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01.09.2021 | Chest Radiology

Tocilizumab effects in COVID-19 pneumonia: role of CT texture analysis in quantitative assessment of response to therapy

verfasst von: Giorgio Maria Masci, Franco Iafrate, Fabio Ciccarelli, Giacomo Pambianchi, Valeria Panebianco, Patrizia Pasculli, Maria Rosa Ciardi, Claudio Maria Mastroianni, Paolo Ricci, Carlo Catalano, Marco Francone

Erschienen in: La radiologia medica | Ausgabe 9/2021

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Abstract

Purpose

To evaluate CT and laboratory changes in COVID-19 patients treated with tocilizumab, compared to a control group, throughout a combined semiquantitative and texture analysis of images.

Materials and methods

From March 11 to April 20, 2020, 57 SARS-CoV-2 positive patients were retrospectively compared: group T (n = 30) receiving tocilizumab and group non-T (n = 27) undergoing only antivirals/antimalarials. Chest-CT and laboratory findings were analyzed before and after treatment. CT evaluation included both semiquantitative scoring and texture analysis of all parenchymal lesions. Survival and recovery analyses were also provided with Kaplan–Meier method.

Results

In group T, no significant differences were found for CT score after treatment, while several texture features significantly changed, including mean attenuation (p < 0.0001), skewness (p < 0.0001), entropy (p = 0.0146) and higher-order parameters, suggesting considerable fading of parenchymal lesions. PaO₂/FiO₂ mean value significantly increased after treatment, from 240 ± 93 to 363 ± 107 (p = 0.0003), with parallel decrease in inflammatory biomarkers (CRP, D-dimer and LDH).

In group non-T, CT scoring, texture and laboratory parameters showed significant worsening at follow-up. Findings were clinically associated with opposite trends between two groups, with reduction of severe cases in group T (from 21/30 to 5/30; p < 0.0001) as compared to a significant worsening in group non-T (severe cases increasing from 6/27 to 14/27; p = 0.0473).

Probability of discharge was significantly higher in group T (p < 0.0001), as well as survival rate, although not statistically significant.

Conclusions

Our results suggest the potential role of CT texture analysis for assessing response to treatment in COVID-19 pneumonia, using Tocilizumab, as compared to semiquantitative evaluation, providing insight into the intrinsic parenchymal changes.

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Titel: Tocilizumab effects in COVID-19 pneumonia: role of CT texture analysis in quantitative assessment of response to therapy
verfasst von: Giorgio Maria Masci
Franco Iafrate
Fabio Ciccarelli
Giacomo Pambianchi
Valeria Panebianco
Patrizia Pasculli
Maria Rosa Ciardi
Claudio Maria Mastroianni
Paolo Ricci
Carlo Catalano
Marco Francone
Publikationsdatum: 01.09.2021
Verlag: Springer Milan
Erschienen in: La radiologia medica / Ausgabe 9/2021
Print ISSN: 0033-8362
Elektronische ISSN: 1826-6983
DOI: https://doi.org/10.1007/s11547-021-01371-7

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Tocilizumab effects in COVID-19 pneumonia: role of CT texture analysis in quantitative assessment of response to therapy