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Pulmonary vascular enlargement on thoracic CT for diagnosis and differential diagnosis of COVID-19: a systematic review and meta-analysis.

ABSTRACT: Background:The 2019 coronavirus disease (COVID-19) has become a global pandemic. To date, although many studies have reported on the computed tomography (CT) manifestations of COVID-19, the vascular enlargement sign (VES) of COVID-19 has not been deeply examined, with the few available studies reporting an inconsistent prevalence. We thus performed a systematic review and meta-analysis based on the best available studies to estimate the prevalence and identify the underlying differential diagnostic value of VES. Methods:We searched nine English and Chinese language databases up to April 23, 2020. Studies that evaluated CT features of COVID-19 patients and reported VES, with or without comparison with other pneumonia were included. The methodologic quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Meta-analyses with random effects models were performed to calculate the aggregate prevalence and pooled odds ratios (ORs) of VES. We also conducted meta-regression and subgroup analyses to analyze heterogeneity. Results:VES findings from a total of 1969 patients were summarized and pooled across 22 studies. Our analysis demonstrated that the prevalence of VES among COVID-19 patients was 69.37% [95% confidence interval (CI): 57.40-79.20%]. Compared with non-COVID-19 patients, VES manifestation was more frequently observed in confirmed COVID-19 patients (OR =6.43, 95% CI: 3.39-12.22). Studies that explicitly defined distribution of VES in the lesion area demonstrated a significantly higher prevalence (P=0.03). Subgroup analyses also revealed a relatively higher VES rate in studies with a sample size larger than 50, but the difference was not statistically significant. No significant difference in VES rates was found between different countries (China/Italy), regions (Hubei/outside Hubei), average age groups (over/less than 50-year-old), or slice thicknesses of CT scan. Extensive heterogeneity was identified across most estimates (I2>80%). Some of the variations (R2=19.73%) could be explained by VES distribution, and sample size. No significant publication bias was seen (P=0.29). Conclusions:VES on thoracic CT was found in almost two-thirds of COVID-19 patients, and was more prevalent compared with that of the non-COVID-19 patients, supporting a promising role for VES in identifying pneumonia caused by coronavirus.

SUBMITTER: Lv H

PROVIDER: S-EPMC7396779 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Pulmonary vascular enlargement on thoracic CT for diagnosis and differential diagnosis of COVID-19: a systematic review and meta-analysis.

Lv Haiying H Chen Tongtong T Pan Yaling Y Wang Hanqi H Chen Liuping L Lu Yong Y

Annals of translational medicine 20200701 14

<h4>Background</h4>The 2019 coronavirus disease (COVID-19) has become a global pandemic. To date, although many studies have reported on the computed tomography (CT) manifestations of COVID-19, the vascular enlargement sign (VES) of COVID-19 has not been deeply examined, with the few available studies reporting an inconsistent prevalence. We thus performed a systematic review and meta-analysis based on the best available studies to estimate the prevalence and identify the underlying differential ...[more]

PMID: 32793722

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Project description:BackgroundGas exchange in COVID-19 pneumonia is impaired and vessel obstruction has been suspected to cause ventilation-perfusion mismatch. Dual-energy CT (DECT) can depict pulmonary perfusion by regional assessment of iodine uptake.ObjectiveThe purpose of this study was the analysis of pulmonary perfusion using dual-energy CT in a cohort of 27 consecutive patients with severe COVID-19 pneumonia.MethodWe retrospectively analyzed pulmonary perfusion with DECT in 27 consecutive patients (mean age 57 years, range 21-73; 19 men and 8 women) with severe COVID-19 pneumonia. Iodine uptake (IU) in regions-of-interest placed into normally aerated lung, ground-glass opacifications (GGO) and consolidations was measured using a dedicated postprocessing software. Vessel enlargement (VE) within opacifications and presence of pulmonary embolism (PE) was assessed by subjective analysis. Linear mixed models were used for statistical analyses.ResultsCompared to normally aerated lung 106/151 (70.2%) opacifications without upstream PE demonstrated an increased IU, 9/151 (6.0%) an equal IU and 36/151 (23.8%) a decreased IU. The estimated mean iodine uptake (EMIU) in opacifications without upstream PE (GGO 1.77 mg/mL; 95%-CI: 1.52-2.02; p = 0.011, consolidations 1.82 mg/mL; 95%-CI: 1.56-2.08, p = 0.006) was significantly higher compared to normal lung (1.22 mg/mL; 95%-CI: 0.95-1.49). In case of upstream PE, EMIU of opacifications (combined GGO and consolidations) was significantly decreased compared to normal lung (0.52 mg/mL; 95%-CI: -0.07-1.12; p = 0.043). The presence of VE in opacifications correlated significantly with iodine uptake (p<0.001).ConclusionsDECT revealed the opacifications in a subset of patients with severe COVID-19 pneumonia to be perfused non-uniformly with some being hypo- and others being hyperperfused. Mean iodine uptake in opacifications (both ground-glass and consolidation) was higher compared to normally aerated lung except for areas with upstream pulmonary embolism. Vessel enlargement correlated with iodine uptake: In summary, in a cohort of 27 consecutive patients with severe COVID-19 pneumonia, dual-energy CT demonstrated a wide range of iodine uptake in pulmonary ground-glass opacifications and consolidations as a surrogate marker for hypo- and hyperperfusion compared to normally aerated lung. Applying DECT to determine which pathophysiology is predominant might help to tailor therapy to the individual patient´s needs.

Dataset Information

Pulmonary vascular enlargement on thoracic CT for diagnosis and differential diagnosis of COVID-19: a systematic review and meta-analysis.

Publications

Pulmonary vascular enlargement on thoracic CT for diagnosis and differential diagnosis of COVID-19: a systematic review and meta-analysis.

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