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CC BY-NC-ND 4.0 · World J Nucl Med 2022; 21(03): 210-214
DOI: 10.1055/s-0042-1755411
Original Article

Extensive Nonsegmental Pulmonary Perfusion Defects on SPECT/CT as an Early Sign of COVID-19 Infection

Ana M. Franceschi
1   Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York, United States
,
Robert Matthews
2   Department of Radiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States
,
Osama Ahmed
2   Department of Radiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States
,
Karen Mourtzikos
3   Department of Nuclear Medicine, John D. Dinges Veterans Affairs Hospital, Detroit, Michigan, United States
,
Marika Bajc
4   Department of Clinical Physiology, Lund University, Lund, Scania, Sweden
,
Dinko Franceschi
2   Department of Radiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States
› Author Affiliations Funding None.
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Abstract

We describe a hospitalized patient with confirmed coronavirus disease 2019 in whom the initial chest computed tomography (CT) was negative, while subsequent perfusion single-photon emission computed tomography/computed tomography imaging revealed extensive nonsegmental perfusion defects in addition to newly developing parenchymal densities. Possible reasons for these findings and their relationship to the multisystem severe acute respiratory syndrome coronavirus 2 infection are discussed in this article.

Keywords

pulmonary embolism - perfusion imaging - SPECT/CT - COVID-19 - inflammation - pneumonia

Declaration of Patient Consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for the images and other clinical information to be reported in this journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.


Note

The work was carried out at the Department of Radiology at Stony Brook University Hospital.




Publication History

Article published online:
16 August 2022

© 2022. World Association of Radiopharmaceutical and Molecular Therapy (WARMTH). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Coronavirus disease (COVID-19) Pandemic. Geneva: World Health Organization; https://www.who.int/emergencies/diseases/novel-coronavirus-2019 Accessed April 5, 2022
    Google Scholar
  • 2 Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): a systematic review of imaging findings in 919 patients. AJR Am J Roentgenol 2020; 215 (01) 87-93
    CrossrefPubMedGoogle Scholar
  • 3 Ye Z, Zhang Y, Wang Y, Huang Z, Song B. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol 2020; 30 (08) 4381-4389
    CrossrefPubMedGoogle Scholar
  • 4 Simpson S, Kay FU, Abbara S. et al. Radiological Society of North America Expert Consensus document on reporting chest CT findings related to COVID-19: endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. Radiol Cardiothorac Imaging 2020; 2 (02) e200152 DOI: 10.1148/ryct.2020200152.
    CrossrefPubMedGoogle Scholar
  • 5 Bai HX, Hsieh B, Xiong Z. et al. Performance of radiologists in differentiating COVID-19 from non-COVID-19 viral pneumonia at chest CT. Radiology 2020; 296 (02) E46-E54 ; [ Epub ahead of print ]
    CrossrefPubMedGoogle Scholar
  • 6 Hamming I, Timens W, Bulthuis MLC, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol 2004; 203 (02) 631-637
    CrossrefPubMedGoogle Scholar
  • 7 Li W, Moore MJ, Vasilieva N. et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature 2003; 426 (6965): 450-454
    CrossrefPubMedGoogle Scholar
  • 8 Klok FA, Kruip MJHA, van der Meer NJM. et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020; 191: 145-147
    CrossrefPubMedGoogle Scholar
  • 9 Wadman M, Couzi-Frankel J, Kaiser J, Matacic C. How does coronavirus kill? Clinicians trace a ferocious rampage through the body, from brain to toes. Sciene 2020; 17: 1502-1503
    Google Scholar
  • 10 Poor HD, Ventetuolo CE, Tolbert T. et al. COVID-19 critical illness pathophysiology driven by diffuse pulmonary thrombi and pulmonary endothelial dysfunction responsive to thrombolysis. medRxv preprint. : doi: https://doi.org/10.1101/2020.04.17.20057125
    CrossrefPubMedGoogle Scholar
  • 11 Bajc M, Schümichen C, Grüning T. et al. EANM guideline for ventilation/perfusion single-photon emission computed tomography (SPECT) for diagnosis of pulmonary embolism and beyond. Eur J Nucl Med Mol Imaging 2019; 46 (12) 2429-2451
    Google Scholar
  • 12 Raptis CA, Hammer MM, Short RG. et al. Chest CT and coronavirus disease (COVID-19): a critical review of the literature to date. AJR 2020; 2020: 215
    Google Scholar
  • 13 Hosseiny M, Kooraki S, Gholamrezanezhad A, Reddy S, Myers L. Radiology perspective of coronavirus disease 2019 (COVID-19): lessons from severe acute respiratory syndrome and Middle East respiratory syndrome. AJR Am J Roentgenol 2020; 214 (05) 1078-1082
    CrossrefPubMedGoogle Scholar
  • 14 Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J. Chest CT for typical 2019-nCoV pneumonia: relationship to negative RT-PCR testing. Radiology 2020; [Epub ahead of print]
    Google Scholar
  • 15 Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. HLH Across Speciality Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020; 395 (10229): 1033-1034
    CrossrefPubMedGoogle Scholar
  • 16 Wang W, He J, Lie P. et al. The definition and risks of cytokine release syndrome-like in 11 COVID-19-infected pneumonia critically ill patients: Disease Characteristics and Retrospective Analysis [preprint, April 2020]. https://doi.org/10.1101/2020.02.26.20026989
    CrossrefGoogle Scholar
  • 17 Xie J, Tong Z, Guan X, Du B, Qiu H. Clinical characteristics of patients who died of coronavirus disease 2019 in China. JAMA Netw Open 2020; 3 (04) e205619
    CrossrefPubMedGoogle Scholar
  • 18 Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med 2020; 46 (05) 846-848 ; [ Epub ahead of print ] DOI: 10.1007/s00134-020-05991-x.
    CrossrefPubMedGoogle Scholar
  • 19 Fogarty H, Townsend L, Ni Cheallaigh C. et al. COVID19 coagulopathy in Caucasian patients. Br J Haematol 2020; 189 (06) 1044-1049
    CrossrefPubMedGoogle Scholar
  • 20 Wang T, Chen R, Liu C. et al. Attention should be paid to venous thromboembolism prophylaxis in the management of COVID-19. Lancet Haematol 2020; 7 (05) e362-e363
    CrossrefPubMedGoogle Scholar
  • 21 Léonard-Lorant I, Delabranche X, Séverac F. et al. Acute pulmonary embolism in patients with COVID-19 at CT angiography and relationship to d-Dimer levels. Radiology 2020; 296 (03) E189-E191 [published online ahead of print, 2020 Apr 23]
    CrossrefPubMedGoogle Scholar
  • 22 Fox SE, Akmatbekov A, Harbert JL, Li G, Brown Q, Vander Heife RS. Pulmonary and cardiac pathology in Covid-19: the first autopsy series from New Orleans. medRxiv preprint (April 2020) DOI: 10.1101/2020.04.06.20050575
    CrossrefGoogle Scholar
  • 23 Carsana L, Sonzogni A, Nasr A. et al. Pulmonary post-mortem findings in a large series of COVID-19 cases from Northern Italy. [preprint, April 2020]. https://doi.org/10.1101/2020.04.19.20054262
    CrossrefGoogle Scholar