Lung perfusion findings on perfusion SPECT/CT imaging in non-hospitalized de-isolated patients diagnosed with mild COVID-19 infection

Evbuomwan, Osayande; Engelbrecht, Gerrit; Bergman, M V; Mokwena, S; Ayeni, Oluwatosin

doi:10.1186/s43055-021-00521-1

Cited by 7 publications

(13 citation statements)

References 26 publications

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“…(Continued ) [12,20,21,24,[31][32][33]35,37]. These findings can also virtually rule out pulmonary embolisms in these locations.…”

Section: Tablementioning

confidence: 93%

“…Three studies by Evbuomwan et al [24], Mahaletchumy et al [30], and Le Roux demonstrate the risk of a false-positive diagnosis of pulmonary embolism when the ventilation component is omitted. Le Roux et al also reported this in 31% of all patients in which ventilation was needed to rule out false-positive pulmonary embolism [29].…”

Section: Diagnostic Value Of V/q Rather Than Q At Diagnosis Of Pulmon...mentioning

confidence: 99%

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Diagnostic importance of lung perfusion/ventilation scans in the evaluation of pulmonary embolism in COVID-19 patients: systematic review of the literature

Rahmanipour

Ghorbani

Sadeghi

et al. 2022

Nuclear Medicine Communications

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Objective To investigate the outcomes of ventilation/ perfusion scintigraphy on the diagnosis of pulmonary embolism in coronavirus disease 2019 (COVID-19) patients, we performed a systematic review of the available literature. Materials and methodsPubMed and Scopus were systematically searched up to 4 June 2022, for relevant studies. We included studies on patients with COVID-19 who have performed ventilation/perfusion scintigraphy for diagnosis of pulmonary embolism to describe any diagnosis outcome. Irrelevant and non-English articles were excluded. ResultsOverall, 27 articles were included in our review. The database search yielded studies from PubMed, Scopus, and studies identified through reviewing the reference list of included studies. Extracted information from the included studies could be categorized into several aspects: Diagnosis of pulmonary embolism with Q single-photon emission computed tomography (SPECT) CT, Tracheobronchial uptake, Diagnostic value of V/Q rather than Q at diagnosis pulmonary embolism, Different characteristics (morphological alterations) of COVID-19 in ventilation orperfusion scan, the prevalence of pulmonary embolism with Q or V/Q criteria, and Design of radiotherapy planning in lung cancer patients with COVID-19. ConclusionDifferent perfusion patterns in COVID-19 are challenging but can be alleviated by adding SPECT/ computed tomography (CT) to lung perfusion scans. Although perfusion only SPECT/CT can rule out or rule in others in considerable number of patients, ventilation scan is still needed in certain patients. Nucl Med Commun

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“…(Continued ) [12,20,21,24,[31][32][33]35,37]. These findings can also virtually rule out pulmonary embolisms in these locations.…”

Section: Tablementioning

confidence: 93%

Section: Diagnostic Value Of V/q Rather Than Q At Diagnosis Of Pulmon...mentioning

confidence: 99%

Diagnostic importance of lung perfusion/ventilation scans in the evaluation of pulmonary embolism in COVID-19 patients: systematic review of the literature

Rahmanipour

Ghorbani

Sadeghi

et al. 2022

Nuclear Medicine Communications

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“…Clinical reports support similar findings regarding an association between pulmonary hypertension and more severe disease [ 11 ]. Radiological methods including contrast‐enhanced CT, dual‐energy CT (DECT), and single‐photon emission CT (SPECT) combined with CT indicate disturbances in pulmonary blood distribution [ 12 , 13 , 14 , 15 , 16 , 17 ]. The combined impression of unequal blood distribution in single time point scans (DECT) or composite tracer distribution (SPECT) has further support from findings in a case report of an intensive care unit (ICU) patient using dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI) [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Lung perfusion disturbances in nonhospitalized post‐COVID with dyspnea—A magnetic resonance imaging feasibility study

Granberg

Shams

et al. 2022

J Intern Med

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Background Dyspnea is common after COVID‐19. Though the underlying mechanisms are largely unknown, lung perfusion abnormalities could contribute to lingering dyspnea. Objectives To detect pulmonary perfusion disturbances in nonhospitalized individuals with the post‐COVID condition and persistent dyspnea 4–13 months after the disease onset. Methods Individuals with dyspnea and matched healthy controls were recruited for dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI), a 6‐min walk test, and an assessment of dyspnea. The DCE‐MRI was quantified using two parametric values: mean time to peak (TTP) and TTP ratio, reflecting the total lung perfusion resistance and the fraction of lung with delayed perfusion, respectively. Results Twenty‐eight persons with persistent dyspnea (mean age 46.5 ± 8.0 years, 75% women) and 22 controls (mean age 44.1 ± 10.8 years, 73% women) were included. There was no systematic sex difference in dyspnea. The post‐COVID group had no focal perfusion deficits but had higher mean pulmonary TTP (0.43 ± 0.04 vs. 0.41 ± 0.03, p = 0.011) and TTP ratio (0.096 ± 0.052 vs. 0.068 ± 0.027, p = 0.032). Post‐COVID males had the highest mean TTP of 0.47 ± 0.02 and TTP ratio of 0.160 ± 0.039 compared to male controls and post‐COVID females ( p = 0.001 and p < 0.001, respectively). Correlations between dyspnea and perfusion parameters were demonstrated in males ( r = 0.83, p < 0.001 for mean TTP; r = 0.76, p = 0.003 for TTP ratio), but not in females. Conclusions DCE‐MRI demonstrated late contrast bolus arrival in males with post‐COVID dyspnea, suggestive of primary vascular lesions or secondary effects of hypoxic vasoconstriction. Since this effect was not regularly observed in female patients, our findings suggest sex differences in the mechanisms underlying post‐COVID dyspnea, which warrants further investigation in dedicated trials.

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“…Published data from our facility showed that lung perfusion abnormalities were not uncommon in these patients during the first wave of the pandemic. [17,18] These perfusion abnormalities could be associated with PE, mosaic perfusion, perfusion shunting and pulmonary infiltrates. [17] However, we observed that a subset of these patients had lung perfusion abnormalities that persisted, despite the fact that they had been on long-term anticoagulation therapy.…”

mentioning

confidence: 99%

“…[17,18] These perfusion abnormalities could be associated with PE, mosaic perfusion, perfusion shunting and pulmonary infiltrates. [17] However, we observed that a subset of these patients had lung perfusion abnormalities that persisted, despite the fact that they had been on long-term anticoagulation therapy. This subset of patients also had their perfusion defects matched with a ventilation defect and mosaic hypoattenuation on CT.…”

mentioning

confidence: 99%

Incidence and follow-up of persistent lung perfusion abnormalities as a result of suspected air trapping or microthrombosis in non-hospitalised COVID-19 patients during the early half of the pandemic – experience in a tertiary institution in South Afr

Evbuomwan

Endres²,

Tebieia³

et al. 2022

S Afr Med J

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Background. Available clinical data have revealed that COVID-19 is associated with a risk of pulmonary microthrombosis and small airway disease, especially in patients with severe disease. These patients present with persistent pulmonary symptoms after recovery, with ventilation and perfusion abnormalities present on several imaging modalities. Few data are available on the occurrence of this complication in patients who earlier presented with a milder form of COVID-19, and their long-term follow-up.Objective. To assess the incidence of persistent lung perfusion abnormalities as a result of suspected air trapping or microthrombosis in non-hospitalised patients diagnosed with COVID-19. The long-term follow-up of these patients will also be investigated.Methods. This was a retrospective study conducted at the nuclear medicine department of Universitas Academic Hospital, Bloemfontein. We reviewed the studies of 78 non-hospitalised patients with SARS-CoV-2 infection referred to our department from July 2020 to June 2021 for a perfusion-only single-photon emission computed tomography/computed tomography (SPECT/CT) study or a ventilation perfusion (VQ) SPECT/CT study. All 78 patients were suspected of having pulmonary embolism, and had raised D-dimer levels, with persistent, worsening or new onset of cardiopulmonary symptoms after the diagnosis of COVID-19. Results. Seventy-eight patients were studied. The median (interquartile range) age was 45 (41 - 58) years and the majority (88.5%) were females. Twenty-two (28.2%) of these patients had matching VQ defects with mosaic attenuation on CT. All 9 of the patients who had follow-up studies had abnormalities that persisted, even after 1 year.Conclusion. We confirm that persistent ventilation and perfusion abnormalities suspicious of small airway disease and pulmonary microthrombosis can occur in non-hospitalised patients diagnosed with a milder form of COVID-19. Our study also shows that these complications remain present even 1 year after the initial diagnosis of COVID-19.

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Lung perfusion findings on perfusion SPECT/CT imaging in non-hospitalized de-isolated patients diagnosed with mild COVID-19 infection

Cited by 7 publications

References 26 publications

Diagnostic importance of lung perfusion/ventilation scans in the evaluation of pulmonary embolism in COVID-19 patients: systematic review of the literature

Diagnostic importance of lung perfusion/ventilation scans in the evaluation of pulmonary embolism in COVID-19 patients: systematic review of the literature

Lung perfusion disturbances in nonhospitalized post‐COVID with dyspnea—A magnetic resonance imaging feasibility study

Incidence and follow-up of persistent lung perfusion abnormalities as a result of suspected air trapping or microthrombosis in non-hospitalised COVID-19 patients during the early half of the pandemic – experience in a tertiary institution in South Afr

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