CT imaging often has negative findings for COVID-19

Although computed tomography (CT) scans shouldn’t be used to screen for COVID-19, doctors and other health care workers should have some familiarity with how the disease presents with CT imaging. A new report in the American Journal of Roentgenology looks at CT imaging for children who had COVID-19.¹

Investigators retrospectively looked at the CT findings and clinical symptoms of 30 children who had laboratory-confirmed cases of COVID-19 and were seen at 6 centers in China. The patients were aged 10 months to 18 years. Patients who did not have a chest CT examination were excluded from the study. Lung involvement was scored and characterized by 2 cardiothoracic radiologists and a cardiothoracic imaging fellow.

They found that the CT findings were negative 77% of the time. In children with positive CT scans, the findings included halo and reverse halo signs, a crazy paving pattern, and ground-glass opacities with a peripheral lung distribution. A correlation between increasing age and increasing severity of findings was seen. Eleven of the children had a follow-up chest CT and 10 of the new CT scans showed no change.

The researchers stated that further research is needed to describe clinical symptoms and imaging findings for COVID-19 for every age group, but their findings indicate that CT imaging may be of limited use in the pediatric population. Limitations included the reasons for the follow-up CT scans were not well documented, there was no correlation between worsening symptoms and a follow-up CT, and a small percentage of cases had abnormal CT findings, all of which can make generalization of CT findings a challenge.

References:

1.    Steinberger S, Lin B, Bernheim A, et al. CT features of coronavirus disease (COVID-19) in 30 pediatric patients. AJR Am J Roentgenol. May 22, 2020. Epub ahead of print. doi: 10.2214/AJR.20.23145