COVİD-19 Pandemisinde Radyolojik Değerlendirme

Year 2021, Volume: 4 Issue: 4, 153 - 157, 29.12.2021

Ali Batur Selin Ardalı Düzgün Bülent Erbil Erhan Akpınar

https://doi.org/10.54996/anatolianjem.1037444

Abstract

COVİD-19 pandemisinin başlangıcından bu yana sağlık hizmetlerine erişimin zorlaşması, kaynakların etkin kullanımı için yapılan planlamalar, sağlık kurumlarına başvurularında sayısındaki ciddi artış, yüksek bulaşıcılık oranları, dekontaminasyon maliyet ve süreleri gibi değişkenler sebebiyle görüntüleme yöntemlerinin kullanımı açısından farklılıklar ortaya çıkmıştır. Özellikle COVİD-19 pandemisinin başlangıcında Amerikan Radyoloji Derneği (ACR) yayınladığı bildiri ile özellikle bilgisayarlı tomofrafi (BT) uygulaması sonrası dekontaminasyon sürecinin radyolojik hizmetlerin sunumunda aksamalar oluşturacağını, çapraz enfeksiyon riskini ve bulaş olasılığını artıracağını beyan etmiştir. Bu sebeple pandeminin ilk aylarında ACR COVİD-19 hastalarının taşınabilir cihazlarla çekilen direkt göğüs grafileri ile değerlendirilmesini önermiştir. Ancak ilerleyen zamanda toraks BT’nin tanı koymadaki duyarlılığının yüksekliği sebebiyle Covid-19 hastalarının yönetiminde BT yaygın olarak kullanılmaya başlanmıştır.

COVİD-19 pnömonisinin tipik bulguları, ağırlıklı olarak bazal ve posterior kesimlerde, subplevral yerleşimli buzlu cam dansiteleri, buzlu cam dansitelerine süperpoze olan intra/interlobüler septal kalınlaşmaların yol açtığı “arnavut kaldırımı” bulgusu ve konsolidasyonlardır. Buna ek olarak hava bronkogramları ve vasküler genişleme bulguları da eşlik edebilir. Bu bulgular direkt grafi, ultrasonografi ve bilgisayarlı tomografi (BT) aracılığıyla değerlendirilebilir.

Sonuç olarak hizmet sunum şartları, hasta sayıları, maliyet, teknik yeterlilik ve hasta yönetim planları gibi değişkenler sebebiyle COVİD-19 pnömoni yönetiminde kullanılan görüntüleme yöntemleri farklılıklar göstermiştir. Mevcut durumda halen COVİD-19 vakaları için kesin tanıya ulaştıran görüntüleme yöntemi yoktur. Mevcut görüntüleme yöntemleri sağlık hizmeti sunulan kurumun ve hizmet verilen hastaların özelliklerine göre değişkenlik gösterecektir. Bu değişkenlere uygun görüntüleme yöntemlerinin tercih edilmesi uygun olacaktır.

Keywords

COVİD-19, yatak başı ultrasonografi, bilgisayarlı tomografi, direkt grafi, radyoloji

Radiological Evaluation in the COVID-19 Pandemic

Abstract

Since the beginning of the COVID-19 pandemic, there have been differences in the use of imaging methods due to variables such as the difficulty of accessing health services, the planning made for the efficient use of resources, the significant increase in the number of admissions, high rates of contagiousness, cost, and duration of decontamination. Especially at the beginning of the COVID-19 pandemic, the American Society of Radiology (ACR) declared in its statement that the decontamination process, especially after the application of computed tomography, would cause disruptions in the delivery of radiological services, increase the risk of cross-infection and the possibility of transmission. For this reason, in the first months of the Pandemic, ACR recommended that COVID-19 patients be evaluated with portable direct chest radiographs. However, in the following period, the frequency of use of thorax CT increased due to its high sensitivity in diagnosis.

Typical findings of COVID-19 pneumonia are subpleural ground-glass densities, a “cobblestone” sign caused by intra/interlobular septal thickenings superposed to ground glass densities, and consolidations, predominantly in the basal and posterior segments. In addition, air bronchograms and signs of vascular enlargement may accompany. These findings can be evaluated by X-ray, ultrasonography, and computed tomography.

As a result, imaging methods used in the management of COVID-19 pneumonia differed due to variables such as service delivery conditions, number of patients, cost, technical competence, and patient management plans. Currently, there is no imaging method that leads to a definitive diagnosis for COVID-19 cases. Available imaging methods will vary according to the characteristics of the institution and the patients. It would be appropriate to choose imaging methods suitable for these variables.

Keywords

Covid-19, bedside ultrasonography, computed tomography, plain radiography, radiology

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