Volume 32, Issue 1 (3-2025)
RJMS 2025, 32(1): 1-10 |
Back to browse issues page
Research code: 1
Ethics code: IR.IUMS.FMD.REC.1400.652
Clinical trials code: 1
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Zarei E, Javanmanesh S. Comparison of CT Scan Findings in Children with COVID-19 with Positive and Negative PCR Referred to Aliasghar Children's Hospital in 2021-2022. RJMS 2025; 32 (1) :1-10
URL: http://rjms.iums.ac.ir/article-1-8608-en.html
URL: http://rjms.iums.ac.ir/article-1-8608-en.html
1- Associate Professor of Radiology, Department of Radiology, Aliasghar Children's Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
2- Department of Radiology, Aliasghar Children's Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran ,saberjavanmanesh@gmail.com
2- Department of Radiology, Aliasghar Children's Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran ,
Abstract: (823 Views)
Background & Aims: The outbreak of COVID-19 began as a significant global issue in late December 2019 in Wuhan, China. It quickly escalated into a pandemic, resulting in numerous fatalities despite various global interventions. Early diagnosis of COVID-19 in children is crucial not only for their health but also to mitigate the risk of transmission to adults. Although many diagnostic tests are employed worldwide, the RT-PCR test is recognized as the most reliable laboratory method. However, its average accuracy varies widely, estimated between 40% and 60% due to multiple influencing factors. Therefore, clinical, radiological, and laboratory findings are essential for diagnosing and monitoring COVID-19, particularly in children. Radiological examinations play a vital role in diagnosing COVID-19 as well as other respiratory diseases. Among various imaging techniques, chest computed tomography (CT) is regarded as the primary method for diagnosing and monitoring patients with COVID-19. Evidence indicates that clinical symptoms combined with CT findings can confirm the presence of COVID-19 in some patients, even when PCR tests yield negative results. Given this variability, it is essential to thoroughly understand CT scan findings to make more accurate decisions regarding the diagnosis and treatment of COVID-19 patients. In light of the limited studies evaluating CT scan findings in pediatric patients compared to adults with COVID-19 infection both in Iran and globally, and considering that most classifications of CT findings are primarily based on adult data, this study aimed to assess the radiological findings of children diagnosed with COVID-19, whether PCR positive or negative.
Methods: This cross-sectional study was conducted on children with COVID-19 referred to a university hospital affiliated by Iran University of Medical Sciences, Ali Asghar Children's Hospital in 2021. Patients were divided into two groups: (1) those with positive PCR results for COVID-19 and (2) those with negative PCR results. All patients underwent a CT scan within the first two days of admission. Required information was recorded using a checklist, which included the number of involved lobes, side of involvement (unilateral, bilateral, or none), opacity distribution (central, peripheral, or both), and opacity patterns (pure consolidation, ground-glass opacities (GGO)) with consolidation, pure GGO, nodules, bronchial wall thickening, reticular or linear opacities, lymphadenopathy, and pleural effusion). The CT scans were reviewed by a radiologist, and the children's images were categorized into four groups: typical, atypical, indeterminate, and negative CTs based on RSNA Structured Reporting guidelines. Data were analyzed using SPSS version 23 software, and statistical significance level considered less than 0.05.
Results: A total of 146 patients with COVID-19 were included in the study, of whom 40 patients (27.6%) had negative PCR results and 82 (56.2%) were boys. A total of 59 subjects (40.4%) exhibited lung involvement in their CT scans, including 14 in the PCR-negative group and 45 in the PCR-positive group. Although lung involvement was higher in the PCR-positive group than in the negative group (42.5% vs. 35%), this difference was not statistically significant. In our study, the predominant pattern among both PCR-positive and negative patients was consolidation, followed by mixed patterns and then ground-glass opacities (GGO). The dominant pattern in PCR-negative cases was consolidation, while GGO, consolidation, and mixed patterns were observed almost equally in the PCR-positive group, with the difference between the two groups approaching significance. Although halo and round signs were more prevalent in the PCR-negative group, there were no significant differences between the two groups regarding halo signs, reverse halo signs, crazy paving, or round signs. The rates of typical and indeterminate involvement were equal (15.9%) and higher than atypical involvement (10.9%) in both negative and positive PCR groups, independent of the PCR results. The typicality of lung involvement did not show a significant correlation with disease severity. Comparison of opacity distribution in lung CT scans revealed that peripheral involvement was significantly more common in PCR-positive cases than in PCR-negative cases. Bilateral lung involvement was more frequent in PCR-positive cases; however, this difference was not statistically significant. The classification of lesions was nearly identical between the two groups. Additionally, there was no significant difference in lung lobe involvement between the PCR-positive and negative groups.
Conclusion: The results of our study indicated that there is no significant difference in most CT findings between children with COVID-19 who had positive and negative PCR results. This suggests that the imaging characteristics of the disease may not vary substantially based on PCR status in this pediatric population. However, one notable exception was environmental involvement, which was found to be more prevalent in PCR-positive cases compared to PCR-negative cases. In terms of specific patterns observed in the CT scans, the predominant pattern in PCR-negative cases was consolidation. This finding aligns with existing literature that describes consolidation as a common radiological feature in pediatric patients with respiratory infections. Conversely, in the PCR-positive group, a variety of patterns were noted, including frosted glass opacity patterns, consolidation, and mixed patterns. These patterns were observed almost equally among the patients in this group, indicating a broader spectrum of lung involvement in those with confirmed COVID-19 infection. Overall, our findings highlight the complexity of interpreting CT results in children with COVID-19 and underscore the importance of considering both clinical and radiological factors when assessing these patients.
Methods: This cross-sectional study was conducted on children with COVID-19 referred to a university hospital affiliated by Iran University of Medical Sciences, Ali Asghar Children's Hospital in 2021. Patients were divided into two groups: (1) those with positive PCR results for COVID-19 and (2) those with negative PCR results. All patients underwent a CT scan within the first two days of admission. Required information was recorded using a checklist, which included the number of involved lobes, side of involvement (unilateral, bilateral, or none), opacity distribution (central, peripheral, or both), and opacity patterns (pure consolidation, ground-glass opacities (GGO)) with consolidation, pure GGO, nodules, bronchial wall thickening, reticular or linear opacities, lymphadenopathy, and pleural effusion). The CT scans were reviewed by a radiologist, and the children's images were categorized into four groups: typical, atypical, indeterminate, and negative CTs based on RSNA Structured Reporting guidelines. Data were analyzed using SPSS version 23 software, and statistical significance level considered less than 0.05.
Results: A total of 146 patients with COVID-19 were included in the study, of whom 40 patients (27.6%) had negative PCR results and 82 (56.2%) were boys. A total of 59 subjects (40.4%) exhibited lung involvement in their CT scans, including 14 in the PCR-negative group and 45 in the PCR-positive group. Although lung involvement was higher in the PCR-positive group than in the negative group (42.5% vs. 35%), this difference was not statistically significant. In our study, the predominant pattern among both PCR-positive and negative patients was consolidation, followed by mixed patterns and then ground-glass opacities (GGO). The dominant pattern in PCR-negative cases was consolidation, while GGO, consolidation, and mixed patterns were observed almost equally in the PCR-positive group, with the difference between the two groups approaching significance. Although halo and round signs were more prevalent in the PCR-negative group, there were no significant differences between the two groups regarding halo signs, reverse halo signs, crazy paving, or round signs. The rates of typical and indeterminate involvement were equal (15.9%) and higher than atypical involvement (10.9%) in both negative and positive PCR groups, independent of the PCR results. The typicality of lung involvement did not show a significant correlation with disease severity. Comparison of opacity distribution in lung CT scans revealed that peripheral involvement was significantly more common in PCR-positive cases than in PCR-negative cases. Bilateral lung involvement was more frequent in PCR-positive cases; however, this difference was not statistically significant. The classification of lesions was nearly identical between the two groups. Additionally, there was no significant difference in lung lobe involvement between the PCR-positive and negative groups.
Conclusion: The results of our study indicated that there is no significant difference in most CT findings between children with COVID-19 who had positive and negative PCR results. This suggests that the imaging characteristics of the disease may not vary substantially based on PCR status in this pediatric population. However, one notable exception was environmental involvement, which was found to be more prevalent in PCR-positive cases compared to PCR-negative cases. In terms of specific patterns observed in the CT scans, the predominant pattern in PCR-negative cases was consolidation. This finding aligns with existing literature that describes consolidation as a common radiological feature in pediatric patients with respiratory infections. Conversely, in the PCR-positive group, a variety of patterns were noted, including frosted glass opacity patterns, consolidation, and mixed patterns. These patterns were observed almost equally among the patients in this group, indicating a broader spectrum of lung involvement in those with confirmed COVID-19 infection. Overall, our findings highlight the complexity of interpreting CT results in children with COVID-19 and underscore the importance of considering both clinical and radiological factors when assessing these patients.
Send email to the article author
