The method described is reproducible and provides an assessment of the global amount of LV trabeculation. A trabeculated LV mass above 20% of the global LV mass is highly sensitive and specific for the diagnosis of LVNC.
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 RT-PCR were compared together and with the final discharge diagnosis used as reference standard.
Materials and Methods
A structured CT scan survey (NCT04339686) was sent to 26 hospital radiology departments in France between March 2 and April 24 2020. These dates correspond to the peak of the national COVID-19 epidemic. Radiology departments were selected to reflect the estimated geographical prevalence heterogeneities of the epidemic. All symptomatic patients suspected of having a COVID-19 pneumonia who underwent within 48 hours both initial chest CT and at least one RT-PCR testing 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 Mann-Whitney Test, Student’s t-test, Chi-square test and Pearson’s correlation. A p value <.05 determined statistical significance.
Results
Twenty-six of 26 hospital radiology departments responded to the survey with 7500 patients entered; 2652 did not have RT-PCR results or had unknown or excess delay between RT-PCR and CT. After exclusions, 4824 patients (mean age 64, ± 19 yrs, 2669 males) were included. Using final diagnosis as the reference, 2564 of the 4824 patients were positive for COVID-19 (53%). Sensitivity, specificity, NPV and PPV of chest CT for diagnosing COVID-19 were 2319/2564 (90%, 95% confidence interval [CI]: 89, 91), 2056/2260 (91%, 95%CI: 91, 92%), 2056/2300 (89%, 95%CI; 87, 90%) and 2319/2524 (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 suspected COVID-19 patients was successful.
Elective transanal Doppler-guided hemorrhoidal artery ligation (DG-HAL) has recently been shown to be effective in hemorrhoidal disease. It consists of ligating the terminal branches of the superior rectal artery under Doppler guidance, in order to reduce the hemorrhoidal arterial blood flow and improve the symptoms. By analogy, we propose performing this arterial occlusion using the "emborrhoid" technique (embolization of the hemorrhoidal arteries), in which arterial occlusion is achieved via the endovascular route using coils placed in the terminal branches of the superior rectal arteries. Three patients have been treated by this new technique, and the observations show that it is feasible and reproducible, with no ischemic complications or pain. Additional studies are needed to evaluate the efficacy of this technique for the treatment of hemorrhoidal disease.
Our case studies suggest that coil embolization of the superior rectal arteries is technically feasible, safe and well tolerated. Additional studies are needed to evaluate the efficacy of this new 'emborrhoid' technique in the management of hemorrhoidal disease.
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