Skip to main content
Advertisement

Main menu

  • Home
  • Content
    • Current Issue
    • Publication Preview--Ahead of Print
    • Past Issue Archive
    • Case of the Week Archive
    • Classic Case Archive
    • Case of the Month Archive
  • For Authors
  • About Us
    • About AJNR
    • Editors
    • American Society of Neuroradiology
  • Submit a Manuscript
  • Podcasts
    • Subscribe on iTunes
    • Subscribe on Stitcher
  • More
    • Subscribers
    • Permissions
    • Advertisers
    • Alerts
    • Feedback
  • Other Publications
    • ajnr

User menu

  • Subscribe
  • Alerts
  • Log in

Search

  • Advanced search
American Journal of Neuroradiology
American Journal of Neuroradiology

American Journal of Neuroradiology

  • Subscribe
  • Alerts
  • Log in

Advanced Search

  • Home
  • Content
    • Current Issue
    • Publication Preview--Ahead of Print
    • Past Issue Archive
    • Case of the Week Archive
    • Classic Case Archive
    • Case of the Month Archive
  • For Authors
  • About Us
    • About AJNR
    • Editors
    • American Society of Neuroradiology
  • Submit a Manuscript
  • Podcasts
    • Subscribe on iTunes
    • Subscribe on Stitcher
  • More
    • Subscribers
    • Permissions
    • Advertisers
    • Alerts
    • Feedback
  • Follow AJNR on Twitter
  • Visit AJNR on Facebook
  • Follow AJNR on Instagram
  • Join AJNR on LinkedIn
  • RSS Feeds
Research ArticleADULT BRAIN
Open Access

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?

R.M. Kwee, J. Krdzalic, B.A.C.M. Fasen, T.M.H. de Jaegere and for the COVID-19 CT Investigators South-East Netherlands (CISEN) Study Group
American Journal of Neuroradiology May 2020, DOI: https://doi.org/10.3174/ajnr.A6607
R.M. Kwee
aFrom 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.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for R.M. Kwee
J. Krdzalic
aFrom 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.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for J. Krdzalic
B.A.C.M. Fasen
aFrom 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.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for B.A.C.M. Fasen
T.M.H. de Jaegere
aFrom 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.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for T.M.H. de Jaegere
aFrom 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.
  • Article
  • Figures & Data
  • Info & Metrics
  • References
  • PDF
Loading

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.

ABBREVIATIONS:

COVID-19
coronavirus disease 2019
RT-PCR
real-time reverse transcriptase polymerase chain reaction

The coronavirus disease 2019 (COVID-19) pandemic has caused a global crisis. As of April 19, there were 2,356,475 confirmed cases and 162,070 deaths worldwide.1 In regions where COVID-19 is highly endemic, some hospitals can barely handle the influx of patients.2⇓-4 Nevertheless, rapid triage and isolation of patients with suspected COVID-19 are essential to prevent hospital-related transmission of the virus to other patients and health care workers.5,6 Stroke and traumatic brain injury are highly prevalent worldwide7 and remain common reasons for emergency department visits.8 These patients should be assessed for COVID-19 infection on emergency department arrival in COVID-19-endemic areas. One possible strategy is to perform real-time reverse transcriptase polymerase chain reaction (RT-PCR) in patients who are being hospitalized. However, a major disadvantage of RT-PCR testing is that it takes several hours to obtain results. It has been suggested that chest CT may be used as a tool for rapid COVID-19 detection in endemic areas.9 Head CT is the primary imaging technique of choice to evaluate patients with suspected stroke10,11 or head trauma12 in the emergency setting. Thus, it may be possible to perform additional chest CT for COVID-19 detection in 1 session with head CT. This approach could be particularly useful when rapid triaging is needed and RT-PCR testing capacity and the number of isolation rooms are limited. Furthermore, such a strategy poses a negligible extra burden on available CT equipment and radiology personnel. In addition, the additional radiation exposure of chest CT is not a major concern because patients with suspected stroke or head trauma are usually older and chest CT can be performed with a low-dose protocol.13 Therefore, the purpose of our study was to investigate the value of additional chest CT for COVID-19 detection in patients who undergo head CT for suspected stroke or head trauma in a COVID-19-endemic region.

MATERIALS AND METHODS

Patients

This retrospective study was approved by the institutional review board of our hospital (Zuyderland Medical Center, Heerlen/Sittard/Geleen, the Netherlands) (No. Z2020061), and patient consent was waived. We included 27 consecutive patients (mean age, 74 years; range, 54–90 years; 20 men) who were evaluated for suspected stroke (n = 21) or head trauma (n = 6) in our hospital between March 12, 2020, and April 14, 2020. Our hospital, one of the largest general hospitals in the Netherlands, was located in a COVID-19-endemic region. Our study period encompassed the peak of the highest registered number of daily COVID-19 infections in the Netherlands.14 During the study period, patients had to be transported to other hospitals because the intensive care unit of our hospital was becoming overloaded (as of April 1, 2020, eighty-three percent of all intensive care unit beds were occupied by patients with COVID-19). All 27 patients underwent head CT, additional chest CT for COVID-19 detection, and RT-PCR testing of nasopharyngeal and oropharyngeal swabs. In 3 patients with suspected stroke, CTA was also performed from the aortic arch to the vertex to evaluate for intracranial large-vessel occlusion.

Chest CT Protocol

Chest CT was performed on either a 64-section CT scanner (Incisive; Philips Healthcare) or on a 64-section dual-source scanner (Somatom Definition Flash; Siemens). Scanning parameters were the following: collimation = 64 × 0.625 or 0.6 mm, Tube voltage = 120 kV(peak), Tube current = 667 maximum mA or 404 maximum mA, pitch = 1.0 or 1.2, and matrix size 5 = 12 × 512. CT images were reconstructed with a lung kernel in the transverse plane with a 1.0-mm section thickness and a 1.0-mm increment. Images were also reconstructed in axial, coronal, and sagittal planes with a 3.0-mm section thickness.

Chest CT Interpretation and Reference Standard

Chest CT findings were categorized according to the Radiological Society of North America chest CT classification system for reporting COVID-19 pneumonia—ie, typical, indeterminate, atypical, and negative (Table 1).15 Typical and indeterminate chest CT findings were considered positive, whereas atypical and negative chest CT findings were considered negative for COVID-19. All chest CT scans were prospectively read by radiologists who were available when CT was performed. Results of RT-PCR testing, (ie, positive or negative for COVID-19 infection) served as the reference standard.

View this table:
  • View inline
  • View popup
Table 1:

Radiological Society of North America chest CT classification system for reporting COVID-19 pneumonia (adapted from reference 15)

Statistical Analysis

The number of true-positive, true-negative, false-positive, and true-negative chest CT results was determined. Subsequently, sensitivity, specificity, negative predictive value, and positive predictive value of chest CT in diagnosing COVID-19 were calculated. Statistical analyses were performed using SPSS Statistics for Windows (Version 20.0; IBM).

RESULTS

Patients

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). Correlation of symptoms of possible COVID-19 infection (ie, fever, cough, and/or shortness of breath16), chest CT findings, and RT-PCR results are shown in Table 2. Symptoms of possible COVID-19 infection were present in 20 of 27 (74%) patients. The median time interval between CT and RT-PCR was 0 days (range, 0–7, days; interquartile range, 0–1 day). In 2 of 4 patients with a chest CT result positive for COVID-19 but negative findings on the initial RT-PCR, repeat RT-PCR was performed (with findings remaining negative). Seven of 27 patients (26%) had RT-PCR–confirmed COVID-19 infection. Six patients with RT-PCR–confirmed COVID-19 were symptomatic, whereas 1 patient with RT-PCR–confirmed COVID-19 was asymptomatic. In the asymptomatic patient with RT-PCR–confirmed COVID-19, abnormalities suspicious for COVID-19 were already visible in the upper lung fields on CTA, which was confirmed on additional chest CT (Fig 1). In another patient with head trauma and fever, chest CT findings were negative, whereas RT-PCR 4 days after CT showed COVID-19. This patient was not isolated until the RT-PCR results were known.

View this table:
  • View inline
  • View popup
Table 2:

Correlation between symptoms of possible COVID-19 infection (ie, fever, cough, and/or shortness of breath16), chest CT findings, and RT-PCR results

FIG 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
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.

Diagnostic Yield of Chest CT

Typical, indeterminate, atypical, and negative chest CT features for COVID-19 were present in 3, 8, 2, and 14 patients, respectively. Figs 1 and 2 show examples of typical chest CT features of COVID-19, whereas Fig 3 shows an example of atypical chest CT features of COVID-19. 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%.

FIG 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
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.
  • Download figure
  • Open in new tab
  • Download powerpoint
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.

DISCUSSION

Our initial experience in 27 patients with an emergency indication for head CT shows that the sensitivity of additional chest CT for COVID-19 is fairly high. An estimated 5%–80% of COVID-19-infected persons may be asymptomatic.17 Although asymptomatic, they may transmit the disease to others.18⇓⇓-21 In our study, 7 of 27 patients (26%) did not have symptoms of possible COVID-19 infection (ie, fever, cough, and/or shortness of breath16). One of these asymptomatic patients proved to be infected with COVID-19 by RT-PCR. This finding underlines the importance of vigilantly evaluating the lungs on CTA scans of patients with stroke in a COVID-19-endemic region, even when they are asymptomatic. However, a negative result does not exclude COVID-19. In 1 patient with head trauma and fever, chest CT had negative findings, whereas RT-PCR 4 days after CT showed COVID-19 infection. This patient was not isolated until the RT-PCR results were known and could have put other patients and health care workers at risk to become infected too. Furthermore, the positive predictive value of chest CT was poor. If only chest CT results were used to make patient-management decisions, too many cases would unnecessarily occupy isolation rooms. Therefore, correlation with epidemiologic history and clinical presentation, along with the RT-PCR, is needed for confirmation.22

The diagnostic accuracy of chest CT has been investigated by a few previous studies,9,23,24 in different populations. Our study is unique in that it investigated the value of additional chest CT in patients who already underwent head CT in a COVID-19-endemic region, compared with previous studies that reported chest CT as a stand-alone method in patients who may otherwise not have undergone CT scanning.9,23,24 Furthermore, our study also included asymptomatic patients (26% of our study population) with respect to possible COVID-19. Because of the inclusion of patients without any COVID-19 symptoms, the overall prevalence of COVID-19 infection in our study population was lower than that in previous studies9,23,24 (26% in our study versus 39%–85% in previous studies9,23,24). Nevertheless, the fairly high sensitivity and poor specificity of additional chest CT is in line with the findings of previous studies that reported sensitivity and specificity values of 93.2%–97.0%, and 25.0%–53.3%, respectively.9,23,24 Most important, our observation that a negative chest CT result does not exclude COVID-19 is supported by a study among passengers from the cruise ship Diamond Princess, which showed that 6 of 28 symptomatic patients with COVID-19 had normal chest CT findings.25

RT-PCR of nasopharyngeal and oropharyngeal specimens is considered the standard to diagnose COVID-19.26⇓⇓-29 However, currently available RT-PCR tests are time-consuming (it takes several hours before the results are known), and there is still relatively limited RT-PCR testing capacity worldwide.30,31 In a heavily constrained environment with a lack of sufficient RT-PCR testing capacity and a shortage of isolation beds, additional chest CT may be performed to detect COVID-19 in patients who have already undergone head CT. The data from this study may be used to weigh the potential advantages and disadvantages of performing additional chest CT in such settings. On a different note, additional chest CT in patients who require CT scanning of other body regions may also be helpful for taking appropriate actions in a timely manner to maintain the safety of the CT room. If chest CT findings are positive for possible COVID-19, the CT room should be decontaminated (room downtime for decontamination is typically between 30 minutes to 1 hour32) before scanning the next patient.

Our study has some limitations. First, the number of included patients was relatively low. Nevertheless, we were able to demonstrate the value of additional chest CT for COVID-19 detection in patients with suspected stroke or head trauma. Second, in only 2 of 5 patients with positive findings on chest CT but negative findings on the initial RT-PCR was repeat RT-PCR performed (with findings remaining negative) due to the limited availability of RT-PCR kits in our hospital. Only patients in whom clinical suspicion of COVID-19 persisted were retested.

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 RT-PCR, is needed for confirmation.

Indicates open access to non-subscribers at www.ajnr.org

References

  1. 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#/bda7594740fd40299423467b48e9ecf6. Accessed April 19, 2020
  2. 2.↵
    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-health-care.html. Accessed April 19, 2020
  3. 3.↵
    1. Marquez M,
    2. 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-patients-deaths/index.html. Accessed April 19, 2020
  4. 4.↵
    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
  5. 5.↵
    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-recommendations.html. Accessed April 19, 2020
  6. 6.↵
    1. Wang D,
    2. Hu B,
    3. Hu C, et al
    . Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020 Feb 7. [Epub ahead of print] doi:10.1001/jama.2020.1585 pmid:32031570
    CrossRefPubMed
  7. 7.↵
    World Health Organization. Neurological Disorders. https://www.who.int/mental_health/neur. Accessed April 19, 2020
  8. 8.↵
    Centers for Disease Control and Prevention. Emergency Department Visits. https://www.cdc.gov/nchs/fastats/emergency-department.htm. Accessed April 19, 2020
  9. 9.↵
    1. Ai T,
    2. Yang Z,
    3. Hou H, et al
    . Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology 2020 Feb 26. [Epub ahead of print] doi:10.1148/radiol.2020200642 pmid:32101510
    CrossRefPubMed
  10. 10.↵
    1. Kamalian S,
    2. Lev MH
    . Stroke imaging. Radiol Clin North Am 2019;57:717–32 doi:10.1016/j.rcl.2019.02.001 pmid:31076028
    CrossRefPubMed
  11. 11.↵
    1. Salmela MB,
    2. Mortazavi S,
    3. Jagadeesan BD, et al
    ; Expert Panel on Neurologic Imaging. ACR Appropriateness Criteria® Cerebrovascular Disease. J Am Coll Radiology 2017;14:S34–61 doi:10.1016/j.jacr.2017.01.051 pmid:28473091
    CrossRefPubMed
  12. 12.↵
    1. Shetty VS,
    2. Reis MN,
    3. Aulino JM, et al
    . ACR Appropriateness Criteria head trauma. J Am Coll Radiology 2016;13:668–79 doi:10.1016/j.jacr.2016.02.023 pmid:27262056
    CrossRefPubMed
  13. 13.↵
    1. Kang Z,
    2. Li X,
    3. Zhou S
    . Recommendation of low-dose CT in the detection and management of COVID-2019. Eur Radiol 2020 March 19. [Epub ahead of print] doi:10.1007/s00330-020-06809-6 pmid:32193637
    CrossRefPubMed
  14. 14.↵
    National Institute for Public Health and the Environment. Ontwikkeling COVID-19 in grafieken. https://www.rivm.nl/coronavirus-covid-19/grafieken. Accessed April 19, 2020
  15. 15.↵
    1. Simpson S,
    2. Kay FU,
    3. Abbara S, et al
    . Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19: endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. Radiology: Cardiothoracic Imaging 2020;2:e200152 doi:10.1148/ryct.2020200152
    CrossRef
  16. 16.↵
    Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19): Symptoms of Coronavirus. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html. Accessed April 19, 2020
  17. 17.↵
    Centre for Evidence-Based Medicine. COVID-19: What proportion are asymptomatic? https://www.cebm.net/covid-19/covid-19-what-proportion-are-asymptomatic/. Accessed April 19, 2020
  18. 18.↵
    1. Bai Y,
    2. Yao L,
    3. Wei T, et al
    . Presumed asymptomatic carrier transmission of COVID-19. JAMA 2020 Feb 21. [Epub ahead of print] doi:10.1001/jama.2020.2565 pmid:32083643
    CrossRefPubMed
  19. 19.↵
    1. Hu Z,
    2. Song C,
    3. Xu C, et al
    . Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. Sci China Life Sci 2020;63:706–11 doi:10.1007/s11427-020-1661-4 pmid:32146694
    CrossRefPubMed
  20. 20.↵
    1. Yu X,
    2. Yang R
    . COVID-19 transmission through asymptomatic carriers is a challenge to containment. https://onlinelibrary.wiley.com/doi/pdf/10.1111/irv.12743. Accessed April 19, 2020
  21. 21.↵
    1. Rothe C,
    2. Schunk M,
    3. Sothmann P, et al
    . Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med 2020;382:970–71 doi:10.1056/NEJMc2001468 pmid:32003551
    CrossRefPubMed
  22. 22.↵
    Novel Coronavirus Pneumonia Diagnosis and Treatment Plan (Provisional 7th Edition). http://www.gov.cn/zhengce/zhengceku/2020-03/04/5486705/files/ae61004f930d47598711a0d4cbf874a9.pdf. Accessed April 19, 2020
  23. 23.↵
    1. Caruso D,
    2. Zerunian M,
    3. Polici M, et al
    . Chest CT features of COVID-19 in Rome, Italy. Radiology 2020 April 3. [Epub ahead of print] doi:10.1148/radiol.2020201237] pmid:32243238
    CrossRefPubMed
  24. 24.↵
    1. Wen Z,
    2. Chi Y,
    3. Zhang L, et al
    . Coronavirus disease 2019: initial detection on chest CT in a retrospective multicenter study of 103 Chinese subjects. Radiology: Cardiothoracic Imaging 2020;2:e200092 doi:10.1148/ryct.2020200092
    CrossRef
  25. 25.↵
    1. Inui S,
    2. Fujikawa A,
    3. Jitsu M, et al
    . Erratum: chest CT findings in cases from the cruise ship “Diamond Princess” with coronavirus disease 2019 (COVID-19). Radiology: Cardiothoracic Imaging 2020;2:e204002 doi:10.1148/ryct.2020204002
    CrossRef
  26. 26.↵
    1. Huang C,
    2. Wang Y,
    3. Li X, et al
    . Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497–506 doi:10.1016/S0140-6736(20)30183-5 pmid:31986264
    CrossRefPubMed
  27. 27.↵
    1. Guan WJ,
    2. Ni ZY,
    3. Hu Y, et al
    ; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708–20 doi:10.1056/NEJMoa2002032 pmid:32109013
    CrossRefPubMed
  28. 28.↵
    World Health Organization. WHO interim guidance for laboratory testing. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/laboratory-guidance. Accessed April 19, 2020
  29. 29.↵
    1. Corman VM,
    2. Landt O,
    3. Kaiser M, et al
    . Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill 2020;25 doi:10.2807/1560-7917.ES.2020.25.3.200004]5 pmid:31992387
    CrossRefPubMed
  30. 30.↵
    1. Cheng MP,
    2. Papenburg J,
    3. Desjardins M, et al
    . Diagnostic testing for severe acute respiratory syndrome-related coronavirus-2: a narrative review. Ann Intern Med 2020 April 13. [Epub ahead of print] doi:10.7326/M20-1301 pmid:32282894
    CrossRefPubMed
  31. 31.↵
    National Institute for Public Health and the Environment. Policy on testing for novel coronavirus disease (COVID-19). https://www.rivm.nl/en/novel-coronavirus-covid-19/what-are-we-doing-in-the-netherlands-in-response-to-the-coronavirus/testing-policy. Accessed April 19, 2020
  32. 32.↵
    1. Mossa-Basha M,
    2. Meltzer CC,
    3. Kim DC, et al
    . Radiology department preparedness for COVID-19: Radiology Scientific Expert Panel. Radiology 2020 Mar 16. [Epub ahead of print] doi:10.1148/radiol.2020200988] pmid:32175814
    CrossRefPubMed
  • Received April 20, 2020.
  • Accepted after revision April 29, 2020.
  • © 2020 by American Journal of Neuroradiology
View Abstract
PreviousNext
Back to top
Advertisement
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on American Journal of Neuroradiology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
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?
(Your Name) has sent you a message from American Journal of Neuroradiology
(Your Name) thought you would like to see the American Journal of Neuroradiology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
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?
R.M. Kwee, J. Krdzalic, B.A.C.M. Fasen, T.M.H. de Jaegere, for the COVID-19 CT Investigators South-East Netherlands (CISEN) Study Group
American Journal of Neuroradiology May 2020, DOI: 10.3174/ajnr.A6607

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
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?
R.M. Kwee, J. Krdzalic, B.A.C.M. Fasen, T.M.H. de Jaegere, for the COVID-19 CT Investigators South-East Netherlands (CISEN) Study Group
American Journal of Neuroradiology May 2020, DOI: 10.3174/ajnr.A6607
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Purchase

Jump to section

  • Article
    • Abstract
    • ABBREVIATIONS:
    • MATERIALS AND METHODS
    • RESULTS
    • DISCUSSION
    • CONCLUSIONS
    • References
  • Figures & Data
  • Info & Metrics
  • References
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Reply:
  • Chest CT Scanning in Suspected Stroke: Not Always Worth the Extra Mile
  • Regional Mechanical Thrombectomy Imaging Protocol in Patients Presenting with Acute Ischemic Stroke during the COVID-19 Pandemic
  • Crossref
  • Google Scholar

This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking.

More in this TOC Section

  • MGMT Promoter Methylation Status in Initial and Recurrent Glioblastoma: Correlation Study with DWI and DSC PWI Features
  • Traumatic Cerebral Microbleeds in the Subacute Phase Are Practical and Early Predictors of Abnormality of the Normal-Appearing White Matter in the Chronic Phase
  • CTA Evaluation of Basilar Septations: An Entity Better Characterized as Aberrant Basilar Fenestrations
Show more ADULT BRAIN

Similar Articles

Advertisement

News and Updates

  • Lucien Levy Best Research Article Award
  • Thanks to our 2020 Distinguished Reviewers
  • Press Releases

Resources

  • Evidence-Based Medicine Level Guide
  • How to Participate in a Tweet Chat
  • AJNR Podcast Archive
  • Ideas for Publicizing Your Research
  • Librarian Resources
  • Terms and Conditions

Opportunities

  • Share Your Art in Perspectives
  • Get Peer Review Credit from Publons
  • Moderate a Tweet Chat

American Society of Neuroradiology

  • Neurographics
  • ASNR Annual Meeting
  • Fellowship Portal
  • Position Statements

© 2021 by the American Society of Neuroradiology | Print ISSN: 0195-6108 Online ISSN: 1936-959X

Powered by HighWire