FDG PET/CT of COVID-19

Abstract

A 55-year-old male smoker in Wuhan developed intermittent fever, fatigue and dry cough for 5 days. Initial chest CT from an outside institution suggested hilar malignancy. 18 F-FDG PET/CT was performed for further evaluation. The PET maximum intensity projection image (Figure A) revealed an FDG-avid mass with a maximum standardized uptake value (SUVmax) of 4.9 in the right lung. Increased accumulation of FDG was noted in the right paratracheal and right hilar lymph nodes (arrowheads) as well as bone marrow. On axial images (B, low dose CT; C, PET/CT fusion) there were ground-glass opacities (GGO) with areas of focal consolidation primarily in the right upper lobe (arrows) and a focal opacity in the left upper and right middle lobes (arrows). Influenza, respiratory syncytial virus (RSV) and other common respiratory viral infection were excluded by nasopharyngeal swab tests. Follow-up CT 4 days later revealed progression of lesions in bilateral upper and middle lobes with newly developed focal opacities in the left upper and lower lobes (D, arrows) (1,2). One week later, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was confirmed by real-time fluorescence polymerase chain reaction confirming Corona Virus

Incidental Findings Suggestive of COVID-19 in Asymptomatic Patients Undergoing Nuclear Medicine Procedures in a High-Prevalence Region

“…In our report, all lung lesions on CT were 18 F-FDG-positive, and in 1 patient, 18 F-FDG avidity was identified even in the mediastinal nodes. This metabolically active pattern of COVID-19 pneumonia on 18 F-FDG PET/ CT scans has been supported so far only by a cases series and a case report (11,12). Qin et al (12) described 4 cases of suspected COVID-19 pneumonia with increased 18 F-FDG uptake but no RT-PCR confirmation.…”

“…Although nuclear medicine procedures are unlikely to play a role in the primary diagnosis of COVID-19, the disease may be detected incidentally in asymptomatic but infected patients undergoing scans for other indications, with potentially relevant implications for further management. Patterns of COVID-19 pneumonia on 18 F-FDG PET/CT have recently been anecdotally described for symptomatic patients (10)(11)(12). The aim of the present case series is to describe our local experience in Northern Italy, triggered by an increase in incidental detection of pneumonia suspected of stemming from COVID-19 in our routine nuclear medicine services.…”

Nuclear medicine in responding to global pandemic COVID-19—American College of Nuclear Medicine member experience

“…American College of Nuclear Medicine (ACNM) membership mainly comprises nuclear medicine physicians from the USA and other countries including China. We reached out to our ACNM international members from Wuhan, China, and Singapore who have participated in dealing with COVID-19 for the last 2 months, to learn from their lessons and experiences (Lan, Sun [6], [7,8]), and adopted their measures in our busy nuclear medicine practice in the USA, which routinely consists~100 general nuclear medicine studies including planar and SPECT/CT images, and~130 PET/CT studies on a daily basis. Here, we summarized our ACNM members' This article is part of the Topical Collection on Infection and Inflammation * Yang Lu ylu10@mdanderson.org composite experiences, aiming to provide advices for nuclear medicine department/personnel in fighting this global pandemic COVID-19.…”

“…When in contact with the suspected patients or visitors, nuclear medicine staff should maintain at least 3 ft distance, wear masks, and be mindful of hand hygiene. Before the COVID-19 got detected and known to the public, a later confirmed COVID-19 patient presented to the nuclear medicine department for FDG PET/CT exam in Wuhan [8]. The nuclear medicine staff and physicians were wearing masks and washed their hands frequently as routine for seasonal flu precaution.…”

Less is More: Intelligent Intensive Care for SARS-CoV-2 Based on the Imaging Data

“…The main method for SARS-CoV-2 diagnosis is reverse-transcription polymerase chain reaction (RT-PCR) that has its own limitation such as the amount of its sensitivity (2). However, computed tomography (CT) images were used as first diagnosis line in several departments, although other imaging modalities such as chest radiography, positron emission tomography (PET) and ultrasound are also recruited (3)(4)(5).…”