A new imaging sign in COVID-19 pneumonia: vascular changes and their correlation with clinical severity of the disease

Özet

PURPOSEIt has come to our attention that specific vascular changes (VCs) appear more frequently in chestcomputed tomography (CT) of patients with coronavirus disease 2019 (COVID-19). In this study,we aimed to investigate if these specific VCs in chest CT correlate with clinical severity of thedisease.METHODSCT images of 102 patients who underwent low-dose noncontrast chest CT due to COVID-19 between 11 March 2020 and 11 April 2020 were evaluated retrospectively. The patients were divided into two groups based on the presence of VCs in CT images. VCs in chest CT of patients withCOVID-19 were defined using the following descriptors: decreased lumen caliber, vascular wallirregularity, angulation in the course of the vessel, vascular disruption, and/or interruption. Therelationship of these VCs with disease symptoms (fever, cough, shortness of breath), comorbidconditions (diabetes, hypertension, asthma), smoking habit, disease-specific laboratory changes(white blood cell-lymphocyte count, neutrophil/lymphocyte ratio, C-reactive protein [CRP], D-dimer, lactate dehydrogenase [LDH], ferritin, procalcitonin), lung parenchymal infiltration pattern(ground-glass opacity, crazy-paving pattern, consolidation) and its distribution (peripheral, central, mixed, upper lobes, lower lobes, right middle lobe) on CT were investigated by comparisonof these variables between patients with and without VCs in chest CT.RESULTSVCs were observed in 18 out of 102 patients (18%) with typical parenchymal involvement forCOVID-19. There was no significant difference in terms of age and sex. We found an irregularityin the wall of the vascular structures in the distal branches and decreased lumen caliber of thevessels related to ground-glass opacities in 15 patients, concentric luminal narrowing in annularform in 4 patients, angulation/traction or springiness in the vascular structures towards the active lesions in 3 patients, and interruptions along the vascular course in 1 patient. VCs were significantly correlated with fever (12/18, 66.7%) and shortness of breath (7/18, 39%). These changes were significantly more remarkable in common disease involving both upper and lower lobes(10/18, 56%). In these cases, there was a substantial increase in CRP (15/18, 83%; mean, 5.7±6.3mg/dL) and LDH (8/18, 44%) values compared to those who did not have any VCs.CONCLUSIONThe results of this study suggest that specific VCs observed in chest CT may predict the diseaseseverity in cases of COVID-19 pneumonia. These changes may be related to respiratory distressin the disease.