Rationale and Objectives Few reports have studied lung aeration and perfusion in normal lungs, COVID-19, and ARDS from other causes (NC-ARDS) using dual-energy computed tomography pulmonary angiograms (DE-CTPA). To describe lung aeration and blood-volume distribution using DE-CTPAs of patients with NC-ARDS, COVID-19, and controls with a normal DE-CTPA (“healthy lungs”). We hypothesized that each of these conditions has unique ranges of aeration and pulmonary blood volumes. Materials and Methods This retrospective, single-center study of DE-CTPAs included patients with COVID-19, NC-ARDS (Berlin criteria), and controls. Patients with macroscopic pulmonary embolisms were excluded. The outcomes studied were the (1) lung blood-volume in areas with different aeration levels (normal, ground glass opacities [GGO], consolidated lung) and (2) aeration/blood-volume ratios. Results Included were 20 patients with COVID-19 (10 milds, 10 moderate-severe), six with NC-ARDS, and 12 healthy-controls. Lung aeration was lowest in patients with severe COVID-19 24% (IQR13%–31%) followed by those with NC-ARDS 40%(IQR21%–46%) . Blood-volume in GGO was lowest in patients with COVID-19 [moderate-severe:-28.6 (IQR-33.1–23.2); mild: -30.1 (IQR-33.3–23.4)] and highest in normally aerated areas in NC-ARDS -37.4 (IQR-52.5–30.2-) and moderate-severe COVID-19 -33.5(IQR-44.2–28.5). The median aeration/blood-volume ratio was lowest in severe COVID-19 but some values overlapped with those observed among patients with NC-ARDS. Conclusion Severe COVID-19 disease is associated with low total aerated lung volume and blood-volume in areas with GGO and overall aeration/blood volume ratios, and with high blood volume in normal lung areas. In this hypothesis-generating study, these findings were most pronounced in severe COVID disease. Larger studies are needed to confirm these preliminary findings.
【저자키워드】 ARDS, dual-energy computed tomography, aeration-blood-volume ratio, COVID-19 lung disease, lung aeration, pulmonary blood volume,