Bronchovascular texture pattern on quantitative CT reveals airway and vascular remodeling in post-COVID-19 Lungs

Xuan Zhang; Prathish K Rajaraman; Alejandro P Comellas; Eric A Hoffman; Tianbao Yang; Junfeng Guo; Ching-Long Lin

doi:10.1186/s12931-026-03784-2

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Bronchovascular texture pattern on quantitative CT reveals airway and vascular remodeling in post-COVID-19 Lungs

Journal article

Open access

Peer reviewed

Bronchovascular texture pattern on quantitative CT reveals airway and vascular remodeling in post-COVID-19 Lungs

Xuan Zhang, Prathish K Rajaraman, Alejandro P Comellas, Eric A Hoffman, Tianbao Yang, Junfeng Guo and Ching-Long Lin

Respiratory research

06/26/2026

DOI: 10.1186/s12931-026-03784-2

PMID: 42363216

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Abstract

The long-term consequences of COVID-19 remain poorly understood. To assess CT image-based biomarkers and clinical symptoms in COVID-19 survivors approximately 3-4 years after infection. Eighty post-COVID-19 participants (81% infected with the pre-Alpha strain) underwent pulmonary function tests (PFTs) and inspiratory/expiratory CT at approximately 5 months (Visit 1, V1) and 3-4 years (Visit 2, V2) after infection. At V2, participants completed the St. George's Respiratory Questionnaire (SGRQ), Leicester Cough Questionnaire (LCQ), Fatigue Severity Scale (FSS), modified Medical Research Council Dyspnea Scale (mMRC), and a study-specific symptom and medical history questionnaire. Seventy-eight healthy individuals served as controls. Image-based biomarkers included airway diameter, airway wall thickness, functional small airway disease percentage (fSAD%), ground-glass opacity percentage (GGO%), and bronchovascular percentage (Bronchovascular%). Post-COVID-19 participants exhibited normal predicted PFT values, but consistently lower DLCO compared with healthy controls at both visits. At V2, they also reported significantly worse SGRQ scores than the general population, indicating reduced quality of life. Although the elevated fSAD% and GGO% observed at V1 largely resolved by V2, several biomarkers of airway and vascular remodeling persisted, including increased Bronchovascular%, airway narrowing and wall thickening, and a compositional shift from large to small airways and a shift from small to large vessels. Persistent symptoms-such as fatigue, brain fog, cough, and hypertension-were associated with these structural abnormalities. Airway and vascular structural abnormalities persisted in COVID-19 survivors 3-4 years after infection and were associated with ongoing symptoms and reduced quality of life.

Computed Tomography

COVID-19

Long COVID

Airway and vascular remodeling

Small airway disease

Fibrosis

Details

Title: Subtitle: Bronchovascular texture pattern on quantitative CT reveals airway and vascular remodeling in post-COVID-19 Lungs
Creators: Xuan Zhang - University of Iowa
Prathish K Rajaraman - University of Iowa
Alejandro P Comellas - University of Iowa
Eric A Hoffman - University of Iowa
Tianbao Yang - Texas A&M University
Junfeng Guo - University of Iowa
Ching-Long Lin - University of Iowa
Resource Type: Journal article
Publication Details: Respiratory research
DOI: 10.1186/s12931-026-03784-2
PMID: 42363216
NLM abbreviation: Respir Res
ISSN: 1465-993X
eISSN: 1465-993X
Publisher: Springer Nature
Grant note: NIH R01-HL168116 / NIH HHS ED P116S210005 / Department of Education, United States
Language: English
Electronic publication date: 06/26/2026
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Pulmonary, Critical Care, and Occupational Medicine; ICTS; IIHR--Hydroscience and Engineering; Mechanical Engineering; Internal Medicine
Record Identifier: 9985176660102771

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