RT Journal Article
SR Electronic
T1 COVID-19 Stroke Apical Lung Examination Study: A Diagnostic and Prognostic Imaging Biomarker in Suspected Acute Stroke
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
DO 10.3174/ajnr.A6832
A1 Siddiqui, J.
A1 Bala, F.
A1 Sciacca, S.
A1 Falzon, A.M.
A1 Benger, M.
A1 Matloob, S.A.
A1 Miller, F.N.A.C.
A1 Simister, R.J.
A1 Chatterjee, I.
A1 Sztriha, L.K.
A1 Davagnanam, I.
A1 Booth, T.C.
YR 2020
UL http://www.ajnr.org/content/early/2020/09/17/ajnr.A6832.abstract
AB BACKGROUND AND PURPOSE: Diagnosis of coronavirus disease 2019 (COVID-19) relies on clinical features and reverse-transcriptase polymerase chain reaction testing, but the sensitivity is limited. Carotid CTA is a routine acute stroke investigation and includes the lung apices. We evaluated CTA as a potential COVID-19 diagnostic imaging biomarker.MATERIALS AND METHODS: This was a multicenter, retrospective study (n = 225) including CTAs of patients with suspected acute stroke from 3 hyperacute stroke units (March-April 2020). We evaluated the reliability and accuracy of candidate diagnostic imaging biomarkers. Demographics, clinical features, and risk factors for COVID-19 and stroke were analyzed using univariate and multivariate statistics.RESULTS: Apical ground-glass opacification was present in 22.2% (50/225) of patients. Ground-glass opacification had high interrater reliability (Fleiss κ = 0.81; 95% CI, 0.68–0.95) and, compared with reverse-transcriptase polymerase chain reaction, had good diagnostic performance (sensitivity, 75% [95% CI, 56–87]; specificity, 81% [95% CI, 71–88]; OR = 11.65 [95% CI, 4.14–32.78]; P < .001) on multivariate analysis. In contrast, all other contemporaneous demographic, clinical, and imaging features available at CTA were not diagnostic for COVID-19. The presence of apical ground-glass opacification was an independent predictor of increased 30-day mortality (18.0% versus 5.7%, P = .017; hazard ratio = 3.51; 95% CI, 1.42–8.66; P = .006).CONCLUSIONS: We identified a simple, reliable, and accurate COVID-19 diagnostic and prognostic imaging biomarker obtained from CTA lung apices: the presence or absence of ground-glass opacification. Our findings have important implications in the management of patients presenting with suspected stroke through early identification of COVID-19 and the subsequent limitation of disease transmission.BSTIBritish Society of Thoracic ImagingCOVID-19coronavirus disease 2019GGOground-glass opacificationIRRinterrater reliabilityRT-PCRreverse-transcriptase polymerase chain reactionSARS-CoV-2Severe Acute Respiratory Syndrome coronavirus 2