Manejo y seguimiento radiológico del paciente post-COVID-19

Alarcón-Rodríguez, J.; Fernández-Velilla, M.; Ureña-Vacas, A.; Martín-Pinacho, J. J.; Rigual-Bobillo, J. A.; Jaureguízar-Oriol, A.; Gorospe-Sarasúa, L.

La mayor parte de los pacientes que superan la infección por SARS-CoV-2 no presentan complicaciones ni requieren un seguimiento específico, pero una proporción significativa (especialmente aquellos con formas clínicas moderadas/graves de la enfermedad) necesitan un seguimiento clínico-radiológico. Aunque apenas existen referencias o guías clínicas sobre el seguimiento a largo plazo de estos pacientes post-COVID-19, se están realizando pruebas radiológicas y constituyendo consultas monográficas de vigilancia en la mayor parte de los centros hospitalarios para atender sus necesidades. El propósito de este trabajo es compartir nuestra experiencia en el manejo del paciente post-COVID-19 en dos instituciones que han tenido una elevada incidencia de la COVID-19 y proponer unas recomendaciones generales de seguimiento desde una perspectiva clínica y radiológica. Objective To describe the computed tomography (CT) findings in patients with COVID-19 in different phases of the disease and to evaluate the reliability and reproducibility of a visual radiologic score to estimate the lung inflammatory burden. Methods We retrospectively reviewed chest CT studies from 182 patients with RT-PCR findings positive for SARS-CoV-2. Patients were classified according to the time elapsed from the onset of symptoms, as follows: early (0-4 days), intermediate/progressive (5-9 days), or advanced (≥10 days). We analyzed the frequency of each radiologic finding, as well as the predominant pattern, appearance, and distribution of lung involvement. A visual tomographic score (range, 0-25) was used to estimate the inflammatory in each lobe and in the entire lung volume. Results The predominant CT finding was the ground-glass pattern (n=110; 60.4%), the most common distribution was peripheral (n = 116; 66.7%), and the most prevalent appearance was typical (n=112; 61.5%). The halo sign was seen most frequently in the early phase, whereas ground-glass opacities, the crazy paving pattern, and subpleural bands were more common in the intermediate/progressive and advanced phases. The median severity score was 10 (IQR: 5-13), and the scores increased as the disease progressed. The interobserver agreement (kappa) was 0.89 for the visual score. Conclusion The CT findings in patients with COVID-19 vary with the course of the infection. The proposed visual radiologic score is a simple, reproducible, and reliable tool for assessing lung involvement in COVID-19 pneumonia.