{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:32:14Z","timestamp":1789000334239,"version":"build-2803163510"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T00:00:00Z","timestamp":1764633600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007561","name":"Chiesi Foundation","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/100007561","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Petrus och Augusta Hedlunds Foundation","award":["M-2021-1670"],"award-info":[{"award-number":["M-2021-1670"]}]},{"name":"Heart and Lung Foundation","award":["20200921, 20210114, 20210209"],"award-info":[{"award-number":["20200921, 20210114, 20210209"]}]},{"name":"City Council of Stockholm","award":["ALF"],"award-info":[{"award-number":["ALF"]}]},{"name":"City Council of Stockholm","award":["ALF"],"award-info":[{"award-number":["ALF"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Persistent respiratory symptoms in COVID-19 patients have raised concerns about structural remodelling in the lung. We assessed structural changes and their correlation with reduced DLCO, eight months after discharge, in previously hospitalised COVID-19 patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>An exploratory observational study was conducted on 26 male patients (mean age: 60 years, range: 50\u201369) previously hospitalised for COVID-19. CT scans, performed eight months post-discharge, were analysed using functional respiratory imaging (FRI) to assess lung structure and function. Analyses were made based on diffusion capacity for carbon monoxide (DLCO).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients with low DLCO (\u226475%; n\u2009=\u20099) exhibited a significantly lower proportion of small blood vessels with a cross-sectional area\u2009&lt;\u20095 mm\u00b2 compared to patients with normal DLCO (&gt;75%; n\u2009=\u200917) (median (IQR) 56 (51\u201359) % vs. 60 (56\u201364) %, p\u2009=\u20090.008), as well as a reduced absolute volume of small vessels with a cross-sectional area\u2009&lt;\u20095 mm\u00b2 (129 (121\u2013151) ml vs. 155 (132\u2013175) ml, p\u2009=\u20090.025). Bronchial dilatation was more evident in the low DLCO group, with a higher ratio of airway volume to lobar volume (siVaw) (149 (138\u2013165) % vs. 117 (93\u2013132) %, p\u2009=\u20090.002). SiVaw showed a significant inverse relationship with DLCO (r\u2009=\u2009\u20130.56, p\u2009=\u20090.004, R\u00b2\u2009=\u20090.31). Lobar volumes were reduced in both DLCO groups, and more pronounced in the low DLCO group (72 (65\u201381) % vs. 90 (79\u201395) %, p\u2009=\u20090.001), as was total lung capacity (TLC) (73 (64\u201385) % vs. 92 (85\u201398) % of predicted, p\u2009=\u20090.003). FEV\u2081\/FVC ratios were elevated in both groups, with a potential difference observed between the low and normal DLCO groups (110 (103\u2013118) % vs. 105 (95\u2013113) %, p\u2009=\u20090.074).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We demonstrate long-term vascular and airway remodelling detected with FRI in previously hospitalised COVID-19 patients and highlight potential mechanisms underlying persistent pulmonary dysfunction and emphasise the need to investigate the underlying pathophysiology to identify potential individualised treatment strategies for this patient group.<\/jats:p>\n                  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Yanagawa","year":"2010","journal-title":"Radiology"},{"issue":"3","key":"pone.0335075.ref019","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1088\/0031-9155\/52\/3\/018","article-title":"Improvement of spatial resolution in the longitudinal direction for isotropic imaging in helical CT","volume":"52","author":"S Tsukagoshi","year":"2007","journal-title":"Phys Med Biol"},{"issue":"4","key":"pone.0335075.ref020","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.01519-2022","article-title":"European Respiratory Society\/American Thoracic Society technical statement: standardisation of the measurement of lung volumes, 2023 update","volume":"62","author":"NR Bhakta","year":"2023","journal-title":"Eur Respir J"},{"issue":"1","key":"pone.0335075.ref021","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.00016-2016","article-title":"2017 ERS\/ATS standards for single-breath carbon monoxide uptake in the lung","volume":"49","author":"BL Graham","year":"2017","journal-title":"Eur Respir J"},{"issue":"3","key":"pone.0335075.ref022","doi-asserted-by":"crossref","first-page":"299","DOI":"10.3109\/03009738609178670","article-title":"Reference values for lung function tests in men: regression equations with smoking variables","volume":"91","author":"H Hedenstr\u00f6m","year":"1986","journal-title":"Ups J Med Sci"},{"key":"pone.0335075.ref023","volume-title":"Diffusing Capacity of the Lungs for Carbon Monoxide","author":"P Modi","year":"2024"},{"issue":"11","key":"pone.0335075.ref024","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1159\/000518141","article-title":"Six-Month Pulmonary Impairment after Severe COVID-19: A Prospective, Multicentre Follow-Up Study","volume":"100","author":"P Faverio","year":"2021","journal-title":"Respiration"},{"issue":"2","key":"pone.0335075.ref025","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1111\/imj.15935","article-title":"Assessment of respiratory function and 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