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

Publication History

Received: 02 March 2021

Accepted: 11 May 2021

Article published online:
14 October 2021

• References

• 1 World Health Organization (WHO). WHO Coronavirus Disease (COVID-19) Dashboard. Im Internet (Stand: 02.05.2021): https://covid19.who.int
• 2 Robert-Koch-Institut (RKI). Aktueller Lage-/Situationsbericht des RKI zu COVID-19. Im Internet (Stand: 02.05.2021): https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/Gesamt.html
• 3 Cevik M, Kuppalli K, Kindrachuk J. et al. Virology, transmission, and pathogenesis of SARS-CoV-2. BMJ 2020; 371: m3862 DOI: 10.1136/bmj.m3862.
• 4 van Doremalen N, Bushmaker T, Morris DH. et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med 2020; 382: 1564-1567 DOI: 10.1056/NEJMc2004973.
• 5 Zhu J, Ji P, Pang J. et al. Clinical characteristics of 3062 COVID-19 patients: A meta-analysis. J Med Virol 2020; 92: 1902-1914 DOI: 10.1002/jmv.25884.
• 6 Agyeman AA, Chin KL, Landersdorfer CB. et al. Smell and Taste Dysfunction in Patients With COVID-19: A Systematic Review and Meta-analysis. Mayo Clin Proc 2020; 95: 1621-1631 DOI: 10.1016/j.mayocp.2020.05.030.
• 7 Pfeifer M, Hamer OW. [COVID-19 pneumonia]. Gastroenterologe 2020; 1-11 DOI: 10.1007/s11377-020-00488-x.
• 8 Salje H, Tran Kiem C, Lefrancq N. et al. Estimating the burden of SARS-CoV-2 in France. Science 2020; 369: 208-211 DOI: 10.1126/science.abc3517.
• 9 Gupta A, Madhavan MV, Sehgal K. et al. Extrapulmonary manifestations of COVID-19. Nat Med 2020; 26: 1017-1032 DOI: 10.1038/s41591-020-0968-3.
• 10 Ackermann M, Verleden SE, Kuehnel M. et al. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. N Engl J Med 2020; 383: 120-128 DOI: 10.1056/NEJMoa2015432.
• 11 Adams HJA, Kwee TC, Yakar D. et al. Chest CT Imaging Signature of Coronavirus Disease 2019 Infection: In Pursuit of the Scientific Evidence. Chest 2020; 158: 1885-1895 DOI: 10.1016/j.chest.2020.06.025.
• 12 Revzin MV, Raza S, Warshawsky R. et al. Multisystem Imaging Manifestations of COVID-19, Part 1: Viral Pathogenesis and Pulmonary and Vascular System Complications. Radiographics 2020; 40: 1574-1599 DOI: 10.1148/rg.2020200149.
• 13 Prokop M, van Everdingen W, van Rees Vellinga T. et al. CO-RADS – A categorical CT assessment scheme for patients with suspected COVID-19: definition and evaluation. Radiology 2020; 201473 DOI: 10.1148/radiol.2020201473.
• 14 Wang Y, Dong C, Hu Y. et al. Temporal Changes of CT Findings in 90 Patients with COVID-19 Pneumonia: A Longitudinal Study. Radiology 2020; 296: E55-E64 DOI: 10.1148/radiol.2020200843.
• 15 Ding X, Xu J, Zhou J. et al. Chest CT findings of COVID-19 pneumonia by duration of symptoms. Eur J Radiol 2020; 127: 109009 DOI: 10.1016/j.ejrad.2020.109009.
• 16 Bernheim A, Mei X, Huang M. et al. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Radiology 2020; 200463 DOI: 10.1148/radiol.2020200463.
• 17 Pan F, Ye T, Sun P. et al. Time Course of Lung Changes On Chest CT During Recovery From 2019 Novel Coronavirus (COVID-19) Pneumonia. Radiology 2020; 200370 DOI: 10.1148/radiol.2020200370.
• 18 Pan Y, Guan H, Zhou S. et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol 2020; 30: 3306-3309 DOI: 10.1007/s00330-020-06731-x.
• 19 Wormanns D, Hamer OW. [Glossary of Terms for Thoracic Imaging--German Version of the Fleischner Society Recommendations]. Rofo 2015; 187: 638-661 DOI: 10.1055/s-0035-1553216.
• 20 Piyavisetpat N, Pongpirul K, Sukkasem W. et al. ‘Ring of fire’ appearance in COVID-19 pneumonia. BMJ Case Rep 2020; 13 DOI: 10.1136/bcr-2020-236167.
• 21 Müller CIS, Müller NL. Chest CT target sign in a couple with COVID-19 pneumonia. Radiol Bras 2020; 53: 252-254 DOI: 10.1590/0100-3984.2020.0089.
• 22 Jafari R, Maghsoudi H, Saburi A. A Unique Feature of COVID-19 Infection in Chest CT; “Pulmonary Target” Appearance. Acad Radiol 2021; 28: 146-147 DOI: 10.1016/j.acra.2020.11.004.
• 23 Yang R, Li X, Liu H. et al. Chest CT Severity Score: An Imaging Tool for Assessing Severe COVID-19. Radiol Cardiothorac Imaging 2020; 2 DOI: 10.1148/ryct.2020200047.
• 24 Inui S, Fujikawa A, Jitsu M. et al. Chest CT Findings in Cases from the Cruise Ship “Diamond Princess” with Coronavirus Disease 2019 (COVID-19). Radiol Cardiothorac Imaging 2020; 2: e200110 DOI: 10.1148/ryct.2020200110.
• 25 Kwee TC, Kwee RM. Chest CT in COVID-19: What the Radiologist Needs to Know. Radiographics 2020; 40: 1848-1865 DOI: 10.1148/rg.2020200159.
• 26 Duzgun SA, Durhan G, Demirkazik FB. et al. COVID-19 pneumonia: the great radiological mimicker. Insights Imaging 2020; 11: 118 DOI: 10.1186/s13244-020-00933-z.
• 27 Wong HYF, Lam HYS, Fong AH-T. et al. Frequency and Distribution of Chest Radiographic Findings in Patients Positive for COVID-19. Radiology 2020; 296: E72-E78 DOI: 10.1148/radiol.2020201160.
• 28 Cleverley J, Piper J, Jones MM. The role of chest radiography in confirming covid-19 pneumonia. BMJ 2020; 370: m2426 DOI: 10.1136/bmj.m2426.
• 29 Stephanie S, Shum T, Cleveland H. et al. Determinants of Chest X-Ray Sensitivity for COVID- 19: A Multi-Institutional Study in the United States. Radiol Cardiothorac Imaging 2020; 2 DOI: 10.1148/ryct.2020200337.
• 30 Kanne JP, Little BP, Chung JH. et al. Essentials for Radiologists on COVID-19: An Update-Radiology Scientific Expert Panel. Radiology 2020; 296: E113-E114 DOI: 10.1148/radiol.2020200527.
• 31 Jacobi A, Chung M, Bernheim A. et al. Portable chest X-ray in coronavirus disease-19 (COVID-19): A pictorial review. Clin Imaging 2020; 64: 35-42 DOI: 10.1016/j.clinimag.2020.04.001.
• 32 Salehi S, Abedi A, Balakrishnan S. et al. Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging Findings in 919 Patients. Am J Roentgenol 2020; 215: 87-93 DOI: 10.2214/Am J Roentgenol.20.23034.
• 33 Soldati G, Smargiassi A, Inchingolo R. et al. Is There a Role for Lung Ultrasound During the COVID-19 Pandemic?. J Ultrasound Med Off J Am Inst Ultrasound Med 2020; 39: 1459-1462 DOI: 10.1002/jum.15284.
• 34 Revel M-P, Parkar AP, Prosch H. et al. COVID-19 patients and the radiology department – advice from the European Society of Radiology (ESR) and the European Society of Thoracic Imaging (ESTI). Eur Radiol 2020; DOI: 10.1007/s00330-020-06865-y.
• 35 Volpicelli G, Gargani L. Sonographic signs and patterns of COVID-19 pneumonia. Ultrasound J 2020; 12: 22 DOI: 10.1186/s13089-020-00171-w.
• 36 Vetrugno L, Bove T, Orso D. et al. Our Italian experience using lung ultrasound for identification, grading and serial follow-up of severity of lung involvement for management of patients with COVID-19. Echocardiography 2020; 37: 625-627 DOI: 10.1111/echo.14664.
• 37 Vetrugno L, Bove T, Orso D. et al. Lung Ultrasound and the COVID-19 “Pattern”: Not All That Glitters Today Is Gold Tomorrow. J Ultrasound Med 2020; 39: 2281-2282 DOI: 10.1002/jum.15327.
• 38 Rubin GD, Ryerson CJ, Haramati LB. et al. The Role of Chest Imaging in Patient Management during the COVID-19 Pandemic: A Multinational Consensus Statement from the Fleischner Society. Chest 2020; DOI: 10.1016/j.chest.2020.04.003.
• 39 Gross A, Heine G, Schwarz M. et al. Structured reporting of chest CT provides high sensitivity and specificity for early diagnosis of COVID-19 in a clinical routine setting. Br J Radiol 2021; 94: 20200574 DOI: 10.1259/bjr.20200574.
• 40 Schalekamp S, Bleeker-Rovers CP, Beenen LFM. et al. Chest CT in the Emergency Department for Diagnosis of COVID-19 Pneumonia: Dutch Experience. Radiology 2020; DOI: 10.1148/radiol.2020203465.
• 41 De Smet K, De Smet D, Ryckaert T. et al. Diagnostic Performance of Chest CT for SARS-CoV-2 Infection in Individuals with or without COVID-19 Symptoms. Radiology 2021; 298: E30-E37 DOI: 10.1148/radiol.2020202708.
• 42 Dangis A, Gieraerts C, Bruecker YD. et al. Accuracy and reproducibility of low-dose submillisievert chest CT for the diagnosis of COVID-19. Radiol Cardiothorac Imaging 2020; 2: e200196 DOI: 10.1148/ryct.2020200196.
• 43 Herpe G, Lederlin M, Naudin M. et al. Efficacy of Chest CT for COVID-19 Pneumonia in France. Radiology 2020; 202568 DOI: 10.1148/radiol.2020202568.
• 44 Schulze-Hagen M, Hübel C, Meier-Schroers M. et al. Low-Dose Chest CT for the Diagnosis of COVID-19—A Systematic, Prospective Comparison With PCR. Dtsch Arzteblatt Int 2020; 117: 389-395 DOI: 10.3238/arztebl.2020.0389.
• 45 Xie X, Zhong Z, Zhao W. et al. Chest CT for Typical 2019-nCoV Pneumonia: Relationship to Negative RT-PCR Testing. Radiology 2020; 200343 DOI: 10.1148/radiol.2020200343.
• 46 Huang P, Liu T, Huang L. et al. Use of Chest CT in Combination with Negative RT-PCR Assay for the 2019 Novel Coronavirus but High Clinical Suspicion. Radiology 2020; 295: 22-23 DOI: 10.1148/radiol.2020200330.
• 47 Raptis CA, Hammer MM, Short RG. et al. Chest CT and Coronavirus Disease (COVID-19): A Critical Review of the Literature to Date. Am J Roentgenol 2020; 215: 839-842 DOI: 10.2214/Am J Roentgenol.20.23202.
• 48 Feng Z, Yu Q, Yao S. et al. Early prediction of disease progression in COVID-19 pneumonia patients with chest CT and clinical characteristics. Nat Commun 2020; 11: 4968 DOI: 10.1038/s41467-020-18786-x.
• 49 Francone M, Iafrate F, Masci GM. et al. Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. Eur Radiol 2020; 30: 6808-6817 DOI: 10.1007/s00330-020-07033-y.
• 50 Wynants L, Van Calster B, Collins GS. et al. Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal. BMJ 2020; 369: m1328 DOI: 10.1136/bmj.m1328.
• 51 Vogel-Claussen J, Ley-Zaporozhan J, Agarwal P. et al. Recommendations of the Thoracic Imaging Section of the German Radiological Society for clinical application of chest imaging and structured CT reporting in the COVID-19 pandemic. Rofo 2020; 192: 633-640 DOI: 10.1055/a-1174-8378.
• 52 American College of Radiology (ACR). ACR Recommendations for the use of Chest Radiography and Computed Tomography (CT) for Suspected COVID-19 Infection (22.03.2020). Im Internet (Stand: 02.05.2021): https://www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/Recommendations-for-Chest-Radiography-and-CT-for-Suspected-COVID19-Infection
• 53 World Health Organization (WHO). Use of chest imaging in COVID-19 – A rapid advice guide (11.06.2020). Im Internet (Stand: 02.05.2021): https://www.who.int/publications-detail-redirect/use-of-chest-imaging-in-covid-19
• 54 Flor N, Dore R, Sardanelli F. On the Role of Chest Radiography and CT in the Coronavirus Disease (COVID-19) Pandemic. Am J Roentgenol 2020; 215: W44 DOI: 10.2214/Am J Roentgenol.20.23411.
• 55 Cheng Z, Yan F, Yang W. Reply to “On the Role of Chest Radiography and CT in the Coronavirus Disease (COVID-19) Pandemic”. Am J Roentgenol 2020; 215: W45 DOI: 10.2214/Am J Roentgenol.20.24159.
• 56 An JY, Unsdorfer KML, Weinreb JC. BI-RADS, C-RADS, CAD-RADS, LI-RADS, Lung-RADS, NI-RADS, O-RADS, PI-RADS, TI-RADS: Reporting and Data Systems. Radiographics 2019; 39: 1435-1436 DOI: 10.1148/rg.2019190087.
• 57 Schwartz LH, Panicek DM, Berk AR. et al. Improving communication of diagnostic radiology findings through structured reporting. Radiology 2011; 260: 174-181 DOI: 10.1148/radiol.11101913.
• 58 Simpson S, Kay FU, Abbara S. et al. Radiological Society of North America Expert Consensus Statement 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: e200152 DOI: 10.1148/ryct.2020200152.
• 59 de Jaegere TMH, Krdzalic J, Fasen BACM. et al. Radiological Society of North America Chest CT Classification System for Reporting COVID-19 Pneumonia: Interobserver Variability and Correlation with RT-PCR. Radiol Cardiothorac Imaging 2020; 2 DOI: 10.1148/ryct.2020200213.
• 60 Som A, Lang M, Yeung T. et al. Implementation of the Radiological Society of North America Expert Consensus Guidelines on Reporting Chest CT Findings Related to COVID-19: A Multireader Performance Study. Radiol Cardiothorac Imaging 2020; 2 DOI: 10.1148/ryct.2020200276.
• 61 Zimmerman M. Handreiking Standaardverslag CT-thorax COVID inclusief CO-RADS en CT score (13.05.2020). Im Internet (Stand: 02.05.2021): https://www.radiologen.nl/secties/netwerk-covid-19/documenten/handreiking-standaardverslag-ct-thorax-covid-inclusief-co-rads
• 62 Tan BK, Mainbourg S, Friggeri A. et al. Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis. Thorax 2021; DOI: 10.1136/thoraxjnl-2020-215383.
• 63 Katsanos AH, Palaiodimou L, Zand R. et al. The Impact of SARS-CoV-2 on Stroke Epidemiology and Care: A Meta-Analysis. Ann Neurol 2021; 89: 380-388 DOI: 10.1002/ana.25967.
• 64 Yaghi S, Ishida K, Torres J. et al. SARS-CoV-2 and Stroke in a New York Healthcare System. Stroke 2020; 51: 2002-2011 DOI: 10.1161/STROKEAHA.120.030335.
• 65 Albiero R, Seresini G. Letter by Albiero and Seresini Regarding Article, “SARS-CoV-2 and Stroke in a New York Healthcare System”. Stroke 2020; 51: e310-e311 DOI: 10.1161/STROKEAHA.120.031093.
• 66 Spence JD, de Freitas GR, Pettigrew LC. et al. Mechanisms of Stroke in COVID-19. Cerebrovasc Dis 2020; 49: 451-458 DOI: 10.1159/000509581.
• 67 Modin D, Claggett B, Sindet-Pedersen C. et al. Acute COVID-19 and the Incidence of Ischemic Stroke and Acute Myocardial Infarction. Circulation 2020; 142: 2080-2082 DOI: 10.1161/CIRCULATIONAHA.120.050809.
• 68 Kang Y, Chen T, Mui D. et al. Cardiovascular manifestations and treatment considerations in COVID-19. Heart 2020; 106: 1132-1141 DOI: 10.1136/heartjnl-2020-317056.
• 69 Singh B, Kaur P. COVID-19 and acute mesenteric ischemia: A review of literature. Hematol Transfus Cell Ther 2020; DOI: 10.1016/j.htct.2020.10.959.
• 70 Bhayana R, Som A, Li MD. et al. Abdominal Imaging Findings in COVID-19: Preliminary Observations. Radiology 2020; 297: E207-E215 DOI: 10.1148/radiol.2020201908.
• 71 Goldberg-Stein S, Fink A, Paroder V. et al. Abdominopelvic CT findings in patients with novel coronavirus disease 2019 (COVID-19). Abdom Radiol (NY) 2020; 45: 2613-2623 DOI: 10.1007/s00261-020-02669-2.
• 72 Avila J, Long B, Holladay D. et al. Thrombotic complications of COVID-19. Am J Emerg Med 2021; 39: 213-218 DOI: 10.1016/j.ajem.2020.09.065.
• 73 Bellosta R, Luzzani L, Natalini G. et al. Acute limb ischemia in patients with COVID-19 pneumonia. J Vasc Surg 2020; 72: 1864-1872 DOI: 10.1016/j.jvs.2020.04.483.
• 74 Kashi M, Jacquin A, Dakhil B. et al. Severe arterial thrombosis associated with Covid-19 infection. Thromb Res 2020; 192: 75-77 DOI: 10.1016/j.thromres.2020.05.025.
• 75 Egbert AR, Cankurtaran S, Karpiak S. Brain abnormalities in COVID-19 acute/subacute phase: A rapid systematic review. Brain Behav Immun 2020; 89: 543-554 DOI: 10.1016/j.bbi.2020.07.014.
• 76 Kremer S, Lersy F, Anheim M. et al. Neurologic and neuroimaging findings in patients with COVID-19: A retrospective multicenter study. Neurology 2020; 95: e1868-e1882 DOI: 10.1212/WNL.0000000000010112.
• 77 Jain R, Young M, Dogra S. et al. COVID-19 related neuroimaging findings: A signal of thromboembolic complications and a strong prognostic marker of poor patient outcome. J Neurol Sci 2020; 414: 116923 DOI: 10.1016/j.jns.2020.116923.
• 78 Kremer S, Lersy F, de Sèze J. et al. Brain MRI Findings in Severe COVID-19: A Retrospective Observational Study. Radiology 2020; 297: E242-E251 DOI: 10.1148/radiol.2020202222.
• 79 Shi S, Qin M, Shen B. et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol 2020; 5: 802-810 DOI: 10.1001/jamacardio.2020.0950.
• 80 Guo T, Fan Y, Chen M. et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol 2020; 5: 811-818 DOI: 10.1001/jamacardio.2020.1017.
• 81 Ruan Q, Yang K, Wang W. et al. 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: 846-848 DOI: 10.1007/s00134-020-05991-x.
• 82 Bavishi C, Bonow RO, Trivedi V. et al. Special Article – Acute myocardial injury in patients hospitalized with COVID-19 infection: A review. Prog Cardiovasc Dis 2020; 63: 682-689 DOI: 10.1016/j.pcad.2020.05.013.
• 83 Knight DS, Kotecha T, Razvi Y. et al. COVID-19: Myocardial Injury in Survivors. Circulation 2020; 142: 1120-1122 DOI: 10.1161/CIRCULATIONAHA.120.049252.
• 84 Puntmann VO, Carerj ML, Wieters I. et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiol 2020; 5: 1265-1273 DOI: 10.1001/jamacardio.2020.3557.
• 85 Revzin MV, Raza S, Srivastava NC. et al. Multisystem Imaging Manifestations of COVID-19, Part 2: From Cardiac Complications to Pediatric Manifestations. Radiographics 2020; 40: 1866-1892 DOI: 10.1148/rg.2020200195.
• 86 Kim L, Whitaker M, O’Halloran A. et al. Hospitalization Rates and Characteristics of Children Aged <18 Years Hospitalized with Laboratory-Confirmed COVID-19 – COVID-NET, 14 States, March 1-July 25, 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 1081-1088 DOI: 10.15585/mmwr.mm6932e3.
• 87 Riphagen S, Gomez X, Gonzalez-Martinez C. et al. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020; 395: 1607-1608 DOI: 10.1016/S0140-6736(20)31094-1.
• 88 Huang C, Huang L, Wang Y. et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021; 397: 220-232 DOI: 10.1016/S0140-6736(20)32656-8.
• 89 Han X, Fan Y, Alwalid O. et al. Six-Month Follow-up Chest CT findings after Severe COVID-19 Pneumonia. Radiology 2021; 203153 DOI: 10.1148/radiol.2021203153.
• 90 Finkenzeller T, Lenhart S, Reinwald M. et al. Risk to Radiology Staff for Occupational COVID-19 Infection in a High-Risk and a Low-Risk Region in Germany: Lessons from the “First Wave”. Rofo 2021; DOI: 10.1055/a-1393-6668.