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<meta name="HW.identifier" content="/ajnr/early/2020/05/21/ajnr.A6607.atom" />
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<meta name="DC.Title" content="CT Scanning in Suspected Stroke or Head Trauma: Is it Worth to go the Extra Mile and Include the Chest to Screen for COVID-19 Infection?" />
<meta name="DC.Identifier" content="10.3174/ajnr.A6607" />
<meta name="DC.Date" content="2020-05-21" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2020 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
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<meta name="DC.Description" content="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.

COVID-19
:   coronavirus disease 2019
RT-PCR
:   real-time reverse transcriptase polymerase chain reaction" />
<meta name="DC.Contributor" content="R.M. Kwee" />
<meta name="DC.Contributor" content="J. Krdzalic" />
<meta name="DC.Contributor" content="B.A.C.M. Fasen" />
<meta name="DC.Contributor" content="T.M.H. de Jaegere" />
<meta name="DC.Contributor" content="for the COVID-19 CT Investigators South-East Netherlands (CISEN) Study Group" />
<meta name="article:published_time" content="2020-05-21" />
<meta name="article:section" content="ADULT BRAIN" />
<meta name="citation_title" content="CT Scanning in Suspected Stroke or Head Trauma: Is it Worth to go the Extra Mile and Include the Chest to Screen for COVID-19 Infection?" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;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.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Our study included 27 patients (mean age, 74 years; range, 54–90 years; 20 men) who underwent head CT for suspected stroke (&lt;i&gt;n&lt;/i&gt; = 21) or head trauma (&lt;i&gt;n&lt;/i&gt; = 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.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Final neurologic diagnoses were ischemic stroke (&lt;i&gt;n&lt;/i&gt; = 11), brain contusion (&lt;i&gt;n&lt;/i&gt; = 5), nontraumatic intracranial hemorrhage (&lt;i&gt;n&lt;/i&gt; = 2), brain metastasis (&lt;i&gt;n&lt;/i&gt; = 1), and no primary neurologic disorder (&lt;i&gt;n&lt;/i&gt; = 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%.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;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.&lt;/p&gt;" />
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<meta name="citation_publication_date" content="2020/05/21" />
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<meta name="twitter:title" content="CT Scanning in Suspected Stroke or Head Trauma: Is it Worth to go the Extra Mile and Include the Chest to Screen for COVID-19 Infection?" />
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<meta name="twitter:description" content="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.

COVID-19
:   coronavirus disease 2019
RT-PCR
:   real-time reverse transcriptase polymerase chain reaction" />
<meta name="og-title" property="og:title" content="CT Scanning in Suspected Stroke or Head Trauma: Is it Worth to go the Extra Mile and Include the Chest to Screen for COVID-19 Infection?" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2020/05/21/ajnr.A6607" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="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.

COVID-19
:   coronavirus disease 2019
RT-PCR
:   real-time reverse transcriptase polymerase chain reaction" />
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">R.M. Kwee</span>, <span class="highwire-citation-author" data-delta="1">J. Krdzalic</span>, <span class="highwire-citation-author" data-delta="2">B.A.C.M. Fasen</span>, <span class="highwire-citation-author" data-delta="3">T.M.H. de Jaegere</span> and <span class="highwire-citation-author" data-delta="4"><span class="nlm-collab" data-hwp-id="collab-1">for the COVID-19 CT Investigators South-East Netherlands (CISEN) Study Group</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2020,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A6607 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-75509--6803118707" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">R.M. Kwee </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (R.M.K., J.K., B.A.C.M.F., T.M.H.d.J.), Zuyderland Medical Center, Heerlen/Sittard/Geleen, the Netherlands.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.M.%2BKwee%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kwee%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AR.M.%2BKwee%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-7760-867X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R.M. Kwee</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">J. Krdzalic </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (R.M.K., J.K., B.A.C.M.F., T.M.H.d.J.), Zuyderland Medical Center, Heerlen/Sittard/Geleen, the Netherlands.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BKrdzalic%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Krdzalic%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BKrdzalic%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-9030-0052" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Krdzalic</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">B.A.C.M. Fasen </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (R.M.K., J.K., B.A.C.M.F., T.M.H.d.J.), Zuyderland Medical Center, Heerlen/Sittard/Geleen, the Netherlands.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=B.A.C.M.%2BFasen%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Fasen%20B&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AB.A.C.M.%2BFasen%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-7411-0307" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for B.A.C.M. Fasen</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">T.M.H. de Jaegere </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (R.M.K., J.K., B.A.C.M.F., T.M.H.d.J.), Zuyderland Medical Center, Heerlen/Sittard/Geleen, the Netherlands.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=T.M.H.%2Bde%2BJaegere%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=de%20Jaegere%20T&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AT.M.H.%2Bde%2BJaegere%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-0240-6293" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T.M.H. de Jaegere</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (R.M.K., J.K., B.A.C.M.F., T.M.H.d.J.), Zuyderland Medical Center, Heerlen/Sittard/Geleen, the Netherlands.</div></span></div></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" xmlns:xhtml="http://www.w3.org/1999/xhtml" class="section ref-list" id="ref-list-1"><h2 class="">References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a><div class="cit ref-cit ref-web" id="cit-ajnr.A6607v1.1"><div class="cit-metadata"><cite><span class="cit-article-title">COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU)</span>. <a href="https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6">https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6</a>. <span class="cit-date-in-citation">Accessed April 19, 2020</span></cite></div><div class="cit-extra"></div></div></li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a><div class="cit ref-cit ref-journal" id="cit-ajnr.A6607v1.2"><div class="cit-metadata"><cite><span class="cit-article-title">Italy’s Health Care System Groans Under Coronavirus—a Warning to the World</span>. <abbr class="cit-jnl-abbrev">The New York Times</abbr>. <span class="cit-month">March</span> <span class="cit-day">27</span>, <span class="cit-pub-date">2020</span>. <a href="https://www.nytimes.com/2020/03/12/world/europe/12italy-coronavirus-health-care.html">https://www.nytimes.com/2020/03/12/world/europe/12italy-coronavirus-health-care.html</a>. <span class="cit-date-in-citation">Accessed April 19, 2020</span></cite></div><div class="cit-extra"></div></div></li><li><span class="ref-label">3.</span><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3. in text" id="ref-3">↵</a><div class="cit ref-cit ref-web" id="cit-ajnr.A6607v1.3"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Marquez</span>  <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Moghe</span>  <span class="cit-name-given-names">S</span></span></li></ol><cite>. <span class="cit-article-title">Inside a Brooklyn hospital that is overwhelmed with Covid-19 patients and deaths</span>. <span class="cit-publ-name">CNN</span>. <span class="cit-month">March</span> <span class="cit-day">31</span>, <span class="cit-pub-date">2020</span>. <a href="https://edition.cnn.com/2020/03/30/us/brooklyn-hospital-coronavirus-patients-deaths/index.html">https://edition.cnn.com/2020/03/30/us/brooklyn-hospital-coronavirus-patients-deaths/index.html</a>. <span class="cit-date-in-citation">Accessed April 19, 2020</span></cite></div><div class="cit-extra"></div></div></li><li><span class="ref-label">4.</span><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4. in text" id="ref-4">↵</a><div class="cit ref-cit ref-web" id="cit-ajnr.A6607v1.4"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Rothfeld</span>  <span class="cit-name-given-names">M</span></span></li></ol><cite>. <span class="cit-article-title">13 Deaths in a Day: An ‘Apocalyptic’ Coronavirus Surge at an N.Y.C. 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[<span class="cit-comment">Epub ahead of print</span>]<span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1148/radiol.2020200988]</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>32175814</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1148/radiol.2020200988]&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=32175814&amp;link_type=MED&amp;atom=%2Fajnr%2Fearly%2F2020%2F05%2F21%2Fajnr.A6607.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li></ol></div></div>  </div>

  
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      <div class="highwire-cite-title">CT Scanning in Suspected Stroke or Head Trauma: Is it Worth to go the Extra Mile and Include the Chest to Screen for COVID-19 Infection?</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">R.M.</span> <span class="nlm-surname">Kwee</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Krdzalic</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">B.A.C.M.</span> <span class="nlm-surname">Fasen</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">T.M.H.</span> <span class="nlm-surname">de Jaegere</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-collab" data-hwp-id="collab-1">for the COVID-19 CT Investigators South-East Netherlands (CISEN) Study Group</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2020, </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A6607 </span></div>
  
  
  
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