Acute Ischemic Stroke: Apical Lung Assessment on CTA Could Also Identify COVID-19

Apical lung assessment on computed tomography angiography (CTA) has been deemed an accurate screening tool to detect COVID-19 and “can serve as part of a combined screening approach” among patients presenting with acute ischemic stroke (AIS), according to new findings published in Stroke.¹

“Every second counts when treating a person experiencing a stroke,” said lead study author Charles Esenwa, MD, MS, stroke neurologist and assistant professor at the Albert Einstein College of Medicine in the Bronx, New York, in a press release.²

“Conducting a CTA is already part of the stroke management process, and these scans provide an opportunity to assess the lungs for signs suggestive of COVID-19,” Dr Esenwa explained.² “Our team sought to determine if this already necessary scan could have a secondary use of identifying potential COVID-19 patients more quickly than a standard nasal swab COVID-19 test.”²

Dr Esenwa and colleagues’ findings emerged from an analysis (N = 57) in which researchers examined the efficacy of apical lung examination on CTA in detecting lung findings specific to COVID-19. The diagnostic precision of lung examination alone and in combination with symptoms reported by patients were measured and used to develop what the researchers described as a “COVID-19 era AIS algorithm.”

The results of the study indicated that, for the diagnosis of COVID-19 among patients who presented to the hospital with AIS, apical lung assessment alone had a sensitivity of 0.67, specificity of 0.93, positive predictive value of 0.19, negative predictive value of 0.99, and accuracy of 0.92.

The sensitivity of apical lung assessment was found to improve to 0.83 when assessed in combination with self-reported clinical symptoms of cough or shortness of breath, the researchers wrote.

“In combination with symptoms, CTA scan analysis is relatively accurate in diagnosing COVID-19, even compared to the nasal swab test. Since this analysis is much faster and at no extra cost, we hope it could be incorporated as a rapid diagnosis tool for patients with acute stroke,” said Dr Esenwa in a press release.²

“In addition, accurately diagnosing COVID-19 within hours, rather than the sometimes days wait-time to receive the results from nasal swab tests, could help protect both patients and medical professionals,” Dr Esenwa added.²

—Christina Vogt

References:

1. Esenwa C, Lee JA, Nisar T, et al. Utility of apical lung assessment on computed tomography angiography as a COVID-19 screen in acute stroke. Stroke. Published online October 29, 2020. doi:10.1161/STROKEAHA.120.030959
2. Lung scans for stroke patients could provide earlier COVID-19 detection. News release. American Heart Association; October 29, 2020. Accessed October 29, 2020. https://newsroom.heart.org/news/lung-scans-for-stroke-patients-could-provide-earlier-covid-19-detection?preview=e0e8