Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1405 Clifton Rd. NE, Atlanta, GA, 30322, USA.
Children's Healthcare of Atlanta, Atlanta, GA, USA.
Pediatr Radiol. 2021 Feb;51(2):231-238. doi: 10.1007/s00247-020-04921-9. Epub 2021 Jan 6.
Although the radiographic features of coronavirus disease 2019 (COVID-19) in children have been described, the distinguishing features of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 are not well characterized.
We compared the chest radiographic findings of MIS-C with those of COVID-19 and described other distinguishing imaging features of MIS-C.
We performed a retrospective case series review of children ages 0 to 18 years who were hospitalized at Children's Healthcare of Atlanta from March to May 2020 and who either met the Centers for Disease Control and Prevention (CDC) case definition for MIS-C (n=11) or who had symptomatic, laboratory-confirmed COVID-19 (n=16). Two radiologists reviewed the most severe chest radiographs for each patient. The type and distribution of pulmonary opacities and presence or absence of pleural effusions were recorded. The chest radiographs were categorized based on potential COVID-19 imaging findings as typical, indeterminate, atypical or negative. An imaging severity score was also assigned using a simplified version of the Radiographic Assessment of Lung Edema Score. Findings were statistically compared between patients with MIS-C and those with COVID-19. Additional imaging findings of MIS-C were also described.
Radiographic features of MIS-C included pleural effusions (82% [9/11]), pulmonary consolidations (73% [8/11]) and ground glass opacities (91% [10/11]). All of the lung opacities (100% [10/10]) were bilateral, and the majority of the pleural effusions (67% [6/9]) were bilateral. Compared to children with COVID-19, children with MIS-C were significantly more likely to develop pleural effusions on chest radiograph (82% [9/11] vs. 0% [0/0], P-value <0.01) and a lower zone predominance of pulmonary opacifications (100% [10/10] vs. 38% [5/13], P-value <0.01). Children with MIS-C who also had abdominal imaging had intra-abdominal inflammatory changes.
Key chest radiographic features of MIS-C versus those of COVID-19 were pleural effusions and lower zone pulmonary opacifications as well as intra-abdominal inflammation. Elucidating the distinguishing radiographic features of MIS-C may help refine the case definition and expedite diagnosis and treatment.
虽然已经描述了儿童 2019 年冠状病毒病（COVID-19）的放射学特征，但与 COVID-19 相关的儿童多系统炎症综合征（MIS-C）的特征仍未得到很好的描述。
我们比较了 MIS-C 的胸部影像学表现与 COVID-19 的表现，并描述了 MIS-C 的其他鉴别影像学特征。
我们对 2020 年 3 月至 5 月在亚特兰大儿童保健中心住院的年龄在 0 至 18 岁的儿童进行了回顾性病例系列研究，这些儿童要么符合疾病预防控制中心（CDC）的 MIS-C 病例定义（n=11），要么有症状，实验室确诊的 COVID-19（n=16）。两名放射科医生对每位患者最严重的胸部 X 光片进行了审查。记录了肺混浊的类型和分布以及胸腔积液的存在或不存在。根据潜在的 COVID-19 影像学发现，将胸部 X 光片分为典型、不确定、非典型或阴性。还使用简化的肺部水肿评分放射学评估来分配影像学严重程度评分。比较了 MIS-C 患者和 COVID-19 患者的影像学表现。还描述了 MIS-C 的其他影像学表现。
MIS-C 的放射学特征包括胸腔积液（82%[9/11]）、肺实变（73%[8/11]）和磨玻璃影（91%[11/11]）。所有的肺部混浊（100%[10/10]）都是双侧的，大多数胸腔积液（67%[6/9]）是双侧的。与 COVID-19 患儿相比，MIS-C 患儿的胸腔积液在胸部 X 光片上更常见（82%[9/11]比 0%[0/0]，P 值<0.01），下区肺混浊的优势也更明显（100%[10/10]比 38%[5/13]，P 值<0.01）。同时进行腹部影像学检查的 MIS-C 患儿有腹部炎症改变。
MIS-C 与 COVID-19 相比，关键的胸部 X 线特征是胸腔积液和下区肺部混浊以及腹部炎症。阐明 MIS-C 的鉴别影像学特征可能有助于完善病例定义，并加快诊断和治疗。
