Role of chest computed tomography in the diagnosis of SARS-CoV-2 pneumonia in children

Abstract

Background: First PCR-confirmed COVID-19 cases among Russian children were reported in early March 2020. Chest computed tomography (CT) is the most sensitive imaging modality in diagnosing early signs of viral lung damage. Limited data are available on clinical and laboratory features of COVID-19 in children and on their correlation with imaging findings. Studying COVID-19 features in children is crucial for modern medicine, which makes our research relevant.

Objective: To determine the diagnostic efficacy and correlation between laboratory, clinical, and CT findings in children and adolescents with COVID-19.

Materials and methods: From February 2020 to February 2021 372 patients with suspected COVID-19 were admitted to Morozov Children’s City Clinical Hospital (Moscow, Russian Federation). This retrospective study included 158 patients who presented with positive oropharyngeal and nasopharyngeal swab results, IgM and IgG test results, changes in complete blood count, blood biochemistry and coagulation test results, clinical symptoms, and suspected SARS-CoV-2 pneumonia based on chest CT findings.

Results: Chest CT sensitivity and specificity for diagnosis of SARS-CoV-2 pneumonia were up to 98% and 85%, respectively. We considered that severe respiratory motion artifacts in young children under general anesthesia adversely affected the diagnostic efficacy. Sensitivity and specificity in this group were up to 89% and 71%, respectively.

Conclusions: Viral pneumonia signs on chest CT scans were statistically significantly more frequent in children with cough, respiratory failure signs, lymphopenia, and increased D-dimer and C-reactive protein levels. One of these signs or a combination of them are an indication for chest CT in children with suspected SARS-CoV-2 pneumonia.