Diagnosis of COVID-19 pneumonia in asymptomatic patients after an oncological PET/CT

Abstract

Introduction On January 30, 2020, the World Health Organization (WHO) declared an international emergency due to the pandemic caused by a new coronavirus. There are some oncological indications that have special priority and studies are still being carried out despite the current situation. In these studies we have found suspicious findings of COVID-19 pneumonia in asymptomatic patients. The objective of this work is to assess the incidence of these findings, describe their characteristics and the evolution of suspected patients. Material and methods Oncological PET studies carried out in asymptomatic patients between March 18 and April 8, 2020 have been reviewed. Patients who presented findings suggestive of corresponding to an pulmonary infectious process were selected. Clinical findings have been reviewed to confirm or rule out SARS-CoV2 infection. Results During the specified period, a total of 129 PET-CT studies were performed. Of these, 11 (8.5%) found suspicious findings of a pulmonary infectious process. These were 8 men and 3 women aged between 30 and 79 years (mean 62.2). Conclusions Patients with COVID 19 can present few symptoms of the disease, and in PET-CT studies both presymptomatic and almost asymptomatic patients can be detected, so nuclear medicine physicians should take special attention to the pulmonary evaluation of PET-CT studies.

Incidental Findings Suggestive of COVID-19 Pneumonia in Oncologic Patients Undergoing 18F-FDG PET/CT Studies: Association Between Metabolic and Structural Lung Changes

“…Incidental changes suggesting COVID-19 pneumonia in chest CT were founded in 4.1% of cancer patients derived to 18 F-FDG PET/CT in our centre, a lower proportion than previously reported (7,1-9.2%) (7,8,16). These heterogeneous results could be explained by the health care facilities and policies assumed in different medical centres and countries, the time-dependent transmissibility of the virus and/or other factors related with the study sample (4,11,17).…”

“…Although the diagnostic potential of the metabolic activity observed in pulmonary infiltrates of suggestive or confirmed COVID-19 pneumonia on PET/CT studies has been described in some recent researches, the correlation between tomographic structural changes (CO-RADS system) and metabolic activity (SUVmax) of the lung parenchyma had not been evaluated in detail until now (6)(7)(8)(9)(10)(16)(17)(18)(19)(20)(21). Our preliminary results could provide a new perspective on the pathophysiology of SARS2-CoV-2 lung infection and even redefine the best diagnostic imaging criteria in several patient subpopulations.…”

“…Few reports and small case series of cancer patients documented the presence of incidental lung changes with fluorine-18 fluorodeoxyglucose ( 18 F-FDG) uptake in positron emission tomography-computed tomography (PET/CT) studies suggestive of COVID-19 pneumonia. This data suggests a potential contribution of this technique in the differential diagnosis of complex or asymptomatic presentations of COVID-19 (6)(7)(8)(9)(10). In addition, a deeper knowledge about the shift in cellular metabolism of SARS-CoV-2 infected cells could provide new insights about pathogenic of viral infection and host response and help to diagnose the pulmonary and distant involvement in selected cases.…”

COVID-19 in the act: incidental 18F-FDG PET/CT findings in asymptomatic patients and those with symptoms not primarily correlated with COVID-19 during the United Kingdom coronavirus lockdown

“…In our study of 160 adult patients, we observed a total prevalence of incidental findings of 16.25% of which 9.3% were lung-related compatible with COVID-19 pulmonary manifestations and 7% with other incidental findings such as PE, abnormal cardiac uptake, increased FDG uptake in the parotid glands and the tonsils and signs of increased upper gastrointestinal uptake and colitis known extrapulmonary organs affected by COVID-19 on imaging [11]. The published literature on the role of 18F-FDG PET/CT value during the COVID-19 pandemic is scarce and consists mainly of sporadic case reports and a larger series of 65 asymptomatic patients from Italy and 129 from Spain, which showed incidental pulmonary findings in six (9%) and eleven (8.5%) of patients compatible with COVID-19 respectively [15,16]. Although extrathoracic symptoms have been described [4], there are no comprehensive publications for COVID-19-related extrathoracic imaging findings on 18F-FDG PET/CT.…”

Incidental and simultaneous finding of pulmonary thrombus and COVID-19 pneumonia in a cancer patient derived to 18F-FDG PET/CT. New pathophysiological insights from hybrid imaging

“…The true prevalence of COVID-19 pneumonia in asymptomatic cancer patients referred to PET/CT is unknown. Only available data are derived from a few small case series of subjects with suspicious tomographic findings and none/partial laboratory confirmation [4] , [5] , [6] , reporting a frequency of tomographic suggestive findings ranging broadly from 8.5% [5] to 39% [6] , and confirmed COVID-19 pneumonia in 4% and 8% of studies, respectively.…”