背景:文献中没有发现双能计算机断层扫描(DECT)的研究来评估2019年冠状病毒病(COVID-19)患者可能致命的心脏/心肌问题。在COVID-19患者中可以发现心肌灌注缺陷,即使没有任何明显的冠状动脉闭塞,这些缺陷可以通过DECT和完美的评分者间协议来显示。
目的:评估COVID-19患者的肺灌注改变。据我们所知,尚未进行使用DECT评估COVID-19患者可能致命的心脏/心肌问题的研究.这项研究的目的是评估DECT在检测COVID-19相关心脏病中的作用。
方法:两名盲独立检查者根据美国心脏协会对左心室心肌分割的分类,使用17段模型评估CT图像。此外,研究了主要冠状动脉和分支的腔内疾病和异常。在逐段分析之后,在DECT上的碘图图片上识别出灌注缺陷。
结果:本研究共纳入87例患者。其中42人被归类为COVID-19阳性,45人被列为对照.在66.6%(n=30)的病例中发现了灌注缺陷。所有对照患者均具有正常的碘分布图。在心外膜下的DECT碘图图像上发现了灌注缺陷(n=12,40%),心肌内(n=8,26.6%),或透壁(n=10,33.3%)在左心室壁内的解剖位置。任何患者均无心内膜下受累。
结论:即使没有任何明显的冠状动脉闭塞,COVID-19患者也可以发现心肌灌注缺陷。这些缺陷可以通过DECT显示,并具有完美的评分者间协议。此外,灌注缺陷的存在与D-二聚体水平呈正相关。
BACKGROUND: No study on dual energy computed tomography (DECT) has been found in the literature to evaluate possibly fatal cardiac/myocardial problems in corona virus disease 2019 (COVID-19) patients. Myocardial perfusion deficits can be found in COVID-19 patients even without any significant coronary artery occlusion, and these deficits can be shown via DECT with a perfect interrater agreement.
OBJECTIVE: To assess lung perfusion alterations in COVID-19 patients. To our knowledge, no study using DECT has been performed to evaluate possibly fatal cardiac/ myocardial problems in COVID-19 patients. The purpose of this study is to evaluate the role of DECT in the detection of COVID-19-related cardiac diseases.
METHODS: Two blinded independent examiners evaluated CT images using the 17-segment model according to the American Heart Association\'s classification of the segmentation of the left ventricular myocardium. Additionally, intraluminal diseases and abnormalities in the main coronary arteries and branches were investigated. Following segment-by-segment analysis, perfusion deficiencies identified on the iodine map pictures on DECT were identified.
RESULTS: The study enrolled a total of 87 patients. Forty-two of these individuals were classified as COVID-19 positive, and 45 were classified as controls. Perfusion deficits were identified in 66.6% (n = 30) of the cases. All control patients had a normal iodine distribution map. Perfusion deficits were found on DECT iodine map images with subepicardial (n = 12, 40%), intramyocardial (n = 8, 26.6%), or transmural (n = 10, 33.3%) anatomical locations within the left ventricular wall. There was no subendocardial involvement in any of the patients.
CONCLUSIONS: Myocardial perfusion deficits can be found in COVID-19 patients even without any significant coronary artery occlusion. These deficits can be shown via DECT with a perfect interrater agreement. Additionally, the presence of perfusion deficit is positively correlated with D-dimer levels.