Chest Computed Tomography Imaging Features of Novel Coronavirus Omicron Strain Infection in Children
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摘要: 目的：探讨儿童新型冠状病毒奥密克戎毒株感染的胸部CT影像特点。方法：回顾性分析2022年12月10日至2022年12月31日深圳市儿童医院77例核酸检测或抗原检测确诊为COVID-19患者的胸部CT表现，男51例，女26例。其中CT表现阳性50例，年龄1月～14岁，平均5.5岁，中位年龄3.9岁，婴幼儿组（≤3岁）21例，学龄前组（3～7岁）14例，学龄组（≥7岁）15例。由两名放射科医师独立识别肺内病灶位置、肺内病灶CT表现、肺部伴随CT表现、病灶累及范围及影像分期。结果：肺部CT表现阳性50例（64.9％）；病变好发于两肺下叶、胸膜下，近肺门区病变最少，病变数量单发、多发、弥漫分布均有，以弥漫分布最为多见。磨玻璃结节16例（32％），实性结节20例（40％），片状实变24例（48％），片状磨玻璃30例（60％），实变和磨玻璃20例（40％），片状磨玻璃最多见；铺路石样改变4例（8％），小叶间隔增厚12例（24％），树雾征12例（24％），血管增粗13例（26％），胸膜平行征7例（14％），反晕征6例（12％），充气支气管征17例（34％），均无空洞表现；胸腔积液5例（10％），胸膜增厚7例（14％），心包积液1例（2％），淋巴结增大7例（14％）。29例（37.7％）患者为影像分期的早期，15例（19.5％）为进展期，6例（7.8％）为重症期。结论：儿童新型冠状病毒奥密克戎毒株感染的胸部CT表现形态多样，伴随胸腔积液、胸膜增厚和心包积液提示严重预后的风险更高。儿童奥密克戎毒株感染的胸部CT检查能为诊断及判断病情提供有价值的信息。Abstract: Objective: To investigate the chest computed tomography (CT) imaging features of novel coronavirus omicron strain infection in children. Methods: The chest CT imaging of 77 children diagnosed with coronavirus disease (COVID-19) using nucleic acid testing or antigen testing from December 10 to 31, 2022 at Shenzhen Children's Hospital were retrospectively analyzed, including 51 males and 26 females. Among them, 50 cases were positive for CT presentation, and their ages ranged from 1 month to 14 years, with a mean age of 5.5 years and a median age of 3.9 years, including 21 cases in the infant and toddler group (≤3 years), 14 in the preschool group (3~7 years), and 15 cases in the school-age group (≥7 years). Two radiologists independently identified the location of intrapulmonary lesions, CT manifestations of intrapulmonary lesions, concomitant CT manifestations of the lungs, extent of lesion involvement, and imaging staging. Results: 50 patients (64.9%) had positive lung CT presentation, with the most lesions in the lower lobes and subpleural areas of both lungs and the least lesions in the hilus of lung, and the number of lesions were single, multiple, and diffusely distributed, with diffuse distribution being the most common. Ground-glass opacity were seen in 16 cases (32%), solid nodules in 20 (40%), lamellar consolidation in 24 (48%), lamellar ground glass in 30 (60%), and solid and ground glass in 20 (40%), with lamellar ground glass being the most common; crazy-paving pattern in 4 cases (8%), thickening of lobular septa in 12 (24%), tree fog sign in 12 (24%), and vascular enlargement in 13 (26%). 7 cases (14%) were of subpleural curvilinear line, 6 (12%) of reversed halo sign, and 17 (34%) of air bronchogram, all without cavitation; 5 (10%) were of pleural effusion, 7 (14%) of pleural thickening, 1 (2%) of pericardial effusion, and 7 (14%) of lymphadenopathy. 29 patients (37.7%) were in the early stage of imaging, 15 (19.5%) were in the progressive stage, and 6 (7.8%) were in the severe stage. Conclusion: The chest CT imaging of novel coronavirus omicron strain infection in children was morphologically diverse. The presence of pleural effusion, pleural thickening, and pericardial effusion suggests a higher risk of serious prognosis. Chest CT in children with omicron strain infection can provide valuable information for diagnosis and determine the extent of the disease.
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Keywords:
- novel coronavirus /
- Omicron strain /
- children /
- chest computed tomography
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图 1 女，9岁4月，右肺下叶磨玻璃结节
Figure 1. Female, 9 years and 4 months, ground-glass opacity in the lower lobe of the right lung
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图 2 男，10岁7月，双肺大片状磨玻璃伴小叶间隔增厚，形成铺路石样改变
Figure 2. Male, 10 years and 7 months old, lamellar ground glass with lobular septal thickening and crazy-paving pattern in both lungs
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图 3 男，8岁9月，右肺上叶支气管周围间质炎性渗出性改变，呈树雾征
Figure 3. Male, 8 years and 9 months old, tree fog sign in the right upper lung lobe
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图 4 女，10月，白色箭头所指为胸膜平行征
Figure 4. Female, 10 months, subpleural curvilinear line (white arrow)
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图 5 男，12岁，右肺下叶近斜裂处可见片状磨玻璃影（白色箭头所指），为影像早期
Figure 5. Male, 12 years old, a lamellar ground glass is seen in the lower lobe of the right lung near the oblique fissure (white arrow), which is early stage of imaging
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图 6 女，3岁4月，右肺中叶大片状实变（* 所指），伴右肺下叶片状磨玻璃影白色箭头所指，为进展期
Figure 6. Female, 3 years and 4 months old, with a large lamellar consolidation (*) in the middle lobe of the right lung with a lamellar ground glass (white arrow) in the lower right lung, which is imaged in the progressive stage
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图 7 男，3岁4月，MPR重建冠状位示，左肺大片状实变影，表现为“白肺”，为重症期
Figure 7. Male, 3 years and 4 months old, MPR coronal reconstruction shows a large consolidation in the lower lobe of the left lung, showing a "white lung", which is imaged in the severe stage
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图 8 婴幼儿组组内病灶分布、病灶数量、影像分期情况
Figure 8. Distribution of lesions, number of lesions, and imaging stage within the infant and toddler group
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图 9 学龄组组内病灶分布、影像分期情况
Figure 9. Distribution of lesions and imaging stage within the school-age group
表 1 各年龄组组间CT阳性/阴性占比及统计学指标
Table 1 Proportion of positive/negative CT presentation and statistical indicators among the age groups
CT表现 组别 统计检验 婴幼儿组，≤3岁
（n=21）例（％）学龄前组，3～7岁
（n=14）例（％）学龄组，≥7岁
（n=15）例（％）χ2 P 阴性 4（16.0） 4（22.2） 19（55.9） 11.766 0.003 阳性 21（84.0 ）a 14（77.8） 15（44.1）a 注：a-婴幼儿组与学龄组组间两者差异有统计学意义。 
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表 2 各年龄组组间病灶各类征象占比及统计学指标
Table 2 Proportion of various types of lesions and statistical indicators among the age groups
分布特征 组别 统计检验 婴幼儿组，≤3岁
（n=21）例（％）学龄前组，3～7岁
（n=14）例（％）学龄组，≥7岁
（n=15）例（％）χ2 P 累及部位 右肺上叶 15（71.4） 5（35.7） 6（40.0） 5.529 0.079 右肺中叶 9（42.9） 6（42.9） 7（46.7） 0.062 1.000 右肺下叶 13（61.9） 9（64.3） 12（80.0） 1.454 0.512 左肺上叶 15（71.4） 6（42.9） 7（46.7） 3.541 0.173 左肺下叶 15（71.4） 7（50.0） 10（66.7） 1.740 0.488 病灶分布 中央（近肺门） 2（9.5） 3（21.4） 1（6.7） 1.599 0.473 外带（近胸膜） 14（66.7） 9（64.3） 13（86.7） 2.342 0.274 两者之间 6（28.6） 5（35.7） 4（26.7） 0.406 0.857 病灶CT表现 磨玻璃结节 3（14.3） 5（35.7） 8（53.3） 6.216 0.049* 实性结节 6（28.6） 5（35.7） 9（60.0） 3.750 0.166 片状实变 12（57.1） 7（50.0） 5（33.3） 2.018 0.373 片状磨玻璃 15（71.4） 5（35.7） 10（66.7） 4.861 0.095 实变和磨玻璃 10（47.6） 4（28.6） 6（40.0） 1.270 0.541 充气支气管征 7（33.3） 5（35.7） 5（33.3） 0.124 1.000 空洞 0 0 0 铺路石样改变 3（14.3） 1（7.1） 0（0） 2.093 0.285 小叶间隔增厚 7（33.3） 1（7.1） 4（26.7） 3.249 0.216 树雾征 2（9.5） 2（14.3） 8（53.3） 9.038 0.008* 血管增粗 6（28.6） 3（21.4） 4（26.7） 0.296 0.922 胸膜平行征 3（14.3） 1（7.1） 3（20.0） 1.013 0.698 反晕征 3（14.3） 1（7.1） 2（13.3） 0.531 0.874 肺部伴随CT表现 胸腔积液 4（19.0） 1（7.1） 0 3.121 0.165 胸膜增厚 2（9.5） 2（14.3） 3（20.0） 0.961 0.785 心包积液 1（4.8） 0 0 1.444 1.000 淋巴结肿大 2（9.5） 2（14.3） 3（20.0） 0.961 0.785 病变累及范围 单发 4（19.0） 5（35.7） 4（26.7） 1.295 0.556 多发 5（23.8） 4（28.6） 3（20.0） 0.393 0.917 弥漫 12（57.1） 5（35.7） 8（53.3） 1.638 0.515 影像分期 早期 12（57.1） 8（57.1） 9（60.0） 0.035 1.000 进展期 8（38.1） 3（21.4） 4（26.7） 1.172 0.588 重症期 1（4.8） 3（21.4） 2（13.3） 2.312 0.346 吸收消散期 0 0 0 0 0 注：*-磨玻璃结节与树雾征在3组之间差异有统计学意义。
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[1] 中华人民共和国国家卫生健康委员会. 新型冠状病毒感染诊疗方案(试行第十版)[J]. 中华临床感染病杂志, 2023,(16): 1−9. doi: 10.3760/cma.j.issn.1674-2397.2023.01.001 [2] YOON S H, LEE J H, KIM B N. Chest CT findings in hospitalized patients with SARS-CoV-2: Delta versus Omicron variants[J]. Radiology, 2023, (306): 252−260. DOI: 10.1148/radiol.220676.
[3] XIE J, WANG Q, XU Y, et al. Clinical characteristics, laboratory abnormalities and CT findings of COVID-19 patients and risk factors of severe disease: A systematic review and Meta-analysis[J]. Annals of Palliative Medicine, 2021, (10): 1928−1949. DOI: 10.21037/apm-20-1863.
[4] 余鎏, 肖易, 赵泉. 新型冠状病毒肺炎的临床表现及胸部高分辨率CT影像学表现分析[J]. 实用放射学杂志, 2021,37: 1081−1085. DOI: 10.3969/j.issn.1002-1671.2021.07.009. YU L, XIAO Y, ZHAO Q. The clinical manifestations and chest high resolution CT findings of patients with COVID-19[J]. Journal of Practical Radiology, 2021, 37: 1081−1085. DOI: 10.3969/j.issn.1002-1671.2021.07.009. (in Chinese).
[5] 马慧静, 邵剑波, 王永姣, 等. 新型冠状病毒肺炎儿童高分辨率CT表现[J]. 中华放射学杂志, 2020,54(4): 310−313. DOI: 10.3760/cma.j.cn112149-20200206-00100. MA H J, SHAO J B, WANG Y J, et al. High resolution CT features of COVID-19 in children[J]. Chinese Journal of Radiology, 2020, 54(4): 310−313. DOI: 10.3760/cma.j.cn112149-20200206-00100. (in Chinese).
[6] 余成成, 杨彦鸿, 张烈光, 等. 儿童新型冠状病毒Delta变异株感染者的临床和HRCT特征[J]. 广东医学, 2021,42: 1416−1420. DOI: 10.13820/j.cnki.gdyx.20211909. YU C C, YANG Y H, ZHANG L G, et al. High resolution CT findings and clinical features of the novel coronavirus Delta variant in children[J]. Guangdong Medical Journal, 2021, 42: 1416−1420. DOI: 10.13820/j.cnki.gdyx.20211909. (in Chinese).
[7] 冯凯, 云永兴, 王险峰, 等. 儿童2019新型冠状病毒感染15例CT影像特征分析[J]. 中华儿科杂志, 2020,58: 275−278. DOI: 10.3760/cma.j.cn112140-20200210-00071. FENG K, YUN Y X, WANG X F, et al. Analysis of CT features of 15 children with 2019 novel coronavirus infection[J]. Chinese Journal of Pediatrics, 2020, 58: 275−278. DOI: 10.3760/cma.j.cn112140-20200210-00071. (in Chinese).
[8] SHI H, HAN X, JIANG N, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: A descriptive study[J]. The Lancet Infectious Diseases, 2020, 20: 425−434. DOI: 10.1016/s1473-3099(20)30086-4.
[9] CHUNG M, BERNHEIM A, MEI X, et al. CT imaging features of 2019 novel coronavirus (2019-nCoV)[J]. Radiology, 2020, 295: 202−207. DOI: 10.1148/radiol.2020200230.
[10] 萧毅, 郭佑民, 刘士远. 医学影像在新型冠状病毒肺炎诊治中的作用及思考[J]. 中华放射学杂志, 2020,54: 266−268. DOI: 10.3760/cma.j.cn112149-20200208-00114. XIAO Y, GUO Y M, LIU S Y. The role of medical imaging in the diagnosis and treatment of COVID-19[J]. Chinese Journal of Radiology, 2020, 54: 266−268. DOI: 10.3760/cma.j.cn112149-20200208-00114. (in Chinese).
[11] 蒋荣猛, 谢正德, 姜毅, 等. 儿童新型冠状病毒感染诊断、治疗和预防专家共识(第三版)[J]. 中华实用儿科临床杂志, 2021,36: 721−732. DOI: 10.3760/cma.j.cn101070-20210226-00235. JIANG R M, XIE Z D, JIANG Y, et al. Diagnosis, treatment and prevention of 2019 novel coronavirus infection in children: Experts'consensus statement (Third Edition)[J]. Chinese Journal of Applied Clinical Pediatrics, 2021, 36: 721−732. DOI: 10.3760/cma.j.cn101070-20210226-00235. (in Chinese).
[12] LIU Y, ROCKLOV J. The effective reproductive number of the Omicron variant of SARS-CoV-2 is several times relative to Delta[J]. Journal of Travel Medicine, 2022, 29. DOI: 10.1093/jtm/taac037.
[13] NISHIURA H, ITO K, ANZAI A, et al. Relative reproduction number of SARS-CoV-2 Omicron (B.1.1. 529) compared with Delta variant in South Africa[J]. Journal of Clinical Medicine, 2022, 11. DOI: 10.3390/jcm11010030.
[14] INGRAHAM N E, INGBAR D H. The Omicron variant of SARS-CoV-2: Understanding the known and living with unknowns[J]. Clinical and Translational Medicine, 2021, 11: e685. DOI: 10.1002/ctm2.685.
[15] HUI K P Y, HO J C W, CHEUNG M C, et al. SARS-CoV-2 Omicron variant replication in human bronchus and lung ex vivo[J]. Nature, 2022, 603: 715−720. DOI: 10.1038/s41586-022-04479-6.
[16] 莫艳, 莫坚, 梁汝英, 等. 新生儿重型新型冠状病毒肺炎1例报告[J]. 中国当代儿科杂志, 2022,24: 1266−1268. DOI: 10.7499/j.issn.1008-8830.2208135. MO Y, MO J, LIANG R Y, et al. A case report of neonatal severe coronavirus disease 2019[J]. Chinese Journal of Contemporary Pediatrics, 2022, 24: 1266−1268. DOI: 10.7499/j.issn.1008-8830.2208135. (in Chinese).
[17] 李茜, 彭雪华, 孙子燕, 等. 儿童新型冠状病毒肺炎(COVID-19)的临床及影像学表现[J]. 放射学实践, 2020,35: 277−280. DOI: 10.13609/j.cnki.1000-0313.2020.03.007. LI Q, PENG X H, SUN Z Y, et al. Clinical and imaging characteristics of children with corona virus disease 2019 (COVID-19)[J]. Radiologic Practice, 2020, 35: 277−280. DOI: 10.13609/j.cnki.1000-0313.2020.03.007. (in Chinese).
[18] 余成成, 杨彦鸿, 胡天丽, 等. 新型冠状病毒B.1.617.2变异株感染者高分辨率CT与临床特点[J]. 中华放射学杂志, 2021,55: 1054−1058. DOI: 10.3760/cma.j.cn112149-20210618-00574. YU C C, YANG Y H, HU T L, et al. High resolution CT findings and clinical features of the novel coronavirus B.1.617.2 variant[J]. Chinese Journal of Radiology, 2021, 55: 1054−1058. DOI: 10.3760/cma.j.cn112149-20210618-00574. (in Chinese).
[19] 孙莹, 李玲, 刘晓燕, 等. 早期新型冠状病毒肺炎的胸部薄层平扫CT表现特征[J]. CT理论与应用研究, 2023,32: 131−138. DOI: 10.15953/j.ctta.2023.006. SUN Y, LI L, LIU X Y, et al. Imaging features of early COVID-19 on chest thin-slice non-enhanced CT[J]. CT Theory and Applications, 2023, 32: 131−138. DOI: 10.15953/j.ctta.2023.006. (in Chinese).
[20] PHAN L T, NGUYEN T V, LUONG Q C, et al. Importation and human-to-human transmission of a novel coronavirus in vietnam[J]. The New England Journal of Medicine, 2020, 382: 872−874. DOI: 10.1056/NEJMc2001272.
[21] DESHMUKH V, MOTWANI R, KUMAR A, et al. Histopathological observations in COVID-19: A systematic review[J]. Journal of Clinical Pathology, 2021, 74: 76−83. DOI: 10.1136/jclinpath-2020-206995.
[22] CALABRESE F, PEZZUTO F, FORTAREZZA F, et al. Pulmonary pathology and COVID-19: Lessons from autopsy. The experience of European Pulmonary Pathologists[J]. Virchows Archiv: An International Journal of Pathology, 2020, 477: 359−372. DOI: 10.1007/s00428-020-02886-6.
[23] YE Z, ZHANG Y, WANG Y, et al. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): A pictorial review[J]. European Radiology, 2020, 30: 4381−4389. DOI: 10.1007/s00330-020-06801-0.
[24] ZHANG J, CHEN N, ZHAO D, et al. Clinical characteristics of COVID-19 patients infected by the Omicron variant of SARS-CoV-2[J]. Frontiers in Medicine, 2022, 9: 912367. DOI: 10.3389/fmed.2022.912367.
