Is there a role for lung perfusion [^99mTc]-MAA SPECT/CT to rule out pulmonary embolism in COVID-19 patients with contraindications for iodine contrast?

Excerpt

The resent pandemic of the 2019 novel coronavirus disease (COVID-19) is challenging medical institutions around the world. Management of severe acute respiratory symptoms (SARS) caused by the novel corona virus often includes intensive care and invasive ventilation. One important complication associated with COVID-19 disease and a potential differential diagnosis in sudden respiratory distress is pulmonary embolism (PE). A retrospective cohort study by Zhou et al. demonstrated respiratory failure to be the most common complication with 54% of the patients leading transfers to the Intensive Care Unit and death. Severe coagulopathy was present in 19%, but rates differed significantly between survivors (7%) and non-survivors (50%) [1]. This phenomenon is already well known in interalia influenza-associated pneumonia and leads to a predisposition for ischemic events and thrombosis [2]. On this basis, recent data open the discussion of anticoagulation in severe cases of COVID-19 as treatment with low-molecular-weight heparin (LMWH) appeared to be associated with reduced mortality [3]. Therefore, the International Society of Thrombosis and Hemostasis (ISTH) recently published the recommendation that all patients hospitalized for COVID-19 should receive a prophylactic dose of LMWH during hospitalization, in the absence of any contraindications such as active bleeding or platelet counts of less than 25 × 10⁹/l [4]. …