SARS-COV-2 is the culprit of COVID-19 disease. After a recapitulation of the pathological mechanism of infection, we will address the radiological imaging modalities used in the diagnosis of acute and chronic COVID-19 disease, and discuss how imaging contributes to the understanding of the sequelae of COVID-19 disease.

While X-ray and CT are the most commonly used imaging modalities in the acute setting of COVID-19 pneumonia, MRI is often used to evaluate other organ injuries caused by SARS-COV-2, especially cardiac or neurologic abnormalities.

We begin with acute COVID-19 infection of the lung. Hallmarks of COVID-19 pneumonia on imaging are bilateral and peripheral ground-glass opacities and consolidative pulmonary opacities. Many patients in the early stage of disease have a normal CT or chest radiograph. As time passes after the onset of symptoms, CT findings become more frequent and the entire lung is more involved. In severe cases, including ARDS, imaging findings of the lung injury may persist for a long time, often months after the acute infection, leading to fibrotic changes.

In addition, cardiac involvement in COVID-19 was an early focus of the pandemic, with initial studies suggesting a high burden of inflammatory changes in the heart. With the introduction of mandatory cardiac MRI scanning prior to resumption of play in college athletes, a unique opportunity arose to study cardiac involvement in a young and otherwise healthy population. In this setting, numerous studies have been performed that have led to a better understanding of cardiac involvement even in uncomplicated COVID-19. Pericarditis and myocarditis-like findings may be found in low single digits in this particular population. However, whether these findings have clinical significance, i.e., risk for sudden cardiac death or cardiac arrhythmias, remains to be determined.

Furthermore, acute and chronic changes in other organs such as the brain were reported in many COVID-19 patients. As with cardiac findings, the clinical significance of these findings must be determined. To this end, many studies have been initiated to determine these with a long-term follow-up.

Multiple other organs have been described to show abnormal imaging findings in COVID-19 disease. Some of these are the result of direct infection of the organs, while others are due to the often-strong activation of the immune system.

Finally, we will touch on vaccine-associated conditions. In general, establishing a causal link between myocarditis and vaccination is difficult, especially when the prevalence is rare. However, based on present data, pharmacovigilance for myocardial injury related to COVID-19 vaccination should be encouraged during the ongoing vaccination program. Vaccine-related myocardial injury should be considered in the differential diagnosis

Acknowledgements

No acknowledgement found.

References

No reference found.