Accidental diagnosis of COVID-19 pneumonia after 18F FDG PET/CT: a case series

Abstract

Purpose The aim of this case series is to illustrate possible [18F]-FDG uptake patterns associated to COVID-19. Methods Retrospective assessment of all Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scans performed for any clinical / oncological reason from 1st April 2020 to 30th April 2020. Results of PCR testing for SARS-CoV-2 were retrieved for all patients with lung consolidations and/or peripheral ground glass opacities characterized by increased metabolism to evaluate any possible association with the viral infection. Results Seven (4%) out of 172 FDG-PET scans were included. Six out of seven patients (85%) had positive RT-PCR for SARS-CoV-2, while one patient (15%) had possible (not PCR confirmed) COVID-19 pneumonia. Conclusion Suspicious accidental COVID-19 findings in Nuclear Medicine Department need to be reported and appropriately evaluated to implement proper supportive treatment and infection control measures.

Role of 2-[18F]FDG as a Radiopharmaceutical for PET/CT in Patients with COVID-19: A Systematic Review

“…From the comprehensive computer literature search of PubMed/MEDLINE and Cochrane databases, 169 records were screened. In total, 11 studies were selected and retrieved in full-text version according to the predefined inclusion criteria [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. Conversely, 158 records were excluded because case reports or small case series ( n = 51), reviews, editorials, letters ( n = 39) or because they were outside the field of interest of this review ( n = 68).…”

“…In most of the studies, 2-[ 18 F]FDG PET/CT was performed in patients evaluated for standard indications (mostly oncological indications) and incidental findings suspicious of SARS-CoV-2 infection or COVID-19 at whole-body 2-[ 18 F]FDG PET/CT were described [ 7 , 8 , 9 , 10 , 12 , 13 , 14 , 15 , 16 , 17 ]. Only in one study 2-[ 18 F]FDG PET/CT was performed in COVID-19 patients to assess the inflammatory status at the presumed peak of the inflammatory phase [ 11 ].…”

“…Most of the included studies reported the rate of incidental findings suspicious of SARS-CoV-2 infection or COVID-19 at 2-[ 18 F]FDG PET/CT performed for standard indications. This rate largely varied among the included studies from 2.1% to 16.2% of all whole body 2-[ 18 F]FDG PET/CT scans [ 7 , 8 , 9 , 12 , 13 , 14 , 15 , 16 , 17 ], based on the prevalence of SARS-CoV-2 infection or COVID-19 during the examination period in a specific country or region [ 11 , 12 , 16 ]. A significant association of the appearance of imaging findings suspicious for COVID-19 on 2-[ 18 F]FDG PET/CT with gender, sex, age, or ethnicity was not demonstrated [ 12 ].…”

“…A significant association of the appearance of imaging findings suspicious for COVID-19 on 2-[ 18 F]FDG PET/CT with gender, sex, age, or ethnicity was not demonstrated [ 12 ]. Only a percentage of suspicious COVID-19 at 2-[ 18 F]FDG PET/CT was finally confirmed by further examinations (e.g., RT-PCR or serological testing) [ 7 , 8 , 9 , 10 , 12 , 13 , 14 , 15 , 16 , 17 ].…”

Nuclear Medicine in Times of COVID-19: How Radiopharmaceuticals Could Help to Fight the Current and Future Pandemics

“…As such, [ 18 F]FDG can be used to visualize cells or tissues with increased glucose metabolism, such as active neurons [ 68 , 69 ] and many tumors [ 70 ]. Foci of apparently increased glycolytic activity (due to nonspecific tracer uptake by white blood cells) are also characteristic for infectious and inflammatory processes [ 71 , 72 , 73 ], and [ 18 F]FDG PET has been shown to detect lung abnormalities in asymptomatic patients [ 73 , 74 , 75 ](reviewed in [ 76 ]) and non-human primates [ 5 ] infected with SARS-CoV-2. In previous studies, [ 18 F]FDG PET imaging has also been used to identify inflammatory patterns of monkeypox virus in non-human primates [ 77 , 78 ].…”