Chest CT findings of COVID-19-infected patients, are there differences between pediatric and adult patients? A systematic review

BackgroundPurpose of this study was to deliver a report of chest CT findings of COVID-19-infected pediatric and adult patients and to make an age-based comparison. A systematic search was conducted in accordance with PRISMA guidelines to identify relevant studies in the electronic databases of PubMed, Scopus, ProQuest, ScienceDirect, and Web of Sciences from January 1, 2020 to March 27, 2020 using search terms in the titles and s. Based on our inclusion and exclusion criteria, 762 articles were screened. Finally, 15 eligible articles which had adequate data on chest CT findings of COVID-19-infected patients were enrolled in this systematic review.ResultsIn pediatric patients (15 years old or younger), peripheral distribution was found in 100% of cases, ground glass opacities (GGO) in 55.2%, bilateral involvement in 50%, halo sign in 50%, unilateral involvement in 30%, consolidation in 22.2%, crazy paving pattern in 20%, nodular opacities in 15%, pleural effusion in 4.2%, lymphadenopathy in none, and normal imaging in 20.8% of cases. On the other hand, in adult patients, bilateral involvement was reported in 76.8%, GGO in 68.4%, peripheral distribution in 62.2%, mixed GGO and consolidation in 48.7%, consolidation in 33.7%, crazy paving pattern in 27.7%, mixed central and peripheral distribution in 25.0%, unilateral involvement in 15.2%, nodular opacities in 9.2%, pleural effusion in 5.5%, central distribution of lesions in 5.4%, lymphadenopathy in 2.4%, and normal imaging in 9.8% of cases.ConclusionAccording to the findings of this systematic review, children infected with COVID-19 can present with normal or atypical findings (nodular opacities/unilateral involvement) in chest imaging more frequently than adult patients. Therefore, more caution should be taken to avoid misdiagnosis or missed diagnosis in infected children. Besides, clinical and laboratory findings need to be considered more decision-making for pediatric patients with normal or atypical chest CT scan but high suspicion of COVID-19.

A low-dose chest CT protocol for the diagnosis of COVID-19 pneumonia: a prospective study.

PURPOSE: The increasing trend of chest CT utilization during the COVID-19 pandemic necessitates novel protocols with reduced dose and maintained diagnostic accuracy. We aimed to investigate the diagnostic accuracy of 30-mAs chest CT protocol in comparison with a 150-mAs standard-dose routine protocol for imaging of COVID-19 pneumonia. METHODS: Upon IRB approval, consecutive laboratory-confirmed positive COVID-19 patients aged 50 years or older who were referred for chest CT scan and had same-day normal CXR were invited to participate in this prospective study. First, a standard-dose chest CT scan (150 mAs) was performed. Only if typical COVID-19 pneumonia features were identified, then a low-dose CT (30 mAs) was done immediately. Diagnostic accuracy of low-dose and standard-dose CT in the detection of typical COVID-19 pneumonia features were compared. RESULTS: Twenty patients with a mean age of 64.20 ± 13.8 were enrolled in the study. There was excellent intrareader agreement in detecting typical findings of COVID-19 pneumonia between low-dose and standard-dose (intraclass correlation coefficient [ICC] = 0.98-0.99, P values < 0.001 all readers). The mean effective dose values in standard- and low-dose groups were 6.60 ± 1.47 and 1.80 ± 0.42 mSv, respectively. Also, absolute cancer risk per mean cumulative effective dose values obtained from the standard- and low-dose CT examinations were 2.71 × 10-4 and 0.74 × 10-4, respectively. CONCLUSIONS: According to our study, it was found that proposed low-dose CT chest protocol is reliable in detecting COVID-19 pneumonia in daily practice with significant reduction in radiation dose and estimated cancer risk.

Chest CT findings of COVID-19-infected patients, are there differences between pediatric and adult patients? A systematic review

Background: Purpose of this study was to deliver a report of chest CT findings of COVID-19-infected pediatric and adult patients and to make an age-based comparison. A systematic search was conducted in accordance with PRISMA guidelines to identify relevant studies in the electronic databases of PubMed, Scopus, ProQuest, ScienceDirect, and Web of Sciences from January 1, 2020 to March 27, 2020 using search terms in the titles and abstracts. Based on our inclusion and exclusion criteria, 762 articles were screened. Finally, 15 eligible articles which had adequate data on chest CT findings of COVID-19-infected patients were enrolled in this systematic review. Results: In pediatric patients (15 years old or younger), peripheral distribution was found in 100% of cases, ground glass opacities (GGO) in 55.2%, bilateral involvement in 50%, halo sign in 50%, unilateral involvement in 30%, consolidation in 22.2%, crazy paving pattern in 20%, nodular opacities in 15%, pleural effusion in 4.2%, lymphadenopathy in none, and normal imaging in 20.8% of cases. On the other hand, in adult patients, bilateral involvement was reported in 76.8%, GGO in 68.4%, peripheral distribution in 62.2%, mixed GGO and consolidation in 48.7%, consolidation in 33.7%, crazy paving pattern in 27.7%, mixed central and peripheral distribution in 25.0%, unilateral involvement in 15.2%, nodular opacities in 9.2%, pleural effusion in 5.5%, central distribution of lesions in 5.4%, lymphadenopathy in 2.4%, and normal imaging in 9.8% of cases. Conclusion: According to the findings of this systematic review, children infected with COVID-19 can present with normal or atypical findings (nodular opacities/unilateral involvement) in chest imaging more frequently than adult patients. Therefore, more caution should be taken to avoid misdiagnosis or missed diagnosis in infected children. Besides, clinical and laboratory findings need to be considered more decision-making for pediatric patients with normal or atypical chest CT scan but high suspicion of COVID-19.