Investigators aimed to better understand the pathophysiology of SARS-CoV-2 pneumonia in non-critically ill hospitalized patients secondarily presenting with clinical deterioration and increase in oxygen requirement
Investigators plan to consecutively enrol 25 patients without clinical or biological evidence
for superinfection, without left ventricular dysfunction and for whom a pulmonary embolism
was discarded by computed tomography pulmonary angiography. Investigators will investigate
lung ventilation and perfusion (LVP) by LVP scintigraphy, and, 24 hours later, left and right
ventricular function by 99mTc-labelled albumin gated-blood-pool scintigraphy with late (60
mn) tomographic albumin images on the lungs to evaluate lung albumin retention that could
indicate microvascular injuries with secondary edema
Diagnostic Test: lung ventilation/perfusion scintigraphy
Chest CT-scan will be performed with blocked inspiration.
Lung ventilation/perfusion scintigraphy imaging will be performed within 24hrs after CT pulmonary angiography, 410MBq of Technegas will be inhaled by patients and ventilation tomography performed thereafter. Then, 185MBq 99mTc-macroaggegates will be injected intravenously followed by the perfusion tomography.
A combined CT acquisition will be performed.
The day following lung ventilation/perfusion scintigraphy, 740MBq of Tc99m labeled albumin will be intravenously administered.
Cardiac gated-blood-pool scintigraphy will be then performed in best septal left anterior oblique and left profile according to specific parameters.
45-60 min after injection, a non-gated tomographic acquisition over the lungs will be done, with the same parameters than for PS SPECT, resulting in a late albumin acquisition.
Other Name: Array
Inclusion Criteria:
- Non-critically ill patients hospitalized in the COVID-19 Unit of the Centre
Hospitalier Princesse Grace of Monaco
- Presenting with a sudden clinical deterioration defined by a respiratory rate
impairment and/or a rise of oxygen flow to reach a peripheral capillary oxygen
saturation (SpO2) of more than 95% during at least 48 hours
- a diagnosis of pulmonary embolism was discarded by CT pulmonary angiography
- no clinical or biological (procalcitonin levels) evidence of lung superinfection
- without clinical evidence for LV dysfunction
Exclusion Criteria:
- Non confirmed COVID-19 pneumonia according to the WHO guidance by a positive result of
RT-PCR assay of nasal and pharyngeal swabs,
- Patients without peripheral pulmonary ground-glass opacities or air-space
consolidation on their chest CT scan at admission and common laboratory findings
including lymphocytopenia, eosinopenia, significantly elevated markers of organ
inflammation such as fibrinogen and C-reactive protein.
- Patients could not be included if their medical condition was unstable or precluded a
safe transfer to the nuclear medicine department, if they were under mechanical
ventilation (either non-invasive or invasive), if they required critical care unit, or
in case of a pregnancy.
Centre Hospitalier Princesse Grace
Monaco, Monaco