Computed Tomography Features of COVID-19 in Children: A Systematic Review and Meta-analysis

Objectives To systematically analyze the chest CT imaging features of children with COVID-19 and provide references for clinical practice. Methods We searched PubMed, Web of Science, and Embase; data published by Johns Hopkins University; and Chinese databases CNKI, Wanfang, and Chongqing Weipu. Reports on chest CT imaging features of children with COVID-19 from January 1, 2020, to August 10, 2020, were analyzed retrospectively and a meta-analysis carried out using Stata12.0 software. Results Thirty-seven articles (1747 children) were included in this study. The overall rate of abnormal lung CT findings was 63.2% (95% confidence interval [CI]: 55.8–70.6%), with a rate of 61.0% (95% CI: 50.8–71.2%) in China and 67.8% (95% CI: 57.1–78.4%) in the rest of the world in the subgroup analysis. The incidence of ground-glass opacities was 39.5% (95% CI: 30.7–48.3%), multiple lung lobe lesions 65.1% (95% CI: 55.1–67.9%), and bilateral lung lesions 61.5% (95% CI: 58.8–72.2%). Other imaging features included nodules (25.7%), patchy shadows (36.8%), halo sign(24.8%), consolidation (24.1%), air bronchogram signs (11.2%), cord-like shadows (9.7%), crazy-paving pattern (6.1%), and pleural effusion (9.1%). Two articles reported three cases of white lung, another reported two cases of pneumothorax, and another one case of bullae. CONCLUSION The lung CT results of children with COVID-19 are usually normal or slightly atypica, with a low sensitivity and specificity compared with that in adults. The lung lesions of COVID-19 pediatric patients mostly involve both lungs or multiple lobes, and the common manifestations are patchy shadows, ground-glass opacities, consolidation, partial air bronchogram signs, nodules, and halo signs; white lung, pleural effusion, and paving stone signs are rare. CLINICAL IMPACT Therefore, chest CT has limited value as a screening tool for children with COVID-19 and can only be used as an auxiliary assessment tool. Registration This systematic review and meta-analysis was registered in the Prospero International Prospective Register of Systemic Reviews (CRD42020196602). Strengths and limitations of this study The lung CT findings of children with COVID-19 are usually normal or slightly atypical, with a low sensitivity and specificity compared with that in adults. From a systematic review of current literature, the overall rate of abnormal lung CT findings in children was revealed to be 63.2%. Chest CT has limited value as a screening tool for children with COVID-19 and can only be used as an auxiliary assessment tool. The sample size of some included studies is small, which may affect the results.