI) estimated from CT-images. The left panel presents scatterplots illustrating the relationship between a EVLWI-TPTD and EVLWI-CT, b EVLWI-TPTD and EVLWI-CT-Corr, and c EVLWI-TPTD and TVI with a regression line, Spearman correlation (r) and p-value. The right panel displays Bland–Altman plots assessing the agreement between d EVLWI-TPTD and EVLWI-CT, e EVLWI-TPTD and EVLWI-CT-Corr, and f EVLWI-TPTD and TVI, including the mean bias and 95% limits of agreement (LoA)
Fig. 4
Fig. 4
Scatterplot showing the relationship between the lung volume computed from CT and predicted body weight (PBW) with a regression line, Spearman correlation (r) and p-value
See this image and copyright information in PMC

References

    1. Al-Mashat M, Jögi J, Carlsson M, Borgquist R, Ostenfeld E, Magnusson M, Bachus E, Rådegran G, Arheden H, Kanski M (2020) Increased pulmonary blood volume variation in patients with heart failure compared to healthy controls: a noninvasive, quantitative measure of heart failure. J Appl Physiol 128:324–337. 10.1152/japplphysiol.00507.2019 - PubMed
    1. Critchley LAH, Critchley JAJH (1999) A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput 15:85–91. 10.1023/A:1009982611386 - PubMed
    1. Gavelli F, Shi R, Teboul J-L, Azzolina D, Mercado P, Jozwiak M, Chew MS, Huber W, Kirov MY, Kuzkov VV, Lahmer T, Malbrain MLNG, Mallat J, Sakka SG, Tagami T, Pham T, Monnet X (2022) Extravascular lung water levels are associated with mortality: a systematic review and meta-analysis. Crit Care 26:202. 10.1186/s13054-022-04061-6 - PMC - PubMed
    1. Hermann EA, Motahari A, Hoffman EA, Allen N, Bertoni AG, Bluemke DA, Eskandari A, Gerard SE, Guo J, Hiura GT, Kaczka DW, Michos ED, Nagpal P, Pankow J, Shah S, Smith BM, Hinckley Stukovsky K, Sun Y, Watson K, Barr RG (2022) Pulmonary blood volume among older adults in the community: the MESA lung study. Circulation. 10.1161/CIRCIMAGING.122.014380 - PMC - PubMed
    1. Herrmann P, Busana M, Cressoni M, Lotz J, Moerer O, Saager L, Meissner K, Quintel M, Gattinoni L (2021) Using artificial intelligence for automatic segmentation of CT lung images in acute respiratory distress syndrome. Front Physiol 12:676118. 10.3389/fphys.2021.676118 - PMC - PubMed

LinkOut - more resources