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. 2020 Jul;41(7):1165-1169.
doi: 10.3174/ajnr.A6607. Epub 2020 May 21.

CT Scanning in Suspected Stroke or Head Trauma: Is it Worth Going the Extra Mile and Including the Chest to Screen for COVID-19 Infection?

R M Kwee  1 , J Krdzalic  2 , B A C M Fasen  2 , T M H de Jaegere  2 ; COVID-19 CT Investigators South-East Netherlands (CISEN) Study Group
Affiliations

CT Scanning in Suspected Stroke or Head Trauma: Is it Worth Going the Extra Mile and Including the Chest to Screen for COVID-19 Infection?

R M Kwee et al. AJNR Am J Neuroradiol. 2020 Jul.

Abstract

Background and purpose: Chest CT may be used as a tool for rapid coronavirus disease 2019 (COVID-19) detection. Our aim was to investigate the value of additional chest CT for detection of coronavirus 19 (COVID-19) in patients who undergo head CT for suspected stroke or head trauma in a COVID-19-endemic region.

Materials and methods: Our study included 27 patients (mean age, 74 years; range, 54-90 years; 20 men) who underwent head CT for suspected stroke (n = 21) or head trauma (n = 6), additional chest CT for COVID-19 detection, and real-time reverse transcriptase polymerase chain reaction testing in a COVID-19-endemic region. Sensitivity, specificity, and negative and positive predictive values of chest CT in detecting COVID-19 were calculated.

Results: Final neurologic diagnoses were ischemic stroke (n = 11), brain contusion (n = 5), nontraumatic intracranial hemorrhage (n = 2), brain metastasis (n = 1), and no primary neurologic disorder (n = 8). Symptoms of possible COVID-19 infection (ie, fever, cough, and/or shortness of breath) were present in 20 of 27 (74%) patients. Seven of 27 patients (26%) had real-time reverse transcriptase polymerase chain reaction confirmed-COVID-19 infection. Chest CT results were 6 true-positives, 15 true-negatives, 5 false-positives, and 1 false-negative. Diagnostic performance values of chest CT were a sensitivity of 85.7%, specificity of 75.0%, negative predictive value of 93.8%, and positive predictive value of 54.6%.

Conclusions: The sensitivity of additional chest CT is fairly high. However, a negative result does not exclude COVID-19. The positive predictive value is poor. Correlation of chest CT results with epidemiologic history and clinical presentation, along with real-time reverse transcriptase polymerase chain reaction, is needed for confirmation.

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Figures

FIG 1.
FIG 1.
A 73-year-old male patient who underwent head CT and CTA to evaluate intracranial large-vessel occlusion. This patient did not have symptoms of COVID-19 infection (ie, no fever, cough, and/or shortness of breath). Axial chest CT image shows ground-glass opacities posteriorly located in both upper lobes (arrows). These CT features were interpreted as typical for COVID-19 pneumonia, which was confirmed by RT-PCR.
FIG 2.
FIG 2.
An 83-year-old male patient who underwent head CT for suspected stroke. This patient had symptoms of possible COVID-19 infection (cough and shortness of breath). Axial chest CT images at the level of the aortic arch (A) and heart (B) show ground-glass opacities posteriorly and peripherally, located in both upper lobes (arrows in A and B) and in the left lower lobe (arrow, B). These CT features were interpreted as typical for COVID-19 pneumonia, which was confirmed by RT-PCR.
FIG 3.
FIG 3.
An 83-year-old female patient who underwent head CT for suspected stroke. This patient had symptoms of possible COVID-19 infection (shortness of breath). Axial (A) and sagittal (B) chest CT images show segmental consolidation in the left lower lobe (arrows, A and B) and no other long abnormalities. These CT features were interpreted as atypical for COVID-19 pneumonia. RT-PCR was negative for COVID-19.
See this image and copyright information in PMC

Comment in

  • Chest CT Scanning in Suspected Stroke: Not Always Worth the Extra Mile.
    Li MD, Lang M, Yoon BC, Applewhite BP, Buch K, Rincon SP, Leslie-Mazwi TM, Mehan WA Jr. Li MD, et al. AJNR Am J Neuroradiol. 2020 Nov;41(11):E86-E87. doi: 10.3174/ajnr.A6763. Epub 2020 Aug 13. AJNR Am J Neuroradiol. 2020. PMID: 32816772 Free PMC article. No abstract available.
  • Reply.
    Kwee RM. Kwee RM. AJNR Am J Neuroradiol. 2020 Nov;41(11):E88. doi: 10.3174/ajnr.A6787. Epub 2020 Aug 13. AJNR Am J Neuroradiol. 2020. PMID: 32816773 Free PMC article. No abstract available.

References

    1. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594.... Accessed April 19, 2020
    1. Italy’s Health Care System Groans Under Coronavirus—a Warning to the World. The New York Times. March 27, 2020. https://www.nytimes.com/2020/03/12/world/europe/12italy-coronavirus-heal.... Accessed April 19, 2020
    1. Marquez M, Moghe S. Inside a Brooklyn hospital that is overwhelmed with Covid-19 patients and deaths. CNN; March 31, 2020. https://edition.cnn.com/2020/03/30/us/brooklyn-hospital-coronavirus-pati.... Accessed April 19, 2020
    1. Rothfeld M. 13 Deaths in a Day: An ‘Apocalyptic’ Coronavirus Surge at an N.Y.C. Hospital. The New York Times. March 24, 2020. https://www.nytimes.com/2020/03/25/nyregion/nyc-coronavirus-hospitals.html. Accessed April 19, 2020
    1. Centers for Disease Control and Prevention Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommen.... Accessed April 19, 2020