Ein Jahr COVID-19-Pandemie: Was wir Radiologen über die Bildgebung gelernt haben

Zusammenfassung

Hintergrund Seit seinem Ausbruch im Dezember 2019 haben sich weltweit mehr als 151 Millionen Menschen mit Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infiziert. Mehr als 3,1 Millionen Menschen starben an Coronavirus Disease 2019 (COVID-19), der durch das Virus ausgelösten Erkrankung. Hauptmanifestationsort ist neben den oberen Atemwegen die Lunge, wo es zu Pneumonien unterschiedlichen Schweregrades kommt. Darüber hinaus führt SARS-CoV-2 über direkte wie auch indirekte pathogenetische Mechanismen zu verschiedensten extrapulmonalen und vaskulären Manifestationen.

Methode Basierend auf einer systematischen Literaturrecherche mittels PubMed wurden Originalarbeiten, Metaanalysen, Übersichtsartikel und Fallberichte ausgewählt, die den aktuellen Wissensstand zur Bildgebung von COVID-19, insbesondere zum Erscheinungsbild pulmonaler wie extrapulmonaler Manifestationen sowie zur Indikation bildgebender Untersuchungen, wiedergeben. Diese Informationen wurden in der vorliegenden Übersichtsarbeit zusammengefasst und in grundlegende pathophysiologische Zusammenhänge eingeordnet.

Ergebnisse und Schlussfolgerungen Typische Zeichen einer COVID-19-Pneumonie sind multifokale, meist bilaterale, rundliche bzw. polyzyklische, teilweise auch landkartenartig konfluierende Milchglasareale und/oder Konsolidierungen in vorwiegend peripherer Verteilung; in schwereren Fällen sind zusätzlich auch peribronchovaskuläre Lungenabschnitte betroffen. Weitere typische Zeichen sind ein „Crazy Paving“-Muster, seltener auch ein Halo oder Reversed Halo. Venöse Thromboembolien (u. a. Lungenarterienembolien) sind die häufigsten vaskulären Komplikationen von COVID-19, aber auch arterielle thromboembolische Ereignisse wie ischämische Schlaganfälle, Myokardinfarkte und systemische arterielle Embolien treten vermehrt auf. Die häufigsten extrapulmonalen Organmanifestationen von COVID-19 betreffen das Gehirn, das Herz, das hepatobiliäre System sowie den Gastrointestinaltrakt und sind häufig ebenfalls bildmorphologisch zu erkennen. Die größte Rolle bei der bildgebenden Diagnostik von COVID-19 spielt das Thorax-CT. Sein Wert liegt weniger in der primären Diagnosestellung als in der differenzialdiagnostischen Abgrenzung, Einschätzung des Schweregrades sowie Detektion von Begleiterkrankungen und Komplikationen.

Kernaussagen: 

• Typische Zeichen einer COVID-19-Pneumonie sind multifokale, vorwiegend periphere Milchglasareale und/oder Konsolidierungen.

• Bildgebung dient der differenzialdiagnostischen Abgrenzung, Einschätzung des Schweregrades und Detektion von Komplikationen.

• Venöse Thromboembolien, insbesondere Lungenarterienembolien, sind die häufigsten vaskulären Komplikationen von COVID-19.

• Arterielle Thromboembolien wie ischämische Schlaganfälle oder Myokardinfarkte treten ebenfalls vermehrt auf.

• Extrapulmonal betrifft COVID-19 am häufigsten Gehirn, Herz, hepatobiliäres System und Gastrointestinaltrakt.

Zitierweise

• Gross A, Albrecht T. One year of COVID-19 pandemic: what we Radiologists have learned about imaging. Fortschr Röntgenstr 2022; 194: 141 – 151

Key words

COVID-19 - COVID-19 pneumonia - SARS-CoV-2 - CO-RADS - extrapulmonary manifestations - pneumonia

Publikationsverlauf

Eingereicht: 02. März 2021

Angenommen: 11. Mai 2021

Artikel online veröffentlicht:
14. Oktober 2021

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