Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. Sep 25, 2022; 11(5): 331-340
Published online Sep 25, 2022. doi: 10.5501/wjv.v11.i5.331
Effect of age on computed tomography findings: Specificity and sensitivity in coronavirus disease 2019 infection
Erdal Karavas, Edhem Unver, Sonay Aydın, Gonul Seven Yalcin, Erdem Fatihoglu, Ufuk Kuyrukluyildiz, Yusuf Kemal Arslan, Mustafa Yazici
Erdal Karavas, Sonay Aydın, Erdem Fatihoglu, Department of Radiology, Erzincan Binali Yildirim University, Erzincan 24100, Turkey
Edhem Unver, Gonul Seven Yalcin, Department of Pulmonology, Erzincan Binali Yildirim University, Erzincan 24100, Turkey
Ufuk Kuyrukluyildiz, Department of Anesthesiology and Reanimation, Erzincan Binali Yıldırım University, Erzincan 24100, Turkey
Yusuf Kemal Arslan, Department of Biostatistics, Erzincan Binali Yildirim University, Erzincan 24100, Turkey
Mustafa Yazici, Department of Dermatology, Erzincan Binali Yildirim University, Erzincan 24100, Turkey
Author contributions: Karavaş E and Ünver E were responsible for the conceptualization, methodology, and project administration; Karavaş E did the writing-review & editing; Karavaş E, Aydin S, Yalçin GS, Fatihoglu E, Kuyrukluyildiz U, and Yazici M were responsible for the investigation and resources; Aydin S wrote the original draft; Aydin S and Arslan Y performed the data curation and formal analysis.
Institutional review board statement: The study was reviewed and approved by the Erzincan Binali Yildirim University Institutional Review Board (Approval No: 22/06/2020-06/04).
Informed consent statement: The Institutional Ethical Review Board waived informed consent due to the retrospective nature of the study procedure.
Conflict-of-interest statement: The authors whose names are listed immediately above certify that they have NO affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sonay Aydın, MD, Associate Professor, Department of Radiology, Erzincan Binali Yildirim University, Erzincan Binali Yıldırım Üniversitesi Tıp Fakültesi Dekanlığı Başbağlar Mahallesi 1429, Sokak No:2/1 24100 ERZİNCAN, Erzincan 24100, Turkey. sonay.aydin@erzincan.edu.tr
Received: April 24, 2022
Peer-review started: April 24, 2022
First decision: May 12, 2022
Revised: June 1, 2022
Accepted: August 25, 2022
Article in press: August 25, 2022
Published online: September 25, 2022
Processing time: 152 Days and 18.4 Hours
ARTICLE HIGHLIGHTS
Research background

Coronavirus disease 2019 (COVID-19) is a pandemic caused by the severe acute respiratory syndrome coronavirus in 2019. Although the real-time reverse transcription (RT)-PCR test for viral nucleic acids is the gold standard for COVID-19 diagnosis, computed tomography (CT) has grown in importance.

Research motivation

There is a risk of unintentional use because CT contains ionizing radiation. Ionizing radiation is expected to cause more harm to children than to adults.

Research objectives

We aim to define the change of the CT findings as well as the sensitivity and the specificity of these findings according to age.

Research methods

The study included 411 patients with suspected COVID-19 who sought treatment at a tertiary healthcare facility. RT-PCR testing of respiratory secretions obtained via nasopharyngeal or oropharyngeal swab was performed on all patients. Clinical information from electronic medical records was examined. On the day they were admitted to the hospital, all patients had a CT scan without intravenous contrast material. Three thorax imaging experts who were not aware of the RT-PCR test results reviewed all CT images, and the final decision was reached by consensus. When calculating the sensitivity, specificity, and significance for CT positivity, the patients were divided into nine groups based on decades. The group was defined as people aged 80 and up for the ninth group. The sensitivity, specificity, and significance of CT findings into three groups (age group 1: 0-18, age group 2: 18-60, age group 3: 60 and above) was determined.

Research results

There were 181 positive RT-PCR results and 230 negative RT-PCR results out of 411 patients, for a positive rate of 41% (181/411). There were 141 positive and 40 negative CT findings in 181 cases, for a positive rate of 77.9 % (141/181). CT sensitivity was found to be 77.9 % (95% confidence interval: 71.15 to 83.72) for all patients. The findings revealed that the sensitivity of CT increased with age. Ground glass opacity had the highest diagnostic accuracy of 62.5 %, followed by vascular enlargement at 58.5% and bronchial dilatation at 58.3%. Lymphadenopathy, pleurisy, pleural thickening, peripheral localization, bilateral, ground glass, vascular enlargement, bronchial dilatation, subpleural band, reticular density, crazy paving appearance, and fibrosis all increased with age (P < 0.05).

Research conclusions

Due to the large number of cases, doctors from various fields frequently rely on thoracic CT examination, with the tendency to deviate from algorithms and make an easy and quick diagnosis. The inadequacy of the RT-PCR test contributes to the overuse of thoracic CT. The sensitivity of CT diagnosis in the 0-9 age group was found to be quite low in our study. When a low-dose CT scan is required, it is preferable for the pediatric population. Follow-up imaging is only necessary in cases of clinical deterioration and should be kept to a minimum.

Research perspectives

Further research should be conducted to determine the diagnostic potential of COVID-19 CT findings in relation to age subgroups. Additionally, the findings of this study may raise awareness about the proper use of CT scans in children and contribute to radiation protection by limiting CT scans in age groups with low sensitivity.