Razi Journal of Medical Sciences

fa مقایسه یافته‌های سی‌تی اسکن در کودکان مبتلا به کووید-19 با PCR مثبت و منفی مراجعه‌کننده به بیمارستان کودکان حضرت علی اصغر(ع) در سال 1400 Comparison of CT Scan Findings in Children with COVID-19 with Positive and Negative PCR Referred to Aliasghar Children's Hospital in 2021-2022 رادیولوژی Radiology پژوهشي Research <div style="text-align: justify;">زمینه و هدف: الگوهای تصویربرداری هنوز از مسائل مهم برای تشخیص بالینی COVID-19 می‌باشد. در مطالعه حاضر، هدف ارزیابی یافته‌های سی تی اسکن در کودکان مبتلا به کووید-19 با PCR مثبت و منفی مراجعه‌کننده به بیمارستان کودکان علی اصغر(ع) در سال 1400 بود. روش کار: این مطالعه مقطعی بر روی کودکان مبتلا به کووید-19 در سال 1400 انجام شد. در این مطالعه بیماران  کووید 19 به دو گروه تقسیم شدند: (1)  PCR مثبت، (2) PCR منفی. تمام بیماران طی دو روز اول تحت CT قرار گرفتند نماهای CT کودکان بر اساس RSNA Structured Reporting 3) به 4 دسته Typical، Atypical، Indeterminate و Negative Category CTs تقسیم شدند. یافته‌ها: 59 نفر (40.4%)  در سی تی اسکن درگیری ریه داشتند  (14 نفر در گروه PCRمنفی و 45 نفر در گروه PCR مثبت). اگرچه درگیری ریه در گروه PCR  مثبت بیشتر از گروه منفی بود (42.5% در مقابل 35%)، اما این تفاوت از نظر آماری معنی دار نبودالگوی غالب در موارد PCR منفی Consolidation بود؛ در حالی که  الگوهای (Ground Glss Opacity) GGO، Consolidation و Mixed  در گروه PCR مثبت تقریباً به یک اندازه دیده شدند و تفاوت دو گروه از این نظر معنی دار بود. علائم Halo و Round در گروه PCR منفی بیشتر بود، تفاوت معنی داری بین دو گروه در میزان علائم Halo،  Reverse Halo، Crazy Paving وجود نداشت. میزان درگیری تیپیک  و اینتر مدیت به طور مساوی (15.9%) و بیشتر از آتیپیک (10.9) در دو گروه PCR منفی و مثبت بود مقایسه توزیع اپاسیته در سی تی اسکن نشان داد که درگیری محیطی در موارد PCR مثبت  به طور معنی داری بیشتر از موارد PCR منفی است درگیری دو طرفه ریه در موارد PCR مثبت بیشتر بود، اما تفاوت بین دو گروه از نظر آماری معنی دار نبود. نتیجه‌گیری: نتایج مطالعه حاضر نشان داد درگیری محیطی در موارد PCR مثبت بیشتر از PCR منفی بود. الگوی غالب در موارد PCR منفی Consolidation بود، و در گروه PCR مثبت الگوهای GGO، Consolidation و Mixed  تقریباً به یک اندازه دیده شدند و تفاوت بین دو گروه از این نظر معنی دار بود.</div> <div style="text-align: justify;">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.</div> کووید-19, کودکان, بیماری کرونا, سی تی اسکن, PCR Covid-19, Pediatrics, Corona virus, CT scan 1 10 http://rjms.iums.ac.ir/browse.php?a_code=A-10-8055-1&slc_lang=fa&sid=1 Elham Zarei الهام زارعی 3900319475328460090988 3900319475328460090988 No Associate Professor of Radiology, Department of Radiology, Aliasghar Children's Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran دانشیار رادیولوژی کودکان، بیمارستان کودکان علی اصغر، دانشکده پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران Saber Javanmanesh صابر جوانمنش saberjavanmanesh@gmail.com 3900319475328460090989 3900319475328460090989 Yes Department of Radiology, Aliasghar Children's Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran متخصص رادیولوژی، گروه رادیولوژی، دانشکده پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران