CT quantification of COVID-19 pneumonia extent to predict individualized outcome.

OBJECTIVES:  This study aimed to predict individual COVID-19 patient prognosis at hospital admission using artificial intelligence (AI)-based quantification of computed tomography (CT) pulmonary involvement. BACKGROUND: Assessing patient prognosis in COVID-19 pneumonia is crucial for patient management and hospital and ICU organization. METHODS: We retrospectively analyzed 559 patients with PCR-verified COVID-19 pneumonia referred to the hospital for a severe disease course. We correlated the CT extent of pulmonary involvement with patient outcome. We also attempted to define cut-off values of pulmonary involvement for predicting different outcomes. RESULTS:  CT-based disease extent quantification is an independent predictor of patient morbidity and mortality, with the prognosis being impacted also by age and cardiovascular comorbidities. With the use of explored cut-off values, we divided patients into three groups based on their extent of disease: (1) less than 28 % (sensitivity 65.4 %; specificity 89.1 %), (2) ranging from 28 % (31 %) to 47 % (sensitivity 87.1 %; specificity 62.7 %), and (3) above 47 % (sensitivity 87.1 %; specificity, 62.7 %), representing low risk, risk for oxygen therapy and invasive pulmonary ventilation, and risk of death, respectively. CONCLUSION: CT quantification of pulmonary involvement using AI-based software helps predict COVID-19 patient outcomes (Tab. 4, Fig. 4, Ref. 38).

Dual-energy Computed Tomography Delayed Myocardial Enhancement in the Diagnostic Dilemma of True versus False Left Ventricular Aneurysm - A Case Report.

The aim of this case report is to show the capability of cardiac computed tomography (CT) in combination with dual-energy CT (DECT) delayed myocardial enhancement to support diagnostic decision making in the complicated differential diagnosis of true versus false left ventricle (LV) aneurysm, as well as provide additional information that can influence overall patient outcome. We present a 71-year-old obese patient with metabolic syndrome, stable chronic coronary syndrome with three-vessel disease, and recent chest discomfort. His coronary angiogram showed no significant coronary artery stenosis, but suspicion of LV apical pseudoaneurysm was expressed. Neither transthoracic nor transesophageal echocardiography was able to dismiss this suspicion. Consequently, coronary CT angiography (CCTA) followed by DECT delayed myocardial enhancement was performed. Findings on CCTA and DECT confirmed the diagnosis of a true aneurysm. Moreover, fibrotic changes within the hypertrophic myocardium were visualized. This finding will influence further patient therapy as well as the outcome. DECT delayed myocardial enhancement can be an important complementary tool for distinguishing true versus false LV aneurysms. Moreover, it can provide additional information for making complex diagnose. Adding DECT delayed myocardial enhancement to CCTA can replace cardiac magnetic resonance imaging evaluation in certain settings.

A complex pulmonary vein varix -- diagnosis with ECG gated MDCT, MRI and invasive pulmonary angiography.

A case of an asymptomatic 32-year-old male with a complex congenital pulmonary vein varix is reported herein. Chest X-ray incidentally revealed a tubular opacity passing from the periphery of the left lingula to the mediastinum. ECG gated multidetector computed tomography showed the opacity to be a vessel emptying into the left atrium via the left superior pulmonary vein. In addition, a second vascular structure was noted within the posterior mediastinum that was emptying into the same pulmonary vein. These findings were also confirmed by magnetic resonance imaging, 4D magnetic resonance angiography and invasive arterial angiography. Based on multimodality imaging findings the diagnosis of complex congenital pulmonary venous varix with posterior mediastinal extension was established.