Efficacy of Chest CT for COVID-19 Pneumonia Diagnosis in France.

Background The role and performance of chest CT in the diagnosis of the coronavirus disease 2019 (COVID-19) pandemic remains under active investigation. Purpose To evaluate the French national experience using chest CT for COVID-19, results of chest CT and reverse transcription polymerase chain reaction (RT-PCR) assays were compared together and with the final discharge diagnosis used as the reference standard. Materials and Methods A structured CT scan survey (NCT04339686) was sent to 26 hospital radiology departments in France between March 2, 2020, and April 24, 2020. These dates correspond to the peak of the national COVID-19 epidemic. Radiology departments were selected to reflect the estimated geographic prevalence heterogeneities of the epidemic. All symptomatic patients suspected of having COVID-19 pneumonia who underwent both initial chest CT and at least one RT-PCR test within 48 hours were included. The final discharge diagnosis, based on multiparametric items, was recorded. Data for each center were prospectively collected and gathered each week. Test efficacy was determined by using the Mann-Whitney test, Student t test, χ2 test, and Pearson correlation coefficient. P < .05 indicated a significant difference. Results Twenty-six of 26 hospital radiology departments responded to the survey, with 7500 patients entered; 2652 did not have RT-PCR test results or had unknown or excess delay between the RT-PCR test and CT. After exclusions, 4824 patients (mean age, 64 years ± 19 [standard deviation], 2669 male) were included. With final diagnosis as the reference, 2564 of the 4824 patients had COVID-19 (53%). Sensitivity, specificity, negative predictive value, and positive predictive value of chest CT in the diagnosis of COVID-19 were 2319 of 2564 (90%; 95% CI: 89, 91), 2056 of 2260 (91%; 95% CI: 91, 92), 2056 of 2300 (89%; 95% CI: 87, 90), and 2319 of 2524 (92%; 95% CI: 91, 93), respectively. There was no significant difference for chest CT efficacy among the 26 geographically separate sites, each with varying amounts of disease prevalence. Conclusion Use of chest CT for the initial diagnosis and triage of patients suspected of having coronavirus disease 2019 was successful. © RSNA, 2021 Online supplemental material is available for this article.

Real three-dimensional assessment of left atrial and left atrial appendage volumes by 64-slice spiral computed tomography in individuals with or without cardiovascular disease.

CONTEXT: Left atrial (LA) volume is a prognosis factor of cardiovascular morbidity in patients with cardiovascular disease (CD). Recent developments of multislice computed tomography (MSCT) have made non invasive coronary angiography reliable for selected patients and new software facilitates truly volume measurements without geometrical assumptions. OBJECTIVE: To define, by using MSCT, LA and left atrial appendage (LAA) volumes in patients with or without CD. METHODS AND RESULTS: In the population of patients referred to our laboratory for a conventional MSCT coronary angiography, 40 individuals without CD (Normal group) and 80 patients with CD (CD group) were prospectively selected. The CD group was constituted from 4 subgroups of patients with either coronary artery disease (n=20), idiopathic dilated cardiomyopathy (n=20), left ventricular hypertrophy (n=20) or severe mitral regurgitation (MR group, n=20). LAA and LA volumes were measured on a commercially available workstation. LA maximal and minimal volumes were lower in Normal group than in CD group, as LA ejection fraction (54+/-10 versus 67+/-20 ml/m(2), p<0.0001; 31+/-8 versus 46+/-20 ml/m(2), p<0.0001; 43+/-8% versus 33+/- 14%, p<0.001). LAA volume was larger in MR group than in Normal group (15+/-7 ml versus 9+/-3 ml, p<0.0001). CONCLUSION: This MSCT study provides normal values of LA and LAA volumes for patients who underwent MSCT coronary angiography and suggests that MSCT is helpful to assess the changes of LA volumes related to various CD.

A new method for measurement of left atrial volumes using 64-slice spiral computed tomography: comparison with two-dimensional echocardiographic techniques.

BACKGROUND: Left atrial (LA) volume, is related to cardiovascular morbidity. LA enlargement is usually assessed using trans-thoracic echocardiography (TTE). The association of modern multislice computed tomography (MSCT) imaging and new 3D reconstruction software, allows direct cardiac chamber volume measurement without geometrical assumptions. This study was designed to evaluate the maximal (LAmax) and minimal (LAmin) LA volumes during the cardiac cycle using MSCT and TTE approaches. METHODS: We screened 26 consecutive patients referred for coronary imaging using a 64-MSCT scanner and a TTE within 12 h. Contiguous multiphase images were generated from axial MSCT data and semi-automated 3D segmentation technique was applied to generate LA volumes. Using TTE, LA volumes and LA ejection fraction (LAEF) were obtained using five assumptions methods: cubing equation, diameter-length formula, area-length formula, ellipsoidal formula and biplane Simpson rule. RESULTS: Five patients were excluded for inadequate TTE visualization and one for ectopic beats during MSCT. The sample consisted in 20 patients (11 men, age: 56+/-14 years). Using MSCT, LA volumes indexed to body surface area were: LAmax=74+/-27 ml/m(2), LAmin=49+/-26 ml/m(2), with close correlations with TTE measurements and a significant underestimation by all TTE approaches. A close correlation was observed between LAEF using MSCT and TTE Simpson's method: 36+/-14% vs. 37+/-14%, r=0.99, p<0.0001. CONCLUSION: Theses results suggest that the assessment of LA volumes and ejection fraction was reliable using 64-MSCT in patients referred for coronary computed tomography imaging.

A rare case of left superior vena cava draining into left atrium demonstrated by MDCT.

We describe a rare case of persistent left superior vena cava draining directly into the left atrium with no associated anomaly of the coronary sinus or the atrial septum, discovered by multidetector computed tomography.

Prospective evaluation of the anatomy of the coronary venous system using multidetector row computed tomography.

BACKGROUND: Multidetector row computed tomography (MDCT) is a developing technique mainly used to evaluate the coronary arteries, but less attention has been paid to the coronary venous system. However, with the dramatic technological advancement of percutaneous therapies for heart failure or mitral insufficiency, a better knowledge about the anatomy of the coronary venous system may be of great utility. We sought the efficacy of MDCT imaging to delineate the coronary venous system. METHODS: 16 row MDCT scans were performed in 50 consecutive patients (42 men, age 61+/-15 years, all in sinus rhythm). The inter-individual variability in terms of diameter, distance, angle of the main tributaries of the coronary venous system was reported. RESULTS: The coronary venous system was always visualized. A remnant Thebesian valve was observed in 18 patients, the diameter of the coronary sinus ostium was found 12.2+/-3.6 mm and 15.3+/-3.7 mm respectively in the antero-posterior and supero-inferior directions, the distance between the posterior vein of the left ventricle (PVLV) and the anterior interventricular vein (AIV) was found 108.6+/-15.2 mm with a significant correlation with the mitral annulus diameter (p<.002) and the left ventricular diameter (p<0.01). The left marginal vein (LMV) was more often tortuous when the angle between the LMV and the great cardiac vein was less than 60 degrees (p<0.01). CONCLUSION: 16 row MDCT imaging can be used to investigate non-invasively the coronary venous anatomy and may serve as a useful tool before percutaneous therapies involving the coronary veins.

Anomalous septal artery originating from the right coronary sinus and detection of the interarterial course using multislice computed tomography (MSCT).

Anomalies of the coronary arteries are uncommon but may produce life-threatening symptoms and myocardial ischemia. Multislice computed tomography (MSCT) has become a major technique for imaging the coronary arteries. We present a case of a patient with a septal and a circumflex arteries originating from the right coronary sinus and a duplicate left anterior descending artery. The interarterial course of the septal branch is clearly demonstrated with MSCT technique as the abnormal circumflex artery that coursed posterior to the aortic root.