Radio density profile in residual lung lesions of COVID-19
Keywords:
COVID-19; cross-sectional studies; lung; lung diseases, interstitial; lung injury; tomography, X-Ray computedAbstract
Introduction: Computed tomography (CT) is crucial for evaluating pulmonary sequelae in post-COVID-19 patients. However, residual lesion characterization relies predominantly on qualitative descriptions, lacking objective density quantification.
Objective: To quantify radiodensity profiles in Hounsfield Units (HU) of residual lung lesions in post-COVID-19 patients.
Methods: Cross-sectional study of 26 patients with post-COVID-19 pulmonary sequelae. High-resolution CT (HRCT) images were analyzed by defining regions of interest (ROI) on specific imaging patterns. Radiodensity (HU) was measured using eFilm software's ROI tool. Statistical analysis included ANOVA for profile comparisons.
Results: Four distinct radiological patterns with significantly different radiodensity profiles were identified (p < 0.0001): 1) Healthy tissue: -900 to -800 HU; 2) Undefined pattern: -799 to -701 HU; 3) Ground-glass opacity (GGO): -700 to -500 HU; 4) Pulmonary consolidation (PC): -499 to -201 HU. A -500 HU cutoff differentiated GGO from PC. The undefined pattern represents a novel finding.
Conclusion: This study proposes the first specific quantitative HU ranges for post-COVID-19 pulmonary lesions. These radiodensity profiles provide an objective, standardized tool for diagnosing, characterizing, and monitoring post-COVID-19 interstitial lung disease, establishing foundations for clinical practice and future research.
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1. Cobo Tabar DZ, Souto Canteli DB, González Ocio DJ, Peña Sarnago DJM, Gandiaga Mandiola DA, Lázaro Serrano DM. NIU, diagnóstico paso a paso [Internet]. Seram. 2021 [acceso: 15/03/2024];1(1):35-42. Disponible en: https://piper.espacio-seram.com/index.php/seram/article/view/4204
2. Giménez-Palleiro A, Mazzini SP, Franquet T. El informe radiológico en patología intersticial pulmonar [Internet]. Radiología. 2022;64(3):215-26. DOI: 10.1016/j.rx.2022.01.007
3. Armiñana A, Montón-Gómez C, Puig-Chilet A, Infante-Fuenzalida T, Fontenla-Martínez C, Torres-Espallardó I, et al. Tomografía computarizada espectral y unidades Hounsfield: bases para una correcta interpretación [Internet]. An RANM. 2023;140(2):101-13. DOI: 10.32440/ar.2023.140.02.rev01
4. Upegui-Jiménez D, Espinosa Cruz MÁ, Gómez Milanés S, Alcántara Martínez MF. Radiómica: ¿qué es y en dónde estamos? [Internet]. Medicina (Bogotá). 2024;46(1):89-102. DOI: 10.56050/01205498.2379
5. Gillies RJ, Kinahan PE, Hricak H. Radiomics: Images are more than pictures, they are data. Radiology. 2016;278(2):563-77. DOI: 10.1148/radiol.2015151169
6. Kligerman SJ, Franks TJ, Galvin JR. From the radiologic pathology archives: organization and fibrosis as a response to lung injury in diffuse alveolar damage, organizing pneumonia, and acute fibrinous and organizing pneumonia [Internet]. Radiographics. 2013;33(7):1951-75. DOI: 10.1148/rg.337130057
7. Wang Q, Jiang H, Xie Y, Zhang T, Liu S, Wu S, et al. Long-term clinical prognosis of human infections with avian influenza A(H7N9) viruses in China after hospitalization [Internet]. EClinical Medicine. 2020;20:100282. DOI: 10.1016/j.eclinm.2020.100282
8. Ahmed H, Patel K, Greenwood DC, Halpin S, Lewthwaite P, Salawu A, et al. Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalisation or ICU admission: A systematic review and meta-analysis [Internet]. J Rehabil Med. 2020;52(5):jrm00063. DOI: 10.2340/16501977-2694
9. Carfì A, Bernabei R, Landi F, Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent symptoms in patients after acute COVID-19 [Internet]. JAMA. 2020;324(6):603-5. DOI: 10.1001/jama.2020.12603
10. Thaweethai T, Jolley SE, Karlson EW, Levitan EB, Levy B, McComsey GA, et al. Development of a definition of postacute sequelae of SARS-CoV-2 infection [Internet]. JAMA. 2023;329(22):1934-46. DOI: 10.1001/jama.2023.8823
11. Munipalli B, Seim L, Dawson NL, Knight D, Abu-Dabrh AM. Post-acute sequelae of COVID-19 (PASC): a meta-narrative review of pathophysiology, prevalence, and management [Internet]. SN Compr Clin Med. 2022;4(1):90. DOI: 10.1007/s42399-022-01167-4
12. Mandal S, Barnett J, Brill SE, Brown JS, Denney EK, Hare SS, et al. 'Long-COVID': a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19 [Internet]. Thorax. 2021;76(4):396-8. DOI: 10.1136/thoraxjnl-2020-215818
13. DenOtter TD, Schubert J. Hounsfield unit [Internet]. En: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024. [acceso: 15/03/2024]. Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK547721/
14. Hata A, Schiebler ML, Lynch DA, Hatabu H. Interstitial lung abnormalities: state of the art [Internet]. Radiology. 2021;301(1):19-34. DOI: 10.1148/radiol.2021204367
15. Raghu G, Remy-Jardin M, Myers JL, Richeldi L, Ryerson CJ, Lederer DJ, et al. Diagnosis of idiopathic pulmonary fibrosis. An official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med. 2018;198(5):e44-e68. DOI: 10.1164/rccm.201807-1255ST
16. Herrera Ortiz AF, Díaz Ordoñez JC, Motta Castaño MF, Peña Pérez FA. Patrones característicos de COVID-19 en tomografía de tórax: una revisión de la literatura [Internet]. Rev Neuronum. 2020 [acceso: 15/03/2024];6(4):350-68. Disponible en: https://eduneuro.com/revista/index.php/revistaneuronum/article/view/298
17. Solomon JJ, Heyman B, Ko JP, Condos R, Lynch DA. CT of post-acute lung complications of COVID-19 [Internet]. Radiology. 2021;301(2):E383-E395. DOI: 10.1148/radiol.2021211396
18. Webb WR. Thin-section CT of the secondary pulmonary lobule: anatomy and the image. Radiology. 2006;239(2):322-38. DOI: 10.1148/radiol.2392041968
19. Cabrales Fuentes J, Mendoza Cabalé AL, Zaldivar Acosta Y. Acercamiento imagenológico e histológico para el diagnóstico de lesiones pulmonares por SARS-CoV-2 [Internet]. Rev Fac Med UNAM. 2024;67(2):26-31. DOI: 10.22201/fm.24484865e.2024.67.2.04
20. Ackermann M, Verleden SE, Kuehnel M, Haverich A, Welte T, Laenger F, et al. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19 [Internet]. N Engl J Med. 2020;383(2):120-8. DOI: 10.1056/NEJMoa2015432
21. Raghu G, Remy-Jardin M, Myers JL, Richeldi L, Ryerson CJ, Lederer DJ, et al. Diagnosis of idiopathic pulmonary fibrosis: an official ATS/ERS/JRS/ALAT clinical practice guideline [Internet]. Am J Respir Crit Care Med. 2018;198(5):e44-e68. DOI: 10.1164/rccm.201807-1255ST
22. Armiñana A, Montón-Gómez C, Puig-Chilet A, Infante-Fuenzalida T, Fontenla Martínez C, Torres-Espallardó I, et al. Tomografía computarizada espectral y unidades Hounsfield: bases para una correcta interpretación [Internet]. An RANM. 2023;140(2):101-13. DOI: 10.32440/ar.2023.140.02.rev01
23. Negroni D, Zagaria D, Paladini A, Falaschi Z, Arcoraci A, Barini M, et al. COVID-19 CT scan lung segmentation: how we do it [Internet]. J Digit Imaging. 2022;35(3):424-31. DOI: 10.1007/s10278-022-00593-z
24. Emad Y, Ragab Y, Abd-Elsalam M, Rasker JJ. Antisynthetase syndrome complicating the course of established case with rheumatoid arthritis: a rare and under-recognized overlapping disease [Internet]. Reumatol Clin (Engl Ed). 2020;16(5 Pt 1):419-22. DOI: 10.1016/j.reuma.2018.06.002
25. Xu F, Zhu W, Shen Y, Wang J, Xu R, Oudkerk C, et al. Radiomic-based quantitative CT analysis of pure ground-glass nodules to predict the invasiveness of lung adenocarcinoma [Internet]. Front Oncol. 2020;10:872. DOI: 10.3389/fonc.2020.00872
26. Yabuuchi H, Matsuo Y, Tsukamoto H, Horiuchi T, Sunami S, Kamitani T, et al. Evaluation of the extent of ground-glass opacity on high-resolution CT in patients with interstitial pneumonia associated with systemic sclerosis: comparison between quantitative and qualitative analysis [Internet]. Clin Radiol. 2014;69(7):758-64. DOI: 10.1016/j.crad.2014.03.008
27. Shin KE, Chung MJ, Jung MP, Choe BK, Lee KS. Quantitative computed tomographic indexes in diffuse interstitial lung disease: correlation with physiologic tests and computed tomography visual scores [Internet]. J Comput Assist Tomogr. 2011;35(2):266-71. DOI: 10.1097/RCT.0b013e31820ccf18
28. Mohamed Hoesein FA, de Hoop B, Zanen P, Gietema H, Kruitwagen CL, van Ginneken B, et al. CT-quantified emphysema in male heavy smokers: association with lung function decline [Internet]. Thorax. 2011;66(9):782-7. DOI: 10.1136/thx.2010.145995
29. Dirksen A, Piitulainen E, Parr DG, Deng C, Wencker M, Shaker SB, et al. Exploring the role of CT densitometry: a randomised study of augmentation therapy in alpha1-antitrypsin deficiency [Internet]. Eur Respir J. 2009;33(6):1345-53. DOI: 10.1183/09031936.00159408
30. Chen A, Karwoski RA, Gierada DS, Bartholmai BJ, Koo CW. Quantitative CT analysis of diffuse lung disease [Internet]. Radiographics. 2020;40(1):28-43. DOI: 10.1148/rg.2020190099
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