{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T06:08:03Z","timestamp":1771481283329,"version":"3.50.1"},"reference-count":47,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T00:00:00Z","timestamp":1771113600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007109","name":"University of Ferrara","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100007109","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Purpose: To explore the correlation between radiologic patterns on high-resolution computed tomography (HRCT) and circulating biomarkers of inflammation and endothelial activation in patients with COVID-19 pneumonia, with the aim of identifying imaging-biomarker phenotypes that may offer insights for clinical stratification. Materials and Methods: This prospective single-center study included 84 consecutive patients hospitalized with PCR-confirmed SARS-CoV-2 infection and respiratory failure. All underwent baseline HRCT, along with parallel biohumoral profiling, including inflammatory (IL-1Ra, IL-6, IL-10) and endothelial (Angiopoietin-2, sVCAM-1, sE-Selectin) biomarkers. HRCT scans were reviewed for parenchymal and vascular abnormalities (vascular tree-in-bud [TIB], vascular enlargement pattern [VEP]). Semi-quantitative scores were assigned for parenchymal (PS) and vascular (VS) involvement. Results: Patients with higher PS had significantly prolonged hospital stay (35 vs. 17 days; p = 0.014), increased ICU admission rates (68.8% vs. 21.4%; p = 0.003), and elevated serum levels of IL-1Ra, IL-6, and IL-10 (p &lt; 0.05). At multivariable analysis, PS remained independently associated with ICU admission after adjustment for age, inflammatory burden, and comorbidities (p = 0.014). A high VS was associated with significantly increased Angiopoietin-2 levels (p = 0.036), although it did not directly correlate with ICU admission or mortality. A significant positive correlation was observed between PS and VS (r =0.392; p &lt; 0.001). Conclusions: in this study, HRCT-based parenchymal and vascular patterns appear significantly correlated with biological processes occurring in severe COVID-19 pneumonia. These observations, although preliminary, may offer a conceptual basis for future studies exploring radiologic and biomarker-based stratification in severe respiratory infections.<\/jats:p>","DOI":"10.3390\/diagnostics16040587","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T14:09:54Z","timestamp":1771250994000},"page":"587","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Integrated Analysis of Parenchymal and Vascular HRCT Patterns with Circulating Biomarkers in Severe COVID-19 Pneumonia"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8191-6042","authenticated-orcid":false,"given":"Aldo","family":"Carnevale","sequence":"first","affiliation":[{"name":"Radiology Section, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7264-206X","authenticated-orcid":false,"given":"Luca","family":"Morandi","sequence":"additional","affiliation":[{"name":"Pneumology Unit, Cardiothoracic and Vascular Department, Sant\u2019Anna University Hospital, 44123 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9739-4082","authenticated-orcid":false,"given":"Gaetano","family":"Scaramuzzo","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5027-5318","authenticated-orcid":false,"given":"Savino","family":"Spadaro","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianluca Calogero","family":"Campo","sequence":"additional","affiliation":[{"name":"Cardiology Section, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melchiore","family":"Giganti","sequence":"additional","affiliation":[{"name":"Radiology Section, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Papi","sequence":"additional","affiliation":[{"name":"Pneumology Section, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Contoli","sequence":"additional","affiliation":[{"name":"Pneumology Section, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,15]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization Data (2024, July 23). 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