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      <h1 class="highwire-cite-title" id="page-title">COVID-19 Stroke Apical Lung Exam Study: Is it Really an Accurate Diagnostic Method?</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">S. Marquez</span>, <span class="highwire-citation-author" data-delta="1">J. Campaña</span> and <span class="highwire-citation-author" data-delta="2">N. Bedoya</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">August 2021,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">42 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E53; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A7141 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-92370--61334648588" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">S. Marquez </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Diagnostic Imaging DepartmentFundacion Santa Fe De Bogota University HospitalBogotá, Colombia</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=S.%2BMarquez%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=Marquez%20S&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%3AS.%2BMarquez%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/0000-0001-5438-516X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Marquez</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">J. Campaña </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Diagnostic Imaging DepartmentFundacion Santa Fe De Bogota University HospitalBogotá, Colombia</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.%2BCampa%C3%B1a%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=Campa%C3%B1a%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.%2BCampa%25C3%25B1a%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/0000-0003-2229-1614" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Campaña</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">N. Bedoya </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Diagnostic Imaging DepartmentFundacion Santa Fe De Bogota University HospitalBogotá, Colombia</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=N.%2BBedoya%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=Bedoya%20N&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%3AN.%2BBedoya%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/0000-0002-7718-2178" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for N. Bedoya</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><p id="p-1">We have read with great interest the article by Dr J. Siddiqui et al,<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup> titled “COVID-19 Stroke Apical Lung Examination Study: A Diagnostic and Prognostic Imaging Biomarker in Suspected Acute Stroke,” which was published in January 2021. We want to congratulate you in advance for addressing an important issue, such as the association between infection with Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) and a cerebrovascular accident, because of the impact that the latter has on both mortality and quality of life for patients. As the literature has shown, so far, the incidence of stroke in these patients is up to 5%.<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a></sup></p><p id="p-2">As we know, the standard reference test to establish the diagnosis of coronavirus disease 2019 (COVID-19) is reverse transcription–polymerase chain reaction. However, it is also widely known that its diagnostic accuracy is not 100%, which is why other diagnostic methods such as chest tomography scans have been used because of their wide availability, speed in acquisition and interpretation, and diagnostic performance.</p><p id="p-3">CT is not approved as a diagnostic method for COVID-19 and its main function is to classify the degree of pulmonary involvement instead of being a detection tool. In no circumstances does it replace the administration of the reverse transcription–polymerase chain reaction test in individuals who are suspected of having an infection.<sup><a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3</a></sup></p><p id="p-4">From the studies carried out so far and our experiences with patients with COVID-19, it is known that the main pulmonary involvement (especially in patients in the initial phase of the infection who probably do not yet present symptoms) is found in the posterior aspect and the pulmonary bases and is much smaller in the apices. The latter may even be respected in the initial stages of the disease.<sup><a id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4</a></sup> Therefore, we believe that using only the presence of ground-glass opacities in the lung apices is not a reliable or accurate biomarker for the diagnosis of COVID-19 and should not replace the acquisition of a complete chest tomography, much less the performance of reverse transcription–polymerase chain reaction testing.</p><p id="p-5">Finally, we consider that it would have been interesting and accurate to include in the article which underlying diseases and other risks factors these patients had that could have influenced the occurrence of a cerebrovascular event.</p><div 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-journal" id="cit-42.8.E53.1" data-doi="10.3174/ajnr.A6832"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Siddiqui</span>  <span class="cit-name-given-names">J</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Bala</span>  <span class="cit-name-given-names">F</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Sciacca</span>  <span class="cit-name-given-names">S</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">COVID-19 stroke apical lung examination study: a diagnostic and prognostic imaging biomarker in suspected acute stroke</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2021</span>;<span class="cit-vol">42</span>:<span class="cit-fpage">138</span>–<span class="cit-lpage">43</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>10.3174/ajnr.a6832</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>32943416</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo4OiI0Mi8xLzEzOCI7czo0OiJhdG9tIjtzOjE5OiIvYWpuci80Mi84L0U1My5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></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-42.8.E53.2" data-doi="10.22379/24224022280"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Ortiz</span>  <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Valencia</span>  <span class="cit-name-given-names">N</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Moreno</span>  <span class="cit-name-given-names">E</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">ACV y COVID-19: una revisión de los estudios observacionales publicados en época de pandemia</span>. <abbr class="cit-jnl-abbrev">Acta Neurológica Colombiana</abbr> <span class="cit-pub-date">2020</span>;<span class="cit-vol">36</span>:<span class="cit-fpage">63</span>–<span class="cit-lpage">74</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>10.22379/24224022280</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.22379/24224022280&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a></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-journal" id="cit-42.8.E53.3" data-doi="10.1038/s41598-020-80061-2"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Khatami</span>  <span class="cit-name-given-names">F</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Saatchi</span>  <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Zadeh</span>  <span class="cit-name-given-names">S.S</span></span>. <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">A meta-analysis of accuracy and sensitivity of chest CT and RT-PCR in COVID-19 diagnosis</span>. <abbr class="cit-jnl-abbrev">Scientific Reports</abbr> <span class="cit-pub-date">2020</span>;<span class="cit-vol">10</span>:<span class="cit-fpage">22402</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>10.1038/s41598-020-80061-2</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>33372194</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1038/s41598-020-80061-2&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=33372194&amp;link_type=MED&amp;atom=%2Fajnr%2F42%2F8%2FE53.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></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-journal" id="cit-42.8.E53.4" data-doi="10.1148/rg.2020200159"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Kwee</span>  <span class="cit-name-given-names">T</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kwee</span>  <span class="cit-name-given-names">R</span></span></li></ol><cite>. <span class="cit-article-title">Chest CT in COVID-19: what the radiologist needs to know</span>. <abbr class="cit-jnl-abbrev">Radiographics</abbr> <span class="cit-pub-date">2020</span>;<span class="cit-vol">40</span>:<span class="cit-fpage">1848</span>–<span class="cit-lpage">65</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/rg.2020200159</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>33095680</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1148/rg.2020200159&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=33095680&amp;link_type=MED&amp;atom=%2Fajnr%2F42%2F8%2FE53.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li></ol></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2021 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 42</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 8 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Aug 2021 </div></div>
      
      
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