Severe COVID-19 pneumonia leads to post-COVID-19 lung abnormalities on follow-up CT scans

Takuya Hino; Mizuki Nishino; Vladimir I Valtchinov; Staci Gagne; Elizabeth Gay; Noriaki Wada; Shu Chi Tseng; Bruno Madore; Charles R G Guttmann; Kousei Ishigami; Yi Li; David C Christiani; Gary M Hunninghake; Bruce D Levy; Kenneth M Kaye; Hiroto Hatabu

doi:10.1016/j.ejro.2023.100483

Severe COVID-19 pneumonia leads to post-COVID-19 lung abnormalities on follow-up CT scans

Eur J Radiol Open. 2023:10:100483. doi: 10.1016/j.ejro.2023.100483. Epub 2023 Mar 3.

Authors

Takuya Hino^{1

2}, Mizuki Nishino¹, Vladimir I Valtchinov¹, Staci Gagne¹, Elizabeth Gay³, Noriaki Wada¹, Shu Chi Tseng¹, Bruno Madore¹, Charles R G Guttmann⁴, Kousei Ishigami², Yi Li⁵, David C Christiani^{6

7}, Gary M Hunninghake¹, Bruce D Levy³, Kenneth M Kaye⁸, Hiroto Hatabu¹

Affiliations

¹ Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
² Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 8128582, Japan.
³ Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
⁴ Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
⁵ Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
⁶ Department of Environmental Health, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA.
⁷ Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA.
⁸ Division of Infectious Diseases, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.

Abstract

Purpose: To investigate the association of the maximal severity of pneumonia on CT scans obtained within 6-week of diagnosis with the subsequent development of post-COVID-19 lung abnormalities (Co-LA).

Methods: COVID-19 patients diagnosed at our hospital between March 2020 and September 2021 were studied retrospectively. The patients were included if they had (1) at least one chest CT scan available within 6-week of diagnosis; and (2) at least one follow-up chest CT scan available ≥ 6 months after diagnosis, which were evaluated by two independent radiologists. Pneumonia Severity Categories were assigned on CT at diagnosis according to the CT patterns of pneumonia and extent as: 1) no pneumonia (Estimated Extent, 0%); 2) non-extensive pneumonia (GGO and OP, <40%); and 3) extensive pneumonia (extensive OP and DAD, >40%). Co-LA on follow-up CT scans, categorized using a 3-point Co-LA Score (0, No Co-LA; 1, Indeterminate Co-LA; and 2, Co-LA).

Results: Out of 132 patients, 42 patients (32%) developed Co-LA on their follow-up CT scans 6-24 months post diagnosis. The severity of COVID-19 pneumonia was associated with Co-LA: In 47 patients with extensive pneumonia, 33 patients (70%) developed Co-LA, of whom 18 (55%) developed fibrotic Co-LA. In 52 with non-extensive pneumonia, 9 (17%) developed Co-LA: In 33 with no pneumonia, none (0%) developed Co-LA.

Conclusions: Higher severity of pneumonia at diagnosis was associated with the increased risk of development of Co-LA after 6-24 months of SARS-CoV-2 infection.

Keywords: 2019-nCoV, 2019 novel coronavirus; ARDS, acute respiratory distress syndrome; Abnormalities; COVID-19; COVID-19 pneumonia; COVID-19 related lung abnormalities; COVID-19, coronavirus disease 2019; Chest CT; Co-LA, post-COVID-19 lung abnormalities; DAD, diffuse alveolar damage; GGO, ground-glass opacity; ILA, interstitial lung abnormalities; ILD, interstitial lung disease; Lung; OP, organizing pneumonia; PE, pulmonary embolism; SARS-CoV2, severe acute respiratory syndrome coronavirus 2.

Abstract

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