Introduction
Materials and methods
Literature review
Eligibility criteria
Data extraction and quantitative data synthesis
Methodological quality
Statistical analysis
Results
Included studies
Methodological quality
Author [reference] | Questiona | Final consensus | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Reviewer | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | Overall rating | ||
Cai J et al. [14] | 1 | N | Y | N | CD | NA | Y | CD | NA | Y | Fair | Fair |
2 | Y | Y | Y | NA | N | Y | CD | Y | Y | Fair | ||
Chan JF et al. [15] | 1 | Y | Y | NR | CD | NA | Y | CD | NA | Y | Fair | Fair |
2 | Y | Y | Y | Y | N | Y | CD | Y | Y | Fair | ||
Chen C et al. [16] | 1 | Y | Y | NR | NA | N | Y | N | Y | Y | Fair | Fair |
2 | Y | Y | Y | CD | N | Y | CD | Y | Y | Fair | ||
Chen F et al. [35] | 1 | N | NA | NA | NA | N | Y | CD | NA | N | Fair | Poor |
2 | N | Y | NA | NA | N | NA | CD | NA | Y | Poor | ||
Cui Y et al. [17] | 1 | Y | NA | NA | CD | Y | Y | Y | NA | Y | Good | Good |
2 | Y | Y | NA | CD | Y | NA | Y | NA | Y | Good | ||
Feng K et al. [18] | 1 | Y | Y | NR | CD | Y | Y | Y | N | Y | Fair | Fair |
2 | Y | Y | CD | CD | Y | Y | CD | N | Y | Fair | ||
Hu Z et al. [19] | 1 | Y | Y | NR | CD | N | Y | Y | Y | Y | Fair | Fair |
2 | Y | Y | CD | Y | N | Y | Y | Y | Y | Good | ||
Ji LN et al. [20] | 1 | Y | Y | NR | CD | N | Y | CD | NA | Y | Fair | Fair |
2 | Y | Y | NA | CD | N | Y | CD | NA | Y | Good | ||
Li W et al. [21] | 1 | Y | Y | NR | CD | N | Y | Y | NA | Y | Fair | Fair |
2 | Y | Y | CD | CD | N | Y | Y | NA | Y | Good | ||
Liu H et al. [22] | 1 | Y | Y | NR | Y | Y | Y | N | Y | Y | Good | Good |
2 | Y | Y | CD | CD | Y | Y | CD | Y | Y | Good | ||
Liu M et al. [31] | 1 | Y | N | NR | CD | N | Y | CD | NA | Y | Fair | Fair |
2 | Y | Y | NR | Y | Y | N | Y | NA | N | Poor | ||
Lu X et al. [5] | 1 | Y | Y | NR | CD | N | Y | N | N | Y | Fair | Fair |
2 | Y | Y | CD | CD | N | Y | CD | N | Y | Good | ||
Ma H et al. [23] | 1 | Y | Y | NR | CD | Y | Y | Y | Y | Y | Good | Good |
2 | Y | Y | CD | CD | Y | Y | Y | Y | Y | Good | ||
Pan X et al. [24] | 1 | N | Y | NA | CD | N | NA | N | NA | Y | Fair | Fair |
2 | N | Y | Y | Y | N | Y | Y | NA | Y | Fair | ||
Park JY et al. [25] | 1 | Y | NA | NA | NA | N | Y | N | NA | Y | Fair | Fair |
2 | Y | NA | NA | NA | N | Y | Y | NA | Y | Fair | ||
Qiu H et al. [30] | 1 | Y | Y | Y | NA | N | Y | CD | Y | Y | Fair | Fair |
2 | N | Y | NR | Y | Y | Y | NR | NA | N | Poor | ||
Rahimzadeh G et al. [29] | 1 | N | Y | NR | CD | Y | Y | Y | N | Y | Fair | Fair |
2 | Y | Y | CD | CD | N | Y | CD | N | Y | Fair | ||
Shen Q et al. [32] | 1 | Y | Y | NA | Y | Y | Y | Y | NA | Y | Fair | Fair |
2 | Y | Y | NR | Y | Y | Y | Y | NA | Y | Fair | ||
Tang A et al. [26] | 1 | Y | Y | NR | CD | N | Y | CD | Y | Y | Fair | Fair |
2 | Y | Y | CD | CD | N | Y | CD | Y | Y | Fair | ||
Wang D et al. [36] | 1 | Y | Y | NR | CD | N | Y | CD | N | N | Fair | Poor |
2 | Y | N | CD | CD | N | N | CD | N | N | Poor | ||
Wang S et al. [27] | 1 | Y | NA | NA | NA | N | Y | Y | NA | Y | Good | Good |
2 | Y | NA | NA | NA | N | NA | Y | NA | Y | Good | ||
Xia W et al. [28] | 1 | Y | Y | NR | CD | Y | Y | Y | N | Y | Good | Good |
2 | Y | Y | Y | CD | Y | Y | CD | N | Y | Good | ||
Zeng LK et al. [37] | 1 | N | NA | NA | NA | N | Y | CD | NA | N | Fair | Poor |
2 | N | NA | NA | NA | N | Y | CD | NA | N | Poor | ||
Zhang Y et al. [38] | 1 | N | NA | NA | NA | N | Y | Y | NA | N | Poor | Poor |
2 | N | Y | NA | NA | N | Y | CD | NA | N | Poor | ||
Zheng F et al. [33] | 1 | N | Y | Y | Y | Y | Y | N | NA | Y | Fair | Fair |
2 | N | Y | Y | Y | Y | Y | N | Y | Y | Fair | ||
Zhou Y et al. [34] | 1 | Y | Y | NR | NA | Y | Y | Y | NA | Y | Fair | Fair |
2 | Y | Y | NR | Y | Y | Y | Y | NA | N | Fair |
Patient demographics
Author | Sample size (children) | Imaging modality | Initial imaging timinga | Initial imaging findingsb |
---|---|---|---|---|
Cai J et al. [14] | 10 | CXR | Admission | 6 (60%) normal 4 (40%) unilateral patchy infiltrates (1 retrocardiac opacity, left lung; 3 right lung opacification) |
Chan JF et al. [15] | 1 | Chest CT | NS | CT showed GGO (location and laterality not mentioned) |
Chen C et al. [16] | 31 | Chest CT | Admission | 20 (64.5%) normal 8 (25.8%) unilateral pneumonia 3 (9.7%) bilateral pneumonia Example imaging in 4 cases all demonstrated patchy peripheral GGO in middle or lower lobes |
Cui Y et al. [17] | 1 | Chest CT | Admission (Day 6 post symptoms) | Mild perihilar GGO in RUL and RLL |
Feng K et al. [18] | 15 | Chest CT | Admission | 6 (40%) normal 9 (60) inflammatory infiltrations — patchy nodular, GGO, visible halo sign (4 in single lobar segment; 4 in at least two lobar segments; 1 in more than two lobar segments) |
Hu Z et al. [19] | 6 | Chest CT | Admission | 4 (66.7%) normal 1 (16.7%) right basal subpleural ground-glass opacification 1 (16.7%) ground-glass opacification/patchy shadowing |
Ji LN et al. [20] | 2 | Chest CT | NS | 2 (100%) normal |
Li W et al. [21] | 5 | Chest CT | 4 days post admission (range 2–9 days) | 2 (40%) normal 3 (60%) patchy GGO (2 LLL, 1 RUL) |
Liu H et al. [22] | 4 | Chest CT | NS, presumed on admission | 1 (25%) normal 1 (25%) single area of consolidative change, RLL 1 (25%) single area of GGO, RML 1 (25%) multifocal consolidation + pleural effusion |
Liu M et al. [31] | 5 | Chest CT | Admission | 1 (20%) normal 2 (40%) unilateral GGO 1 (204%) unilateral GGO and consolidation 1 (20%) bilateral GGO |
Lu X et al. [5] | 171 | Chest CT | NS | 60 (35%) none 56 (32.7%) ground-glass opacification 32 (18.7%) local patchy shadowing 21 (12.3%) bilateral patchy shadowing 2 (1.2%) interstitial abnormalities |
Ma H et al. [23] | 50 | Chest CT | NS, presumed on admission | 29 (67%) ground-glass opacities 16 (37%) localized patchy shadowing 9 (21%) bilateral patchy shadows 3 (7%) interstitial lesions 1 (2%) pleural effusion Lesion location 28 (65%) lower lobe 9 (18%) middle lobe 22 (44%) upper lobe |
Pan X et al. [24] | 1 | Chest CT | 1 day post admission | Normal |
Park JY et al. [25] | 1 | CXR Chest CT | Admission CXR and CT | CXR: normal CT: patchy, nodular consolidations with peripheral GGO in subpleural areas of RLL |
Qiu H et al. [30] | 36 | Chest CT | NS | 17 (47%) normal 19 (53%) GGO |
Rahimzadeh G et al. [29] | 3 RT-PCR positive cases | CXR Chest CT | CXR at admission CT not specified, presumed upon admission also | CXR 2 (66.7%) ‘airspace shadowing’ (location not specified) 1 (33.3%) no findings recorded, uncertain if this was performed CT 2 (66.7%) patchy consolidation with halo sign, and GGO in both lungs 1 (33.3%) normal |
Shen Q et al. [32] | 9 | CXR Chest CT | NS — both modalities reported together in report | 7 (77.8%) normal 2 (22.2%) unilateral GGO |
Tang A et al. [26] | 26 | CXR Chest CT | NS | 11 (42%) lateral pulmonary infiltrates 7 (27%) bilateral pulmonary infiltrates |
Wang S et al. [27] | 1 | CXR Chest CT | CXR at Day 2 post admission CT at Day 4 post admission | Initial CXR showed thickened lung texture Initial CT showed high-density nodular shadow at posterior segment of LUL |
Xia W et al. [28] | 20 | Chest CT | NS, presumed on admission | 4 (20%) normal 6 (30%) unilateral pulmonary lesion 10 (50%) bilateral lung lesions Of these, 16 (80%) subpleural ground-glass opacities 10 (50%) central consolidation with surrounding ground-glass halo 12 (60%) ground-glass opacities 4 (20%) fine mesh shadow 3 (15%) micronodules |
Zheng F et al. [33] | 25 | Chest CT (in 24/25, 96% cases) | NS, presumed on admission | 8 (33%) normal 5 (21%) unilateral findings 11 (46%) bilateral findings Number of cases with different pattern of abnormalities not stated, although typical findings of bilateral patchy shadows or consolidations were mentioned |
Zhou Y et al. [34] | 9 | Chest CT | CT within 3 days of admission | Pattern 1 (11.1%) normal (incidental bullae noted in LLL) 8 (88.9%) inflammatory changes (6 GGO with consolidation; 1 consolidation only; 1 GGO only) 1 (11.1%) pleural effusion 3 (33.3%) halo sign Distribution 4 (50%) bilateral 4 (50%) unilateral Location 6 (75%) upper lobe 6 (75%) lower lobe 5 (62.5%) middle lobe |
Imaging modality and parameters
Initial imaging findings
Author [reference] | Sample size | Imaging modality | Abnormalities | Lobe affected | Laterality | Segments | Subpleural | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
None | Present | UL | ML/ lingula/ hilar | LL | Multi-lobar/ diffuse | Unilateral | Bilateral | One | Two | ||||
Cai J et al. [14] | 10 | CXR | 6 | 4 | 4 | ||||||||
Chan JF et al. [15] | 1 | Chest CT | 0 | 1 | |||||||||
Chen C et al. [16] | 31 | Chest CT | 20 | 11 | 8 | 3 | |||||||
Cui Y et al. [17] | 1 | Chest CT | 0 | 1 | 1 | 1 | 1 | ||||||
Feng K et al. [18] | 15 | Chest CT | 6 | 9 | 1 | 4 | 4 | ||||||
Hu Z et al. [19] | 6 | Chest CT | 4 | 2 | 1 | 1 | 1 | ||||||
Ji LN et al. [20] | 2 | Chest CT | 2 | 0 | |||||||||
Li W et al. [21] | 5 | Chest CT | 2 | 3 | 1 | 2 | |||||||
Liu H et al. [22] | 4 | Chest CT | 1 | 3 | 1 | 1 | 1 | ||||||
Liu M et al. [31] | 5 | Chest CT | 1 | 4 | 3 | 1 | |||||||
Lu X et al. [5] | 171 | Chest CT | 60 | 111 | 32 | 21 | |||||||
Ma H et al. [23] | 50 | Chest CT | 0 | 50 | 22 | 9 | 28 | 9 | |||||
Pan X et al. [24] | 1 | Chest CT | 1 | 0 | |||||||||
Park JY et al. [25] | 1 | CXR Chest CT | 0 | 1 | 1 | 1 | 1 | ||||||
Qiu H et al. [30] | 36 | Chest CT | 17 | 19 | |||||||||
Rahimzadeh G. et al. [29] | 3 | CXR Chest CT | 1 | 2 | 2 | 2 | |||||||
Shen Q et al. [32] | 9 | CXR Chest CT | 7 | 2 | 2 | ||||||||
Tang A et al. [26] | 26 | CXR Chest CT | 8 | 18 | 11 | 7 | 11 | ||||||
Wang S et al. [27] | 1 | CXR Chest CT | 0 | 1 | 1 | ||||||||
Xia W et al. [28] | 20 | Chest CT | 4 | 16 | 6 | 10 | |||||||
Zheng F et al. [33] | 25 (24 had CT) | Chest CT | 8 | 16 | 5 | 11 | |||||||
Zhou Y et al. [34] | 9 | Chest CT | 1 | 8 | 6 | 5 | 6 | 4 | 4 | ||||
Total | 431 | - | 149/431 (34.6%) | 282/431 (65.4%) | 31/90 (34.4%) | 15/90 (16.7%) | 40/90 (44.4%) | 4/90 (4.4%) | 78/146 (53.4%) | 68/146 (46.6%) | 4 | 4 | 13 |
Author [reference] | Abnormal CT (n) | Pattern described (n) | Pattern | ||||||
---|---|---|---|---|---|---|---|---|---|
GGO | Consolidation | “Halo sign” | Pulmonary “infiltrates/ shadows” | Interstitial lesions | Nodular appearances | Pleural effusion | |||
Chan JF et al. [15] | 1 | 1 | 1 | ||||||
Chen C et al. [16] | 11 | 4 | 4 | ||||||
Cui Y et al. [17] | 1 | 1 | 1 | ||||||
Feng K et al. [18] | 9 | 9 | 9 | 9 | 9 | ||||
Hu Z et al. [19] | 2 | 2 | 2 | 1 | |||||
Li W et al. [21] | 3 | 3 | 3 | ||||||
Liu H et al. [22] | 3 | 3 | 1 | 2 | 1 | ||||
Liu M et al. [31] | 4 | 4 | 4 | 1 | |||||
Lu X et al. [5] | 111 | 111 | 56 | 53 | 2 | ||||
Ma H et al. [23] | 50 | 50 | 29 | 25 | 3 | 1 | |||
Park JY et al. [25] | 1 | 1 | 1 | 1 | |||||
Qiu H et al. [30] | 19 | 19 | 19 | ||||||
Rahimzadeh G et al. [29] | 2 | 2 | 2 | 2 | 2 | ||||
Shen Q et al. [32] | 2 | 2 | 2 | ||||||
Tang A et al. [26] | 18 | 18 | 18 | ||||||
Wang S et al. [27] | 1 | 1 | 1 | 1 | |||||
Xia W et al. [28] | 16 | 16 | 16 | 1 | 10 | 4 | 3 | ||
Zhou Y et al. [34] | 8 | 8 | 8 | 7 | 3 | 1 | |||
Total | 262 | 255 | 159 (62.3%) | 14 (5.5%) | 24 (9.4%) | 111 (43.5%) | 5 (1.9%) | 4 (1.6%) | 3 (1.2%) |
Follow-up imaging findings
Author [reference] | Cases with follow-up imaging | Timing post admission (days) | Remained normal | Complete resolution of abnormalities | Improving abnormalities | Abnormalities unchanged | New abnormalities (previously normal) | Progressive changes |
---|---|---|---|---|---|---|---|---|
Chen C et al. [16] | 28 | NS | 19 | 7 | 1 | 1 | ||
Cui Y et al. [17] | 1 | 11 | 1 | |||||
Feng K et al. [18] | 15 | 3–5 | 3 | 2 | 7 | 3 | ||
Hu Z et al. [19] | 1 | 13 | 1 | |||||
Li W et al. [21] | 3 | 5–7 | 3 | |||||
Liu H et al. [22] | 3 | 7 | 1 | 2 | ||||
Liu M et al. [31] | 5 | 4–14 | 1 | 4 | ||||
Ma H et al. [23] | 29 | NS | 2 | 17 | 2 | 8 | ||
Wang S et al. [27] | 1 | 15 | 1 | |||||
Xia W et al. [28] | 6 | NS | 2 | 4 | ||||
Zhou Y et al. [34] | 8 | 3–5 (n=7) 10 (n=1) | 1 | 1 | 4 | 2 | ||
Total | 100 | 3–15 | 25 (25%) | 15 (15%) | 29 (29%) | 18 (18%) | 4 (4%) | 9 (9%) |