Greater Manchester Comprehensive Stroke Centre, Manchester Centre for Clinical Neurosciences, Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Salford Royal Foundation Trust, UK; Division of Cardiovascular Sciences, Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK.
Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, UK and National Heart and Lung Institute, Imperial College London, UK.
J Stroke Cerebrovasc Dis. 2021 Jun;30(6):105757. doi: 10.1016/j.jstrokecerebrovasdis.2021.105757. Epub 2021 Apr 17.
Accurate and timely diagnosis of pneumonia complicating stroke remains challenging and the diagnostic accuracy of chest X-ray (CXR) in the setting of stroke-associated pneumonia (SAP) is uncertain. The overall objective of this study was to evaluate the use of pulmonary computed tomography (CT) in diagnosis of suspected SAP.
Patients with acute ischemic stroke (IS) or intracerebral hemorrhage (ICH) were recruited within 24h of clinically suspected SAP and underwent non-contrast pulmonary CT within 48h of antibiotic initiation. CXR and pulmonary CT were reported by two radiologists. Pulmonary CT was used as the reference standard for final diagnosis of SAP. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and diagnostic odds ratio (OR) for CXR were calculated.
40 patients (36 IS, 4 ICH) with a median age of 78y (range 44y-90y) and a median National Institute of Health Stroke Scale score of 13 (range 3-31) were included. All patients had at least one CXR and 35/40 patients (88%) underwent pulmonary CT. Changes consistent with pneumonia were present in 15/40 CXRs (38%) and 12/35 pulmonary CTs (34%). 9/35 pulmonary CTs (26%) were reported normal. CXR had a sensitivity of 58.3%, specificity of 73.9%, PPV of 53.8 %, NPV of 77.2 %, diagnostic OR of 3.7 (95% CI 0.7 - 22) and an accuracy of 68.5% (95% CI 50.7% -83.1%).
CXR has limited diagnostic accuracy in SAP. The majority of patients started on antibiotics had no evidence of pneumonia on pulmonary CT with potential implications for antibiotic stewardship.
Pulmonary CT could be applied as a reference standard for evaluation of clinical and biomarker diagnostic SAP algorithms in multi-center studies.
肺炎并发中风的准确和及时诊断仍然具有挑战性，并且在中风相关性肺炎（SAP）中，胸部 X 光（CXR）的诊断准确性尚不确定。本研究的总体目标是评估肺部计算机断层扫描（CT）在疑似 SAP 诊断中的应用。
在临床疑似 SAP 后 24 小时内招募急性缺血性中风（IS）或脑内出血（ICH）患者，并在抗生素开始后 48 小时内行非对比性肺部 CT。CXR 和肺部 CT 由两位放射科医生报告。肺部 CT 用于 SAP 的最终诊断参考标准。计算 CXR 的敏感性、特异性、阳性和阴性预测值（PPV 和 NPV）和诊断比值比（OR）。
纳入 40 名患者（36 名 IS，4 名 ICH），中位年龄为 78 岁（范围 44 岁-90 岁），中位国立卫生研究院中风量表评分 13 分（范围 3 分-31 分）。所有患者均至少有一次 CXR，40 名患者中有 35 名（88%）进行了肺部 CT。在 40 例 CXR 中，有 15 例（38%）存在与肺炎一致的变化，在 35 例肺部 CT 中，有 12 例（34%）存在与肺炎一致的变化。35 例肺部 CT 中有 9 例（26%）报告正常。CXR 的敏感性为 58.3%，特异性为 73.9%，PPV 为 53.8%，NPV 为 77.2%，诊断 OR 为 3.7（95%CI 0.7-22），准确率为 68.5%（95%CI 50.7%-83.1%）。
CXR 在 SAP 中的诊断准确性有限。大多数开始接受抗生素治疗的患者在肺部 CT 上没有肺炎的证据，这可能对抗生素管理有影响。
肺部 CT 可作为评估多中心研究中临床和生物标志物诊断 SAP 算法的参考标准。
