Value of chest computed tomographic scan added to acute stroke neuroimaging protocol for identifying coronavirus disease 2019: A critical assessment of a prospective protocol

Objective: We report our experience of incorporating chest CT scan in the initial neuroimaging protocol for evaluation of acute stroke patients. Background: Coronavirus Disease 2019 (COVID-19) is associated with an increased risk for acute ischemic stroke but screening for COVID-19 based on clinical criteria or laboratory testing may be difficult in acute stroke evaluation. Chest computed tomographic (CT) scan may be another time-sensitive option for identification. of COVID-19 in such patients. Design/Methods: All acute stroke patients underwent chest CT scan concurrent to CT head, CT angiogram of head and neck and CT perfusion for 4 months. We identified patients who had chest CT scan findings that were suggestive of COVID-19 including bilateral, multilobar ground glass opacification with a peripheral or posterior distribution, and/or consolidation (mainly in the lower lobes). All patients subsequently underwent polymerase chain reaction (PCR) testing of nasopharyngeal swab with contact isolation until COVID-19 could be excluded. Results: A total of 224 consecutive patients (mean age 62.12 years±SD;15.3) underwent acute stroke evaluation with a concurrent chest CT scan. The chest CT identified findings suggestive of COVID-19 in 11 (4.9%) patients. Subsequent PCR testing did not confirm the diagnosis of COVID-19 in any of the patient. Another 99 patients (44%) without any findings suggestive of COVID-19 on chest CT scan underwent PCR testing. PCR testing did not confirm the diagnosis of COVID-19 in any of the patients. Four patients (4.3%) with chest CT scan findings suggestive of COVID-19 were found to have an ischemic stroke while 7 patients (5.9%) with chest CT scan findings suggestive of COVID-19 did not have any ischemic stroke (stroke mimic). Conclusions: We found a very low yield for identifying COVID-19 in acute stroke patients by performing chest CT scan concurrent to standard acute stroke neuroimaging protocol.