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Taivans I, Grima L, Jurka N, Zvaigzne L, Gordjušina V, Strazda G. FOT Technique Applied for Monitoring of COVID-19 Pneumonia Reveals Small Airways Involvement. Diagnostics (Basel) 2024; 14:1160. [PMID: 38893686 PMCID: PMC11171776 DOI: 10.3390/diagnostics14111160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
The fact that some SARS-CoV-2 pneumonia patients benefit from changing body position, and some from continuous positive airways pressure (CPAP), indicates the functional character of hypoxia. We hypothesize that such effects could be explained by the closure of small airways. To prove the hypothesis, we evaluated the patency of small airways in 30 oxygen-dependent, spontaneously breathing patients with SARS-CoV-2 pneumonia during their hospital stay using the FOT method and then compared the results with data obtained three months later. During the acute period, total resistance (R5) and peripheral resistance (R5-20) rose above the upper limit of normal (ULN) in 28% and 50% of all patients, respectively. Reactance indices X5, AX and Fres exceeded ULN in 55%, 68% and 66% of cases. Significant correlations were observed between PaO2/FiO2, the time spent in the hospital and R5, X5, AX and Fres. After 3 months, 18 patients were re-examined. During the hospital stay, 11 of them had risen above the upper limit of normal (ULN), for both resistance (R5-20) and reactance (X5, AX) values. Three months later, ULN for R5-20 was exceeded in only four individuals, but ULN for X5 and AX was exceeded in five individuals. Lung function examination revealed a combined restrictive/obstructive ventilatory failure and reduced CO transfer factor. We interpret these changes as lung tissue remodeling due to the process of fibrosis. We conclude that during acute period of SARS-CoV-2 pneumonia, dilated pulmonary blood vessels and parenchymal oedema induce functional closure of small airways, which in turn induce atelectasis with pulmonary right-to-left shunting, followed by the resulting hypoxemia.
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Affiliation(s)
- Immanuels Taivans
- Medical Faculty, University of Latvia, LV1050 Riga, Latvia; (L.G.); (N.J.); (V.G.); (G.S.)
| | - Laura Grima
- Medical Faculty, University of Latvia, LV1050 Riga, Latvia; (L.G.); (N.J.); (V.G.); (G.S.)
| | - Normunds Jurka
- Medical Faculty, University of Latvia, LV1050 Riga, Latvia; (L.G.); (N.J.); (V.G.); (G.S.)
| | | | - Valentina Gordjušina
- Medical Faculty, University of Latvia, LV1050 Riga, Latvia; (L.G.); (N.J.); (V.G.); (G.S.)
| | - Gunta Strazda
- Medical Faculty, University of Latvia, LV1050 Riga, Latvia; (L.G.); (N.J.); (V.G.); (G.S.)
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2
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Ufuk F, Yitik AY, Sarilar B, Altinisik G. Patients With Post-COVID-19 Respiratory Condition: Chest Computed Tomography Findings and Pulmonary Function Tests and Comparison With Asymptomatic Participants. J Comput Assist Tomogr 2024; 48:415-423. [PMID: 38213073 DOI: 10.1097/rct.0000000000001577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
OBJECTIVE The aims of this study were to assess the chest computed tomography (CT) findings in post-COVID-19 respiratory condition (rPCC) patients and compare the findings with asymptomatic participants (APs). It also aimed to evaluate the relationship between CT findings and pulmonary function tests (PFTs) in rPCC patients. Finally, it aimed to compare the quantitative chest CT findings and PFT results of patients with rPCC and APs. METHODS We retrospectively enrolled consecutive patients with rPCC who underwent unenhanced chest CT and PFTs between June 2020 and September 2022. In addition, a control group (APs) was prospectively formed and underwent nonenhanced chest CT and PFTs. The presence and extent of abnormalities in unenhanced chest CT images were evaluated qualitatively and semiquantitatively in a blinded manner. We used fully automatic software for automatic lung and airway segmentation and quantitative analyses. RESULTS Sixty-three patients with rPCC and 23 APs were investigated. Reticulation/interstitial thickening and extent of parenchymal abnormalities on CT were significantly greater in the rPCC group than in the control group ( P = 0.001 and P = 0.004, respectively). Computed tomography extent score was significantly related to length of hospital stay, age, and intensive care unit stay (all P s ≤ 0.006). The rPCC group also had a lower 85th percentile attenuation lung volume ( P = 0.037). The extent of parenchymal abnormalities was significantly correlated with carbon monoxide diffusing capacity ( r = -0.406, P = 0.001), forced vital capacity (FVC) ( r = -0.342, P = 0.002), and forced expiratory volume in 1 second/FVC ( r = 0.427, P < 0.001) values. Pulmonary function tests revealed significantly lower carbon monoxide diffusing capacity ( P < 0.001), FVC ( P = 0.036), and total lung capacity ( P < 0.001) values in the rPCC group. CONCLUSIONS The rPCC is characterized by impaired PFTs, a greater extent of lung abnormalities on CT, and decreased 85th percentile attenuation lung volume. Advanced age, intensive care unit admission history, and extended hospital stay are risk factors for chest CT abnormalities.
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Affiliation(s)
- Furkan Ufuk
- From the Department of Radiology, University of Pamukkale, Denizli, Turkey
| | - Ahmet Yasin Yitik
- From the Department of Radiology, University of Pamukkale, Denizli, Turkey
| | - Burak Sarilar
- From the Department of Radiology, University of Pamukkale, Denizli, Turkey
| | - Goksel Altinisik
- Department of Pulmonology, University of Pamukkale, Denizli, Turkey
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3
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Cha MJ, Solomon JJ, Lee JE, Choi H, Chae KJ, Lee KS, Lynch DA. Chronic Lung Injury after COVID-19 Pneumonia: Clinical, Radiologic, and Histopathologic Perspectives. Radiology 2024; 310:e231643. [PMID: 38193836 PMCID: PMC10831480 DOI: 10.1148/radiol.231643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 01/10/2024]
Abstract
With the COVID-19 pandemic having lasted more than 3 years, concerns are growing about prolonged symptoms and respiratory complications in COVID-19 survivors, collectively termed post-COVID-19 condition (PCC). Up to 50% of patients have residual symptoms and physiologic impairment, particularly dyspnea and reduced diffusion capacity. Studies have also shown that 24%-54% of patients hospitalized during the 1st year of the pandemic exhibit radiologic abnormalities, such as ground-glass opacity, reticular opacity, bronchial dilatation, and air trapping, when imaged more than 1 year after infection. In patients with persistent respiratory symptoms but normal results at chest CT, dual-energy contrast-enhanced CT, xenon 129 MRI, and low-field-strength MRI were reported to show abnormal ventilation and/or perfusion, suggesting that some lung injury may not be detectable with standard CT. Histologic patterns in post-COVID-19 lung disease include fibrosis, organizing pneumonia, and vascular abnormality, indicating that different pathologic mechanisms may contribute to PCC. Therefore, a comprehensive imaging approach is necessary to evaluate and diagnose patients with persistent post-COVID-19 symptoms. This review will focus on the long-term findings of clinical and radiologic abnormalities and describe histopathologic perspectives. It also addresses advanced imaging techniques and deep learning approaches that can be applied to COVID-19 survivors. This field remains an active area of research, and further follow-up studies are warranted for a better understanding of the chronic stage of the disease and developing a multidisciplinary approach for patient management.
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Affiliation(s)
- Min Jae Cha
- From the Department of Radiology, Chung-Ang University Hospital,
Seoul, Korea (M.J.C., H.C.); Departments of Medicine (J.J.S.) and Radiology
(K.J.C., D.A.L.), National Jewish Health, 1400 Jackson St, Denver, CO 80206;
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic
of Korea (J.E.L.); Department of Radiology, Research Institute of Clinical
Medicine of Jeonbuk National University, Biomedical Research Institute of
Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C); and
Department of Radiology, Sungkyunkwan University School of Medicine and Samsung
ChangWon Hospital, Gyeongsangnam, Republic of Korea (K.S.L.)
| | - Joshua J. Solomon
- From the Department of Radiology, Chung-Ang University Hospital,
Seoul, Korea (M.J.C., H.C.); Departments of Medicine (J.J.S.) and Radiology
(K.J.C., D.A.L.), National Jewish Health, 1400 Jackson St, Denver, CO 80206;
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic
of Korea (J.E.L.); Department of Radiology, Research Institute of Clinical
Medicine of Jeonbuk National University, Biomedical Research Institute of
Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C); and
Department of Radiology, Sungkyunkwan University School of Medicine and Samsung
ChangWon Hospital, Gyeongsangnam, Republic of Korea (K.S.L.)
| | - Jong Eun Lee
- From the Department of Radiology, Chung-Ang University Hospital,
Seoul, Korea (M.J.C., H.C.); Departments of Medicine (J.J.S.) and Radiology
(K.J.C., D.A.L.), National Jewish Health, 1400 Jackson St, Denver, CO 80206;
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic
of Korea (J.E.L.); Department of Radiology, Research Institute of Clinical
Medicine of Jeonbuk National University, Biomedical Research Institute of
Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C); and
Department of Radiology, Sungkyunkwan University School of Medicine and Samsung
ChangWon Hospital, Gyeongsangnam, Republic of Korea (K.S.L.)
| | - Hyewon Choi
- From the Department of Radiology, Chung-Ang University Hospital,
Seoul, Korea (M.J.C., H.C.); Departments of Medicine (J.J.S.) and Radiology
(K.J.C., D.A.L.), National Jewish Health, 1400 Jackson St, Denver, CO 80206;
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic
of Korea (J.E.L.); Department of Radiology, Research Institute of Clinical
Medicine of Jeonbuk National University, Biomedical Research Institute of
Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C); and
Department of Radiology, Sungkyunkwan University School of Medicine and Samsung
ChangWon Hospital, Gyeongsangnam, Republic of Korea (K.S.L.)
| | - Kum Ju Chae
- From the Department of Radiology, Chung-Ang University Hospital,
Seoul, Korea (M.J.C., H.C.); Departments of Medicine (J.J.S.) and Radiology
(K.J.C., D.A.L.), National Jewish Health, 1400 Jackson St, Denver, CO 80206;
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic
of Korea (J.E.L.); Department of Radiology, Research Institute of Clinical
Medicine of Jeonbuk National University, Biomedical Research Institute of
Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C); and
Department of Radiology, Sungkyunkwan University School of Medicine and Samsung
ChangWon Hospital, Gyeongsangnam, Republic of Korea (K.S.L.)
| | - Kyung Soo Lee
- From the Department of Radiology, Chung-Ang University Hospital,
Seoul, Korea (M.J.C., H.C.); Departments of Medicine (J.J.S.) and Radiology
(K.J.C., D.A.L.), National Jewish Health, 1400 Jackson St, Denver, CO 80206;
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic
of Korea (J.E.L.); Department of Radiology, Research Institute of Clinical
Medicine of Jeonbuk National University, Biomedical Research Institute of
Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C); and
Department of Radiology, Sungkyunkwan University School of Medicine and Samsung
ChangWon Hospital, Gyeongsangnam, Republic of Korea (K.S.L.)
| | - David A. Lynch
- From the Department of Radiology, Chung-Ang University Hospital,
Seoul, Korea (M.J.C., H.C.); Departments of Medicine (J.J.S.) and Radiology
(K.J.C., D.A.L.), National Jewish Health, 1400 Jackson St, Denver, CO 80206;
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic
of Korea (J.E.L.); Department of Radiology, Research Institute of Clinical
Medicine of Jeonbuk National University, Biomedical Research Institute of
Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C); and
Department of Radiology, Sungkyunkwan University School of Medicine and Samsung
ChangWon Hospital, Gyeongsangnam, Republic of Korea (K.S.L.)
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Abu Hussein N, Machahua C, Ruchti SC, Horn MP, Piquilloud L, Prella M, Geiser TK, von Garnier C, Funke-Chambour M. Circulating calprotectin levels four months after severe and non-severe COVID-19. BMC Infect Dis 2023; 23:650. [PMID: 37789266 PMCID: PMC10546778 DOI: 10.1186/s12879-023-08653-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/27/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Calprotectin is an inflammatory marker mainly released by activated neutrophils that is increased in acute severe COVID-19. After initial recovery, some patients have persistent respiratory impairment with reduced diffusion capacity of the lungs for carbon monoxide (DLCO) months after infection. Underlying causes of this persistent impairment are unclear. We aimed to investigate the correlation between circulating calprotectin, persistent lung functional impairment and intensive care unit (ICU) stay after COVID-19 in two university hospital centres in Switzerland. METHODS Calprotectin levels were measured in serum from 124 patients (50% male) from the Bern cohort (post-ICU and non-ICU patients) and 68 (76% male) from the Lausanne cohort (only post-ICU patients) four months after COVID-19. Calprotectin was correlated with clinical parameters. Multivariate linear regression (MLR) was performed to evaluate the independent association of calprotectin in different models. RESULTS Overall, we found that post-ICU patients, compared to non-ICU, were significantly older (age 59.4 ± 13.6 (Bern), 60.5 ± 12.0 (Lausanne) vs. 48.8 ± 13.4 years) and more obese (BMI 28.6 ± 4.5 and 29.1 ± 5.3 vs. 25.2 ± 6.0 kg/m2, respectively). 48% of patients from Lausanne and 44% of the post-ICU Bern cohort had arterial hypertension as a pre-existing comorbidity vs. only 10% in non-ICU patients. Four months after COVID-19 infection, DLCO was lower in post-ICU patients (75.96 ± 19.05% predicted Bern, 71.11 ± 18.50% Lausanne) compared to non-ICU (97.79 ± 21.70% predicted, p < 0.01). The post-ICU cohort in Lausanne had similar calprotectin levels when compared to the cohort in Bern (Bern 2.74 ± 1.15 µg/ml, Lausanne 2.49 ± 1.13 µg/ml vs. non-ICU 1.86 ± 1.02 µg/ml; p-value < 0.01). Calprotectin correlated negatively with DLCO (r= -0.290, p < 0.001) and the forced vital capacity (FVC) (r= -0.311, p < 0.001). CONCLUSIONS Serum calprotectin is elevated in post-ICU patients in two independent cohorts and higher compared to non-ICU patients four months after COVID-19. In addition, there is a negative correlation between calprotectin levels and DLCO or FVC. The relationship between inflammation and lung functional impairment needs further investigations. TRIAL REGISTRATION NCT04581135.
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Affiliation(s)
- N Abu Hussein
- Department of Pulmonary Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department for BioMedical Research DBMR, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C Machahua
- Department of Pulmonary Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department for BioMedical Research DBMR, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S C Ruchti
- Department of Pulmonary Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - M P Horn
- Department of Clinical Chemistry, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - L Piquilloud
- Division of Pulmonary Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - M Prella
- Department of Diagnostic Laboratory Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - T K Geiser
- Department of Pulmonary Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department for BioMedical Research DBMR, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C von Garnier
- Department of Diagnostic Laboratory Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - M Funke-Chambour
- Department of Pulmonary Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
- Department for BioMedical Research DBMR, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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5
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Dierckx W, De Backer W, Ides K, De Meyer Y, Lauwers E, Franck E, De Backer J. Unraveling pathophysiologic mechanisms contributing to symptoms in patients with post-acute sequelae of COVID-19 (PASC): A retrospective study. Physiol Rep 2023; 11:e15754. [PMID: 37344757 PMCID: PMC10284821 DOI: 10.14814/phy2.15754] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/23/2023] Open
Abstract
Patients with post-acute sequelae of COVID-19 (PASC) present with a decrease in physical fitness. The aim of this paper is to reveal the relations between the remaining symptoms, blood volume distribution, exercise tolerance, static and dynamic lung volumes, and overall functioning. Patients with PASC were retrospectively studied. Pulmonary function tests (PFT), 6-minute walk test (6MWT), and cardiopulmonary exercise test were performed. Chest CT was taken and quantified. Patients were divided into two groups: minor functional limitations (MFL) and severe functional limitations (SFL) based on the completed Post-COVID-19 Functional Status scale (PCFS). Twenty one patients (3 M; 18 FM), mean age 44 (IQR 21) were studied. Eighteen completed the PCFS (8 MFL; 10 SFL). VO2 max was suboptimal in both groups (not significant). 6MWT was significantly higher in MFL-group (p = 0.043). Subjects with SFL, had significant lower TLC (p = 0.029). The MFL-group had more air trapping (p = 0.036). Throughout the sample, air trapping correlated significantly with residual volume (RV) in L (p < 0.001). An increase in air trapping was related to an increase in BV5 (p < 0.001). Mean BV5 was 65% (IQR 5%). BV5% in patients with PASC was higher than in patients with acute COVID-19 infection. This increase in BV5% in patients with PASC is thought to be driven by the air trapping in the lobes. This study reveals that symptoms are more driven by occlusion of the small airways. Patients with more physical complaints have significantly lower TLC. All subjects encounter physical limitations as indicated by suboptimal VO2 max. Treatment should focus on opening or re-opening of small airways by recruiting alveoli.
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Affiliation(s)
- Wendel Dierckx
- Centre for Research and Innovation in Care, Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
- Multidisciplinary Medical CenterKontichBelgium
- Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
| | - Wilfried De Backer
- Multidisciplinary Medical CenterKontichBelgium
- Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
- FLUIDDA NVKontichBelgium
| | - Kris Ides
- Multidisciplinary Medical CenterKontichBelgium
- Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
- CoSys Research Lab, Faculty of Applied EngineeringUniversity of AntwerpAntwerpBelgium
- Flanders Make Strategic Research CenterLommelBelgium
- Department of PediatricsAntwerp University HospitalEdegemBelgium
| | - Yinka De Meyer
- Multidisciplinary Medical CenterKontichBelgium
- Clinical OperationsFLUIDDA NVKontichBelgium
| | - Eline Lauwers
- Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
- Clinical OperationsFLUIDDA NVKontichBelgium
| | - Erik Franck
- Centre for Research and Innovation in Care, Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
- Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
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6
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Han X, Chen L, Fan Y, Alwalid O, Jia X, Zheng Y, Liu J, Li Y, Cao Y, Gu J, Liu J, Zheng C, Ye Q, Shi H. Longitudinal Assessment of Chest CT Findings and Pulmonary Function in Patients after COVID-19. Radiology 2023; 307:e222888. [PMID: 36786698 PMCID: PMC9969419 DOI: 10.1148/radiol.222888] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Background Information on pulmonary sequelae and pulmonary function at 2 years post recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are lacking. Purpose To longitudinally assess changes in chest CT abnormities and pulmonary function in patients after SARS-CoV-2 infection. Materials and Methods In this prospective study, patients discharged from the hospital after SARS-CoV-2 infection between January 15 and March 10, 2020 were considered for enrollment. Patients without chest CT scans on admission or with complete resolution of lung abnormities on discharge were excluded. Three serial chest CT scans and pulmonary function tests were obtained at 6 months (June 20-August 31, 2020), 12 months (December 20, 2020-February 3, 2021), and 2 years (November 16, 2021-January 10, 2022) after symptom onset. The term interstitial lung abnormalities (ILAs) and two subcategories, fibrotic ILAs and non-fibrotic ILAs, were used to describe the residual CT abnormalities on follow-up CT scans. Differences between groups were compared with χ², Fisher's exact test, or independent-samples t-test. Results Totally, 144 participants (median age, 60 [ranges 27-80] years; 79 men and 65 women) were included. On 2-year follow-up CT scans, 39% (56/144) of the subjects presented with ILAs, including 23% (33/144) wi fibrotic ILAs and 16% (23/144) with non-fibrotic ILAs. The remaining 88 cases (61%) showed complete radiological resolution. Over 2 years, the incidence of ILAs gradually decreased (54%, 42% and 39% at 6 months, 12 months and 2 years, respectively; P = .001). Respiratory symptoms (34% vs 15%, P =.007) and abnormal diffusing capacity of the lung for carbon monoxide (DLco,43% vs 20%, P = .004) more frequently occurred in participants with ILAs than those with complete radiological resolution. Conclusions More than one third of participants had persistent interstitial lung abnormalities at 2 years, which were associated with respiratory symptoms and decreased diffusion pulmonary function. See also the editorial by van Beek in this issue.
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Affiliation(s)
- Xiaoyu Han
- Department of Radiology, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei
Province 430022, The People's Republic of China,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, The
People's Republic of China
| | - Lu Chen
- Department of Radiology, Wuhan Jinyintan Hospital, Tongji Medical
College of HuaZhong University of Science and Technology, 430023, The
People's Republic of China
| | - Yanqing Fan
- Department of Radiology, Wuhan Jinyintan Hospital, Tongji Medical
College of HuaZhong University of Science and Technology, 430023, The
People's Republic of China
| | - Osamah Alwalid
- Department of Diagnostic Imaging, Sidra Medicine, Doha 26999,
Qatar
| | - Xi Jia
- Department of Radiology, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei
Province 430022, The People's Republic of China,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, The
People's Republic of China
| | - Yuting Zheng
- Department of Radiology, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei
Province 430022, The People's Republic of China,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, The
People's Republic of China
| | - Jie Liu
- Department of Radiology, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei
Province 430022, The People's Republic of China,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, The
People's Republic of China
| | - Yumin Li
- Department of Radiology, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei
Province 430022, The People's Republic of China,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, The
People's Republic of China
| | - Yukun Cao
- Department of Radiology, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei
Province 430022, The People's Republic of China,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, The
People's Republic of China
| | - Jin Gu
- Department of Radiology, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei
Province 430022, The People's Republic of China,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, The
People's Republic of China
| | - Jia Liu
- Department of Radiology, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei
Province 430022, The People's Republic of China,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, The
People's Republic of China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei
Province 430022, The People's Republic of China,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, The
People's Republic of China
| | - Qing Ye
- Department of Pulmonary Function and Ultrasound, Wuhan Jinyintan
Hospital, Tongji Medical College of Huazhong University of Science and
Technology, 430023, The People's Republic of China
| | - Heshui Shi
- Department of Radiology, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei
Province 430022, The People's Republic of China,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, The
People's Republic of China,Corresponding Author:
Heshui Shi ()
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7
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Huang J, Lin R, Bai N, Su Z, Zhu M, Li H, Chai C, Xia M, Shu Z, Qiu Z, Lei M. Six-month follow-up after recovery of COVID-19 Delta variant survivors via CT-based deep learning. Front Med (Lausanne) 2023; 10:1103559. [PMID: 36817788 PMCID: PMC9932267 DOI: 10.3389/fmed.2023.1103559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023] Open
Abstract
Purpose Using computer-aided diagnosis (CAD) methods to analyze the discharge and 6-month follow-up data of COVID-19 Delta variant survivors, evaluate and summarize the recovery and prognosis, and improve people's awareness of this disease. Methods This study collected clinical data, SGRQ questionnaire results, and lung CT scans (at both discharge and 6-month follow-up) from 41 COVID-19 Delta variant survivors. Two senior radiologists evaluated the CT scans before in-depth analysis. Deep lung parenchyma enhancing (DLPE) method was used to accurately segment conventional lesions and sub-visual lesions in CT images, and then quantitatively analyze lung injury and recovery. Patient recovery was also measured using the SGRQ questionnaire. The follow-up examination results from this study were combined with those of the original COVID-19 for further comparison. Results The participants include 13 males (31.7%) and 28 females (68.3%), with an average age of 42.2 ± 17.7 years and an average BMI of 25.2 ± 4.4 kg/m2. Compared discharged CT and follow-up CT, 48.8% of survivors had pulmonary fibrosis, mainly including irregular lines (34.1%), punctuate calcification (12.2%) and nodules (12.2%). Compared with discharged CT, the ground-glass opacity basically dissipates at follow-up. The mean SGRQ score was 0.041 (0-0.104). The sequelae of survivors mainly included impaired sleep quality (17.1%), memory decline (26.8%), and anxiety (21.9%). After DLPE process, the lesion volume ratio decreased from 0.0018 (0.0003, 0.0353) at discharge to 0.0004 (0, 0.0032) at follow-up, p < 0.05, and the absorption ratio of lesion was 0.7147 (-1.0303, 0.9945). Conclusion The ground-glass opacity of survivors had dissipated when they were discharged from hospital, and a little fibrosis was seen in CT after 6-month, mainly manifested as irregular lines, punctuate calcification and nodules. After DLPE and quantitative calculations, we found that the degree of fibrosis in the lungs of most survivors was mild, which basically did not affect lung function. However, there are a small number of patients with unabsorbed or increased fibrosis. Survivors mainly had non-pulmonary sequelae such as impaired sleep quality and memory decline. Pulmonary prognosis of Delta variant patients was better than original COVID-19, with fewer and milder sequelae.
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Affiliation(s)
- Jianliang Huang
- Zhangjiajie Hospital Affiliated to Hunan Normal University, Zhangjiajie, China
| | - Ruikai Lin
- College of Information and Computer Engineering, Northeast Forestry University, Harbin, China
| | - Na Bai
- College of Information and Computer Engineering, Northeast Forestry University, Harbin, China
| | - Zhongrui Su
- Zhangjiajie Hospital Affiliated to Hunan Normal University, Zhangjiajie, China
| | - Mingxin Zhu
- Zhangjiajie Hospital Affiliated to Hunan Normal University, Zhangjiajie, China
| | - Han Li
- College of Information and Computer Engineering, Northeast Forestry University, Harbin, China
| | - Conghai Chai
- Zhangjiajie Hospital Affiliated to Hunan Normal University, Zhangjiajie, China
| | - Mingkai Xia
- Zhangjiajie Hospital Affiliated to Hunan Normal University, Zhangjiajie, China
| | - Ziwei Shu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zhaowen Qiu
- College of Information and Computer Engineering, Northeast Forestry University, Harbin, China,Heilongjiang Tuomeng Technology Co., Ltd., Harbin, China,*Correspondence: Zhaowen Qiu ✉
| | - Mingsheng Lei
- Zhangjiajie Hospital Affiliated to Hunan Normal University, Zhangjiajie, China,Zhangjiajie College, Zhangjiajie, China,Mingsheng Lei ✉
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Murphy MC, Little BP. Chronic Pulmonary Manifestations of COVID-19 Infection: Imaging Evaluation. Radiology 2023; 307:e222379. [PMID: 36692398 PMCID: PMC9888022 DOI: 10.1148/radiol.222379] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A patient with severe COVID-19 pneumonia requiring ICU admission and prolonged hospital stay is presented. The infection resulted in long term morbidity, functional decline and abnormal chest CT findings. Mechanisms for long term lung injury post COVID-19 infection, imaging appearances and role of imaging in follow-up are discussed.
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Affiliation(s)
- Mark C. Murphy
- Fellow in Cardiothoracic Imaging and Intervention Massachusetts
General Hospital, Boston
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9
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Li F, Zhang X, Comellas AP, Hoffman EA, Yang T, Lin CL. Contrastive learning and subtyping of post-COVID-19 lung computed tomography images. Front Physiol 2022; 13:999263. [PMID: 36304574 PMCID: PMC9593072 DOI: 10.3389/fphys.2022.999263] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/27/2022] [Indexed: 11/30/2022] Open
Abstract
Patients who recovered from the novel coronavirus disease 2019 (COVID-19) may experience a range of long-term symptoms. Since the lung is the most common site of the infection, pulmonary sequelae may present persistently in COVID-19 survivors. To better understand the symptoms associated with impaired lung function in patients with post-COVID-19, we aimed to build a deep learning model which conducts two tasks: to differentiate post-COVID-19 from healthy subjects and to identify post-COVID-19 subtypes, based on the latent representations of lung computed tomography (CT) scans. CT scans of 140 post-COVID-19 subjects and 105 healthy controls were analyzed. A novel contrastive learning model was developed by introducing a lung volume transform to learn latent features of disease phenotypes from CT scans at inspiration and expiration of the same subjects. The model achieved 90% accuracy for the differentiation of the post-COVID-19 subjects from the healthy controls. Two clusters (C1 and C2) with distinct characteristics were identified among the post-COVID-19 subjects. C1 exhibited increased air-trapping caused by small airways disease (4.10%, p = 0.008) and diffusing capacity for carbon monoxide %predicted (DLCO %predicted, 101.95%, p < 0.001), while C2 had decreased lung volume (4.40L, p < 0.001) and increased ground glass opacity (GGO%, 15.85%, p < 0.001). The contrastive learning model is able to capture the latent features of two post-COVID-19 subtypes characterized by air-trapping due to small airways disease and airway-associated interstitial fibrotic-like patterns, respectively. The discovery of post-COVID-19 subtypes suggests the need for different managements and treatments of long-term sequelae of patients with post-COVID-19.
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Affiliation(s)
- Frank Li
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, United States
- IIHR-Hydroscience and Engineering, University of Iowa, Iowa City, IA, United States
| | - Xuan Zhang
- IIHR-Hydroscience and Engineering, University of Iowa, Iowa City, IA, United States
- Department of Mechanical Engineering, University of Iowa, Iowa City, IA, United States
| | | | - Eric A. Hoffman
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, United States
- Department of Radiology, University of Iowa, Iowa City, IA, United States
| | - Tianbao Yang
- Department of Computer Science, University of Iowa, Iowa City, IA, United States
| | - Ching-Long Lin
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, United States
- IIHR-Hydroscience and Engineering, University of Iowa, Iowa City, IA, United States
- Department of Mechanical Engineering, University of Iowa, Iowa City, IA, United States
- Department of Radiology, University of Iowa, Iowa City, IA, United States
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Kanne JP, Little BP, Schulte JJ, Haramati A, Haramati LB. Long-term Lung Abnormalities Associated with COVID-19 Pneumonia. Radiology 2022; 306:e221806. [PMID: 36040336 PMCID: PMC9462591 DOI: 10.1148/radiol.221806] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In the 3rd year of the SARS-CoV-2 pandemic, much has been learned about the long-term effects of COVID-19 pneumonia on the lungs. Approximately one-third of patients with moderate-to-severe pneumonia, especially those requiring intensive care therapy or mechanical ventilation, have residual abnormalities at chest CT 1 year after presentation. Abnormalities range from parenchymal bands to bronchial dilation to frank fibrosis. Less is known about the long-term pulmonary vascular sequelae, but there appears to be a persistent, increased risk of venothromboembolic events in a small cohort of patients. Finally, the associated histologic abnormalities resulting from SARS-CoV-2 infection are similar to those seen in patients with other causes of acute lung injury.
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