Cardiovascular Imaging Manifestations of COVID-19 to Watch For

A presentation given at the Radiological Society of North America (RSNA) Annual Meeting on November 28th covered the cardiovascular imaging manifestations of COVID-19.

“SARS-CoV-2 is a novel coronavirus which primarily affects the respiratory system, but has also been shown to impact other systems, especially with the hypercoagulable state,” said Margaret Revzon, M.D., an associate professor of radiology and biomedical imaging at Yale School of Medicine, in New Haven, Conn. “The hypercoagulable state and resulted vascular complications are not uncommon in patients with COVID-19.”

COVID-19 can result in cardiac complications including myocarditis, arterial and venous thromboembolism, and cardiomyopathy. While ultrasound is the first imaging choice for these patients, computerized tomography (CT) can be selected, but clinicians must note that the COVID-19 patient is often in the prone position. Magnetic resonance imaging (MRI) can be used for complex cases. Dr. Revzon highlighted that awareness and recognition of imaging manifestations of COVID-19 induced thromboembolic complications will ensure optimal treatment for these patients.  

Brian Burns Ghoshhajra, M.D., associate professor of radiology at Harvard medical School in Boston, Mass., said that “there is systematic inflammation, endothelial activation and direct myocardial effects of SARS-CoV-2.”

While cardiovascular imaging, including CT and MRI, play a key role, context and pre-test probably likely matter more than ever. Dr. Ghoshhajra suggested that radiology services should be optimized for cardiac imaging.

“COVID-19 doesn’t occur in a vacuum, so remember your basics and cast a wide diagnostic net of there is not an established COVID-19 diagnosis yet,” Dr. Ghoshhajra said.

There have also been infrequent emerging reports of myocarditis and myocardial injury in a minority of patients after COVID-19 vaccination.

Kate Hanneman, M.D., FRCPC, an associate professor in the department of medical imaging at Women's College Hospital in Toronto, Canada, explained that there are limited data on what cardiac imaging findings are expected in these patients. However, the pattern on imaging appears to be like myocarditis from other causes, but less extensive compared to other causes of myocarditis.

“The extent on imaging, based on the reports we have to date, appears to be relatively mild. So less extensive compared to some other causes of myocarditis,” Dr. Hanneman said.

For more coverage of RSNA 2021, click here.